The Future of Primary Health Care: Trends and Predictions
Discover the role of primary health care (PHC) as the foundation of an effective health system. Explore emerging trends and solutions for improving primary health care.
10 min read
September 16, 2024
Simmran Sharma
Global efforts are committed towards achieving universal health care, which ensures that all individuals have access to essential health services without financial strain. Central to this effort is primary health care (PHC), which forms the foundation of an effective health system. Let us dive into how primary care can redefine comprehensive health care and examine the current challenges faced in this endeavor.
What is Primary Health Care?
Primary care is the first point of contact in the health care system. It focuses on overall health maintenance and disease prevention. This in turn assists early detection and intervention of short-term and long-term illnesses. Primary care is provided by a primary care physician (PCP) who coordinates with specialists for appropriate secondary care while advocating for the patient's needs when needed.
a) What it treats
In India, primary care physicians diagnose and treat a wide range of health issues, including:
> Common illnesses: Treating conditions like colds, flu, and minor infections.
> Chronic diseases: Managing diabetes, hypertension, asthma, anxiety and more.
> Preventive care: Providing vaccinations, health screenings, and lifestyle advice.
> Maternal and child health: Offering prenatal care, vaccinations for children, and growth monitoring.
> Minor injuries: Treating minor injuries and wounds.
> Health education: Advising on nutrition, exercise, and general wellness.
b) How PHC is different from other types of health care
Primary, secondary, and tertiary care represent different levels of health care services, each with distinct roles and responsibilities. Ideally, the provision of health care at all levels and in all circumstances should be available to all patients; such health care is called universal health care.
| Point of distinction | Primary Care | Secondary Care | Tertiary Care |
Focus | > General health maintenance > Disease prevention > Treatment of common illnesses and conditions. | > Specialized care for specific or complex conditions > Diseases that require expertise beyond primary care. | > Highly specialized and advanced care > Severe or complex health conditions > Provision of sophisticated technology and expertise > An extension of tertiary care is Quaternary care |
Providers | > Primary care physicians (PCPs) > Family doctors > Internists, pediatricians > General practitioners. | > Cardiologists > Endocrinologists > Orthopedic surgeons and other such specialists. | > Specialized hospitals > medical centers with sub-specialists > Neurosurgeons, oncologists and other such specialized surgeons |
Services | > Regular check-ups > Immunizations > Management of chronic diseases > Health education and minor acute issues. | > Diagnosis and treatment of specific illnesses > Diagnostic testing like MRIs and specialized blood tests. > Procedures like minor surgeries | > Complex surgeries > Advanced diagnostic procedures > Specialized treatments for rare or serious conditions, > Long-term hospital care for long-term irreversible conditions. > Experimental treatments and complex surgeries for patients in need of Quaternary care. |
Access | > Typically the first point of contact in the health care system > Often involves routine and preventive care. | > Usually requires a referral from a primary care provider > Involves more focused and detailed care. | > Typically requires a referral from primary or secondary care providers > Involves complex and often high-tech interventions |
Primary care facilitates comprehensive health management throughout an individual's life, rather than focusing solely on specific diseases. PHC may well define comprehensive health care as a global phenomenon. Its approach integrates the physical, mental, and social aspects of health, which shape a person's overall well-being.
Addressing the Gaps: Challenges in Primary Health Care
In one word, the biggest problem with PHC in India is ‘shortage’. The lack of trained personnel and finances is the most worrying of all. Here's how:
Aspect | Physician Shortage | Nursing shortage | Funding Shortage |
Meaning | Physician supply refers to the number of active, trained physicians within a healthcare system.
Physician shortages occur when there are insufficient doctors to meet patient needs. |
A nursing shortage arises when the demand for Registered Nurses (RNs) surpasses the available supply at local, national, or global levels. |
A funding shortage in healthcare occurs when there are insufficient financial resources allocated to cover the costs of medical services, infrastructure, and personnel. |
Determinants | > Insufficient education infrastructure to train new workforce.
> Uneven concentration in urban areas mostly due to lack of financial and career incentives in remote areas.
> Excessive administrative burden and bureaucracy leading to job dissatisfaction.
> Disposable supplies can substitute for labor and capital. For instance, an overabundance of accountants can displace medical jobs by handling financial tasks. | > Poor working conditions and burnout.
> Inadequate pay and limited career progression.
> International migration attributed to social, economic, and professional reasons.
> Insufficient education infrastructure to train new workforce.
> Hierarchical subordination that limit professional autonomy | > Inadequate health insurance coverage. Not even half of the country’s population is insured for medical bills.
> Low government expenditure on health care. India spends less than 1.5% of its GDP on healthcare.
> Over reliance on out-of-pocket expenditure by individuals due to lack of comprehensive coverage.
> Underdeveloped healthcare infrastructure. |
Impact | > Reduced quality of health services as overburdened providers offer rushed consultations and less personalized care.
> Increased patient wait times can delay both diagnosis and treatment. Undermining the core concept of PHC.
> Eventually, more patients are referred to secondary and tertiary sects. This makes higher-level services overcrowded. More complex and expensive treatments also increase overall costs. | > Deterioration in the quality of health care, leading to an increase in complications and mortality.
> Nurses being overburdened with responsibilities, causing high levels of stress and burnout.
> The risk of error increases, compromising patient safety.
> Poor working conditions increase risk of occupational injuries in nurses | > Reduced essential services availability and lack of facilities in primary health care centers (PHCs).
> Outdated equipment, and insufficient supplies, impacting the quality of care.
> Lower salaries and fewer incentives for healthcare workers, affecting staffing levels and morale.
> Improper implementation of vaccination drives, maternal and child health care, and other preventive services, leads to higher disease rates. |
Possible solutions | > Boost recruitment efforts, more so in rural and underserved areas.
> Implement measures to reduce stress and burnout, such as manageable workloads and support systems.
> Enhance coordination between primary, secondary, and tertiary care to ensure seamless patient management. | > Expand and enhance training programs to improve skills and knowledge.
> Offer competitive salaries, incentives, and career development opportunities.
> Compete with international markets to retain workforce. | > Explore public-private partnerships, health bonds, and international aid to supplement funding.
> Cross subsidization
> Increase government funding through budget allocation to improve infrastructure, resources, and staffing.
> Efficient utilization targeting the most critical needs and avoiding waste. |
Ultimately, geographic and socioeconomic disparities become more pronounced, with less access to preventive and routine care in underserved regions.
Emerging Positive Trends in Primary Health Care
India is committed towards overcoming these gaps and creating a robust, responsive, and sustainable health care system. The goal is to make health coverage comprehensive and equitable for all. Here are the forward-looking approaches currently receiving significant attention:
Standardized Tools
Standardized tools in health care provide consistency and comparability of crucial information. These are important to provide uniform patient-centered health care. India is home to 1.45 billion citizens and the population curve is still on an upward trajectory. We are seeing an overwhelming amount of clinical data being recorded and fed into the system. Standardized tools can help us map out this information and highlight common links between several cases. Long-established codes and standards can pave the way for new tools that incorporate a futuristic approach. Codes and standards currently in operation for primary healthcare are:
> Indian Public Health Standards (IPHS) 2007
> International Classification of Primary Care (ICPC) 1987
> National Health Mission (NHM) Guidelines 2018
> International Classification of Diseases (ICD) 1893
> Guidelines for Non-Communicable Diseases (NCDs) 2010
> National Immunization Schedule 1978
Medical Coding
Medical coding is an emerging new field of studies opening up in healthcare services. It translates healthcare diagnoses, procedures, and services into standardized alphanumeric codes. These codes can be used for record-keeping and data analysis. Coding systems currently in use are Electronic Health Records (EHR) Standards 2016 and Clinical Decision Support Systems (CDSS) developed in the 1980s.
Medical coding is used for:
> Medical Record-Keeping
> Statistical Research and Analysis
> Insurance Claims
> Billing and Reimbursement
> Surveillance of epidemic or pandemic outbreaks
> Forensics and judicial justice
Some other tech-friendly avenues that India is set to explore are telemedicine, health chatbots, and virtual assistants. Incorporating these practices can strengthen equitable healthcare services by transcending geographical and socio-economic barriers.
Health insurance
Health insurance makes medicare affordable by offering a range of options with low premiums and tax deductions. Health insurance in India has evolved significantly over the years, with various reforms and expansions aimed at improving coverage and access. It mitigates risks and provides financial protection to people. Ultimately reducing out-of-pocket spending solving shortage of funds for many. Unfortunately, less than half of India’s population is protected under comprehensive health plans. However, increasing awareness—particularly following the global pandemic—is driving positive change. Here are the various alternatives available to public:
> Private Sector Insurance: ICICI Lombard, HDFC Ergo, Niva Bupa and more.
> Public Sector Insurance: LIC and GIPSA
> Government-Sponsored Schemes: PM-JAY, Ayushman Bharat
National Health Policy (NHP) has emphasized the expansion of health insurance coverage as a means to achieve universal health coverage and improve access to health services including family health care.
Applied Ethics
In this new era people find themselves under constant surveillance through data collection practices that give rise to specific ethical issues and dilemmas. As a result, there is a strong emphasis on prioritizing applied ethics to guarantee informed consent, confidentiality, and privacy. Common ethical practices include:
> Informed consent
> Protecting personal information and privacy
> Data anonymization and confidentiality
> Transparency and honesty
> Accurate reporting and accountability
> Respect for autonomy
Many data collection projects are reviewed by ethics committees or institutional review boards (IRBs) to evaluate the ethical implications of their practices. Increasingly, organizations are being held accountable under relevant data protection laws, such as GDPR and HIPAA. Giant organizations are incorporating personal data protection policies into their contract, latest being WHO on 15th April 2024.
Bottomline
Primary Health Care (PHC) is crucial for maintaining overall health and preventing disease. However, to create a robust and equitable PHC system India needs to embrace cooperative-based financing, ethical technological advancements and comprehensive health coverage. We wish to embark on this mission with you. Buy your ideal health insurance policy. Reach out to us on +91 6364334343 and book a free consultation with OneAssure experts.