Market Forces in Primary Care Systems
Primary care is the first point of entry for most patients into a health system. This makes primary care an important platform for preventive and promotive efforts, such as nutrition counseling, mothers groups, and outreach for school health. Primary care can also be an important coordination point to address social determinants of health, including clean water and sanitation.
In India, primary care tends to be organized around short term interests. The consumer wants to feel better, quickly, and the provider wants to ensure that they see the most number of patients possible. This approach undermines long term health outcomes in favor of short term results, such as administering medicine for an immediate illness as opposed to determining the root cause of a current or potential illness and taking steps to prevent it.
Taking inspiration from existing health system frameworks, ACCESS Health created a market forces framework that offers a lens for responding to local market dynamics and taking a more strategic long term view of strengthening primary care. It includes a concrete four step process for applying the framework to India and other settings.
By going through this framework, policymakers and program designers can strategize potential solutions to increase access to, and the quality of, primary care, and create programs that shift incentives toward more robust, sustainable, and locally driven solutions. For existing programs, the framework can be used to map progress and make adjustments as required.
With the goal of universal health coverage as a priority, we think reforms to primary care in India are overdue. With this in mind, we developed this framework to facilitate such reforms. We invite you to download the framework here and share it widely within your networks.