The importance of measuring and improving the strength of primary care in Europe: results of an international comparative study

Abstract

Strong primary care (PC) is supposed to improve the capacity of a country to achieve a responsive, high quality and cost-effective health care system. The available evidence-base supporting pro-primary care policies originates from studies with a limited geographical scope, narrow use of dimensions to measure PC strength, and use relatively old data. The recently published PhD Thesis by Dionne Sofia Kringos (Health Systems Researcher from The Netherlands) aimed to get insight into the elements that form (the strength of) primary care in Europe and their impact on health care system outcomes. This article summarizes the results of this work, which has been published in more detail in different scientific publications. The strength of PC was measured by 3 dimensions of PC structure: PC governance, PC workforce development, and economic conditions of PC. The strength of PC services delivery process was measured by 4 dimensions of: accessibility, continuity, coordination, and comprehensiveness of PC. The PC dimensions were operationalized by a total of 77 indicators for which data was collected in 31 European countries. The results show variation in PC strength across Europe, indicating a discrepancy in the responsibility given to PC in (inter)national policy initiatives and the needed investments in PC to solve e.g. future shortages of workforce. Countries are consistent in their PC focus on all important structure dimensions. Countries need to improve their PC information infrastructure to facilitate PC performance management. This study was able to show that strong PC has a positive impact on population health, reducing disparity in health, and avoiding unnecessary hospitalizations.