The Hidden Cause of Healthcare Delays: Primary Care
You’ve likely experienced or heard about the drama of long waiting lists and delays in accessing specialists within various healthcare systems. Often overlooked is that the root of this problem lies at the most neglected level of the system: primary care.
Every year on September 6, we commemorate International Primary Healthcare Day, recalling the Alma-Ata Declaration of 1978 and its reaffirmation in Astana (2018). More than four decades later, primary care remains underutilized and underfunded despite being the most effective, preventive, and cost-efficient level of healthcare.
What Can Primary Care Do That Hospitals Cannot?
Primary care can address up to 80% of a population’s health needs, according to widely supported estimates by the WHO and international studies. Its true power lies in preventing diseases rather than treating them. Key aspects include vaccination, risk factor control, health education, chronic disease management, and early detection.
As I argued in a column on Preventive vs. Curative Health, preventive health not only enhances quality of life but also makes healthcare spending more efficient. Studies published in The Lancet Global Health and BMJ demonstrate that primary care-focused systems yield better population outcomes, greater equity, and lower per capita spending.
Why Does Primary Care Receive So Little Funding?
Despite the importance of primary care, OECD countries allocate on average only 13% to 18% of their healthcare budgets to this level. In contrast, higher-complexity levels like hospitals and specialized care absorb 60% to 70% of total healthcare spending. This disparity not only causes inefficiencies and overburdening within systems but also reflects a reactive logic that prioritizes advanced disease management over prevention and continuous care.
Redistributing this investment is crucial for building more sustainable, equitable, and person-centered health systems.
Who Cares for Those Who Care?
The well-being of primary care professionals is vital for a sustainable health system. However, the shortage of family doctors and other specialists in this level is critical. A study published in JAMA Internal Medicine revealed that to adequately serve a standard population of 2,500 patients, a family doctor would need to dedicate 27 hours daily, seven days a week. This highlights the overload and unsustainability of the current model.
Moreover, doctors spend a significant portion of their day on administrative tasks, especially using electronic records, further reducing time available for direct patient care. If we don’t take care of those who care, the entire system suffers: professional burnout and lack of human resources directly impact the quality and accessibility of care.
Multidisciplinary Teams: Beyond the Family Doctor
Modern primary care doesn’t solely rely on family doctors. In various systems, multidisciplinary teams are recognized, including community nurses, clinical pharmacists, dietitians, psychologists, social workers, and more.
In the UK, Australia, and Canada, these roles are formalized with specialized training. Platforms like BMJ Learning offer accredited modules for all these profiles, focusing on prevention, chronic disease management, and clinical skills.
AI Enhances, but Does Not Replace Primary Care
Artificial intelligence can revolutionize primary care through: diagnostic support using predictive models, clinical record management to reduce administrative burden, remote monitoring of chronic patients, and automated alerts for prevention and therapeutic adherence.
As I discussed in the column on Artificial Intelligence and its Impact on Health, these technologies can generate substantial savings, improve diagnostic accuracy, and expand access in resource-limited contexts. However, they also raise ethical dilemmas and risks of bias if not designed equitably from the start.
The Myth of Direct Specialist Access
In many private healthcare systems, primary care tends to disappear as the entry point. Direct access to specialists becomes the main “attraction” of a perceived higher-quality medicine. This, however, leads to overutilization of more complex levels and makes private healthcare expensive, while also causing a shortage of specialists for the public system.
As I analyzed recently in the column When Health Systems Promise but Don’t Deliver, this logic erodes trust in public systems and pushes millions towards costly private spending.
Private Models That Value Primary Care
In the UK, some corporate health plans have incorporated family doctors as coordination points in the private sector. In Nordic countries, specialist access is mediated by family doctors, even in private insurance, maintaining the logic of continuity and prevention.
What’s Next?
Optimizing primary care use requires political will, strategic investment, specialized training, and ethical adoption of emerging technologies. It’s not just about improving efficiency but building more humane, equitable, and sustainable health systems.
The best medicine is the one that prevents patients from reaching hospitals.
Key Questions and Answers
- What is primary healthcare? Primary healthcare focuses on accessible, affordable, and comprehensive care for communities. It emphasizes prevention, health education, and management of common diseases.
- Why is primary care underfunded? Primary care receives a smaller portion of healthcare budgets compared to specialized care, despite its potential for cost-efficiency and improved population health.
- What are multidisciplinary teams in primary care? These teams include various healthcare professionals such as nurses, pharmacists, dietitians, psychologists, and social workers, working together to provide holistic care.
- How can AI benefit primary care? AI can support diagnostics, streamline administrative tasks, enable remote patient monitoring, and provide automated alerts for prevention and adherence.
- What are the consequences of bypassing primary care in private systems? Direct access to specialists can lead to overutilization of complex care, increased private healthcare costs, and shortages of specialists in public systems.
