Determine the evidence on health outcomes, quality and cost for countries with strong primary health care (PHC) versus those countries with a specialist focus.
Health workforce skills mix data were only available on a small selection of countries. Analysing skills mix and health outcome data does not show a clear relationship. There are many other factors contributing to health outcomes. The data presented in the report are more usefully considered on a country by country basis.
In low and middle income countries, there are a few studies that directly tested the hypothesis that health systems based on a strong PHC orientation lead to better health outcomes at a country-wide level. These identify positive outcomes. Other country-wide studies are suggestive of the role of PHC in population health improvements, but do not explicitly quantify or test the impact of specific PHC interventions. There are a number of studies which report improved health outcomes as a result of PHC at intervention and state level.
No country-wide studies were found of health systems focused on specialist services which had a positive impact on health outcomes. Although it was acknowledged that well functioning specialised tertiary care responds to a real demand, it was argued that the disproportionate focus on hospitals and sub-specialisation has become a major source of inefficiency and inequality which provides poor value for money.