Primary healthcare (PHC) comprises most of the healthcare services a person might receive in their lifetime. It is also the most inclusive, equitable, cost-effective and efficient approach to enhance people’s physical and mental health, as well as social well-being. Because of this, PHC is being highly encouraged and strengthened in health systems globally.
WHO explains that PHC encompasses three inter-related and synergistic components: comprehensive and integrated health services that embrace primary care, as well as public health goods and functions as central pieces; multi-sectoral policies and actions to address the upstream and wider determinants of health and engaging and empowering individuals, families and communities for increased social participation and enhanced self-care and self-reliance in health.
PHC is based on three core pillars:
- Meets people’s health needs through comprehensive promotive, protective, preventive, curative, rehabilitative and palliative care throughout a patient’s life, strategically prioritizing key healthcare services aimed at individuals and families through primary care and the population through public health functions as the central elements of integrated health services;
- Systematically addresses the broader determinants of health (including social, economic, environmental, as well as people’s characteristics and behaviors) through evidence-informed public policies and actions across all sectors.
- Empowers individuals, families and communities to optimize their health, as advocates for policies that promote and protect health and well-being, as co-developers of health and social services, and as self-carers and caregivers to others.
OECD shares that investing in primary care represents good value for money as it can help avoid costly admissions to hospitals, improving care coordination and health outcomes, particularly for the growing number of people with chronic diseases.
Alongside prevention, and due to its nobleites, PHC has been one of the most praised approaches to healthcare after the COVID-19 pandemic to create stronger health systems and be closer to universal health coverage. The World Bank’s study “Walking the Talk: Reimagining Primary Health Care After COVID-19,” explains that the characteristics of high-performing PHC are exactly those that are most critical for managing the pressures coming to bear on health systems in the post-COVID-19 world. Challenges include future infectious outbreaks and other emergent threats but also long-term structural trends that are reshaping the environments in which systems operate in non-crisis times.
Spending on primary care services accounted for an average of 14 percent of all healthcare spending across OECD countries in 2016. This is equivalent to around US$500 per capita, when adjusted for differences in price levels across countries.
Australia and Poland are the two countries with the largest spending on PHC, with 18 percent of their total health spending. Spain and Estonia follow them closely with 17 percent and with 10 percent are Slovakia and Switzerland. PHC spending per capita was the highest in Australia with US$830, Luxemburg with US$814 and Germany with US$788. According to the OECD at the other end of the scale, Mexico (US$162) and Latvia (US$183) spent less than forty percent of the average on PHC services.
General outpatient care for a range of acute or chronic conditions take the largest share of spending. In Mexico and Australia alone, general outpatient care reached over 12 percent of the total health spending.
PHC can also be provided through NGOs, such as the Kaiser Permanente Organization in the US, which is recognized as one of America’s leading healthcare providers and not-for-profit health plans, focusing on health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management.
Mexico’s PHC Urgency Indicators
Mexico reports an overweight and obesity incidence rate of over 70 percent, 32.5 percent for hypertension and 9.2 percent for diabetes. There is a low detection rate and inequality in access to health services due to a model that has proven to be inefficient and of poor quality. In terms of cancer, Mexico registers an ascending prevalence plus a lack of a registration and information. Inequality in access and financial protection is also prevalent, as well as limited supply of services and personnel, coupled with a low detection rate.
Unhealthy old age is common in the country. There is also inequality in healthcare access and financial protection, economic dependence and lack of primary care services for older adults. Regarding communicable infectious diseases, the country sees a high prevalence, as these are the first cause of outpatient consultation. There is a high risk of complications and weak epidemiological surveillance, as well as poor control of antimicrobial resistance, insufficient control of main disease vectors, incomplete coverage of the main biologics in the expanded scheme and infections associated with poorly managed treatments.
Other urgent problems to address through PHC include:
- Sexual and reproductive health, due to poor sex education for teens and high prevalence of sexually transmitted diseases.
- Mental health, due to the high frequency of mental disorders, the increase in the main determinants of mental health problems (violence and addictions) and an increase in the frequency of suicide.
- Disabilities, due to the wide gaps in social and human rights.
PHC Efforts in Mexico
According to the INSP, PHC services aimed at users in the public sector focus on community actions and on prevention, promotion and care services provided at health centers of the State’s Health Services, IMSS’ family medicine units, IMSS-Bienestar’s rural and urban medical units and the latter’s itinerant services provided by mobile medical units in collaboration with the Ministry of Health. The integration between primary care and public health is key to promote greater efficiency and effectiveness for the benefit of the population.
In the private sector, this integration is achieved through different initiatives and platforms. Health entrepreneur Jacobo Luchtan, CEO, Hello Doctor, a digital platform that links doctors and patients to widen healthcare availability, shared with MBN that immediate access to an online doctor means fewer health insurance claims from routine primary care check-ups or visits to emergency rooms. “In the case of Mexico, the employee avoids the horrific experience that is going to IMSS,” Luchtan adds, referring to the perception of quality in the public health sector.
The Mexican Hospital Consortium (CMH) is strengthening primary care by “making it more accessible to the general population,” told to MBN Javier Potes, Director General, CMH. “While many hospitals are not designed to provide primary care, we can initiate alliances to strengthen the facilities that already offer this service, such as pharmacies that have a pharmacy-adjacent medical office (PAMO).” According to Potes, hospitals can also provide medical professionals with training, while integrating patients’ clinical records. “CMH is developing an alliance to train doctors and working with them to offer quality, affordable primary care.”
AXA Keralty is another option for PHC in Mexico. “AXA Keralty operates under a model of primary care prevention rather than correction through a series of clinics,” explained to MBN Hector Sobrino, Director of Health Services, AXA. “With our major medical expense products and our primary care memberships, we offer complete healthcare coverage and address any possible situation a person might face,” said Sobrino.
For mental health, technology is being a watershed in PHC attention. Edilberto Peña de León, Director, Nervous System Research Center (CISNE), explained to MBN that the pandemic has enabled the technological changes necessary to provide care at earlier stages. “Teleconsultations were used in psychiatry but they became more relevant as a result of the pandemic,” said Peña de León. According to his comments, one of the changes they have seen is the adoption of pre-screening protocols, which allow doctors to provide appropriate consultations and facilitate their work.
PHC, which covers prevention, treatment, rehabilitation and palliative care, is the base of a health system’s structural transformation, according to the World Bank. To be effective, PHC should engage and empower individuals, families and communities for enhanced self-care and self-reliance in health, adds WHO. While the private sector continues to innovate and strengthen PHC, the Ministry of health has also defined a model of “Comprehensive Primary Healthcare” on its Sectorial Health Program 2019 – 2024. The program targets the incorporation of a new care model that might transform health centers and units, “particularly the first level of care: mobile units and small health centers with a varied number of offices and expanded health service centers (CSSA).” According to the Ministry of Health, currently 49 percent of health centers have an office and, in the country, there are only about 100 CSSAs.
The ministry states that another important instance that should be transformed is health jurisdiction, “which is currently reduced to a bureaucratic instance with no major impact and that should regain its role as coordinating instance to guarantee the activities of the health centers, as well as promotion, prevention and epidemiological surveillance.”