Article Text

Download PDFPDF

The Primary Care Spend Model: a systems approach to measuring investment in primary care
  1. Robert Baillieu1,
  2. Michael Kidd2,
  3. Robert Phillips3,
  4. Martin Roland4,
  5. Michael Mueller5,
  6. David Morgan5,
  7. Bruce Landon6,
  8. Jennifer DeVoe7,
  9. Viviana Martinez-Bianchi8,
  10. Hong Wang9,
  11. Rebecca Etz10,
  12. Chris Koller11,
  13. Neha Sachdev1,
  14. Hannah Jackson1,
  15. Yalda Jabbarpour1,
  16. Andrew Bazemore1
  1. 1The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, Washington, DC, USA
  2. 2Department of Family and Community Medicine, University of Toronto, Ontario, Canada
  3. 3Center for Professionalism & Value in Health Care, Lexington, Kentucky, USA
  4. 4Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Cambridge, UK
  5. 5OECD Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
  6. 6Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
  7. 7Department of Family And Community Medicine, Oregon Health and Science University, Portland, Oregon, USA
  8. 8Department of Family Medicine and Community Health, Duke University, Durham, North Carolina, USA
  9. 9The Bill and Melinda Gates Foundation, Seattle, Washington, USA
  10. 10Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia, USA
  11. 11Milbank Memorial Fund, New York City, New York, USA
  1. Correspondence to Dr Robert Baillieu; rbaillieu{at}


Increased investment in primary care is associated with lower healthcare costs and improved population health. The allocation of scarce resources should be driven by robust models that adequately describe primary care activities and spending within a health system, and allow comparisons within and across health systems. However, disparate definitions result in wide variations in estimates of spending on primary care. We propose a new model that allows for a dynamic assessment of primary care spending (PC Spend) within the context of a system’s total healthcare budget. The model articulates varied definitions of primary care through a tiered structure which includes overall spending on primary care services, spending on services delivered by primary care professionals and spending delivered by providers that can be characterised by the ‘4Cs’ (first contact, continuous, comprehensive and coordinated care). This unifying framework allows a more refined description of services to be included in any estimate of primary care spend and also supports measurement of primary care spending across nations of varying economic development, accommodating data limitations and international health system differences. It provides a goal for best accounting while also offering guidance, comparability and assessments of how primary care expenditures are associated with outcomes. Such a framework facilitates comparison through the creation of standard definitions and terms, and it also has the potential to foster new areas of research that facilitate robust policy analysis at the national and international levels.

  • primary care
  • healthcare expenditure
  • policy
  • spending

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Handling editor Seye Abimbola

  • Contributors All authors contributed equally to the creation of the PC Spend Model described in this paper. RB is responsible for planning and writing the manuscript. He was assisted in planning the manuscript by MK, RP, AB and MR. All other listed authors contributed to editing and augmenting the text of this manuscript.

  • Funding The American Board of Family Medicine Foundation and the American Academy of Family Physicians supported the Primary Care Spend Conference convening costs. Most US-based participants funded their own travel.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.