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June 2026 (Volume 104)
Quarterly Article
Robert L. Phillips
Rebecca Fisher
Claire Jackson
Danielle Martin
Tim Olde Hartman
Felicity Goodyear-Smith
December 2024
December 2023
Back to The Milbank Quarterly
Policy Points:
Context: Primary care is the foundation of most health systems; yet across diverse countries, structures, policies, and payment models, it is under threat. Many high-income countries face shrinking workforces, worsening access, disrupted continuity, and reduced comprehensiveness.
Methods: Common drivers include underfunding and spending that is inefficient, leading to workforce crises and rising clinical and administrative burdens that drive burnout.
Findings: These shared challenges require shared solutions. Strengthening primary care means adequate funding that is wisely invested to increase workforce capacity—including general practitioners and other primary care team members such as nurses, pharmacists, and social workers—and promotion of sustainable models of care. Policies that impose unfunded mandates or devalue core functions such as continuity and comprehensiveness erode system performance and make it impossible for primary care to deliver on its promise for cost, utilization, satisfaction, and health outcomes.
Conclusions: Sufficient and efficient funding in team-based, person-centered primary care must be a political and policy priority.