How Much Do Countries Spend on Primary Care in the Americas?

The following sections are included:Estimating expenditure on the first level of care or primary care is not an easy task. There is a need to differentiate between primary health care (PHC) as an overarching approach to the organization and operation of health systems and the first level of care or primary care, which refers to a level of care in the provision of health services. Improved resolution capacity of the first level of care to expand access to comprehensive, quality health services is required to advance toward universal access to health and universal health coverage, hence the need to measure how much countries are spending in the first level of care.Results for 13 countries in the Americas chosen in this study indicate that the expenditure in the first level of care or primary care, as a percentage of public expenditure in health, presents a high variability, fluctuating between 12.5% in the United States and 44.2% in El Salvador. Despite the methodological differences found, we estimated a 24% median considering each country as one observation.When the indicator is compared to total health expenditure per capita for each country, two main groups and two outliers (Cuba and the US) are identified: the first (Bolivia, El Salvador, and Jamaica), with high spending in the first level of care as a percentage of total public expenditure in health (over 38%) but with low total expenditure per capita (less than int$550); the second (Argentina, Barbados, Brazil, Chile, Costa Rica, Mexico, and Uruguay), with spending in the first level of care as a percentage of total public expenditure in health (ranging 20–25%) with a high per capita expenditure (ranging 1,000–2,000 dollars).When comparing spending in the first level of care as a percentage of public expenditure in health, with the public expenditure in health as a percentage of GDP, three sets of countries are clearly identified: first, countries that invest between 20% and 25% in the first level of care and over 4% public expenditure in health as a percentage of GDP (Jamaica, Brazil, Chile, Costa Rica, Argentina, Uruguay, and Canada); countries with higher levels of investment in the first level of care, between 25% and 45%, but lower public expenditure in health as a percentage of GDP; and USA and Cuba are outliers, with low investment in first level of care in the first and very high investment in the second.Data found for other regions show a median of 16% of expenditure in the first level of care as a percentage of total public expenditure for the OECD countries, and for a sample of middle- and upper-middle-income countries, a median of 25% for spending in the first level of care as a percentage of total public expenditure.Our results show the need for a more comprehensive study and the promotion of an international definition of or first level of care and that further analysis is needed. For the case of countries in the Americas, there is a clear need also to standardize what is first level of care to allow for a more systematic monitoring and measurement that could be comparable across countries.