For many citizens primary care is the first point of contact with their health care system, where most of their health needs are satisfied but also acting as the gate to the rest of the system. In that respect primary care plays a crucial role in how patients value health systems as responsive to their needs and expectations.

This volume analyses the way how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination. Relating these differences to health system outcomes the authors suggest some priority areas for reducing the gap between the ideal and current realities.

The study also reviews the growing evidence on the added value of strong primary care for the performance of the health system overall and explores how primary care is challenged by emerging financial constraints, changing health threats and morbidity, workforce developments and the growing possibilities of technology.

In a second, companion volume, that is available on-line, structured summaries of the state of primary care in 31 European countries are presented. These summaries explain the context of primary care in each country; governance and economic conditions; the development of the primary care workforce; how primary care services are delivered; and the quality and efficiency of the primary care system.

This book builds on the EU-funded project ‘Primary Health Care Activity Monitor for Europe’ (PHAMEU) that was led by the Netherlands Institute for Health Services Research (NIVEL) and co-funded by the European Commission (Directorate General Health & Consumers).

Contents

• Volume 2: Country reports on primary care
• Preface
• Volume 2: Country reports on primary care
• 1. Introduction
  Wienke Boerma and Dionne Kringos.
  • 1.1. Health care systems facing a diversity of challenges
  • 1.2. What strong primary care is
  • 1.3. Is strong primary care an answer to current challenges?
  • 1.4. Conceptual framework
  • 1.5. Methods of the PHAMEU study
  • 1.6. What this book adds to current knowledge
  • 1.7. Structure of this book
  • References
• 2. Structure and organization of primary care
  Margus Lember, Thomas Cartier, Yann Bourgueil, Toni Dedeu, Allen Hutchinson, and Dionne Kringos.
  • 2.1. Governance
  • 2.2. Economic conditions
  • 2.3. Workforce development
  • 2.4. Overall structure of primary care
  • 2.5. Good practices and challenges for structuring primary care
  • 2.6. Conclusion
  • References
• 3. The delivery of primary care services
  Andrew Wilson, Adam Windak, Marek Oleszczyk, Stefan Wilm, Toralf Hasvold, and Dionne Kringos.
  • 3.1. Access to primary care
  • 3.2. Continuity of primary care
  • 3.3. Coordination of primary care
  • 3.4. Comprehensiveness of services provided in primary care
  • 3.5. Overall service delivery in primary care
  • 3.6. Conclusions
  • References
• 4. Diversity of primary care systems analysed
  Dionne Kringos, Wienke Boerma, Yann Bourgueil, Thomas Cartier, Toni Dedeu, Toralf Hasvold, Allen Hutchinson, Margus Lember, Marek Oleszczyk, and Danica Rotar Pavlič.
  • 4.1. Diversity in structural aspects
  • 4.2. Diversity in the process of care delivery
  • 4.3. Diversity in the overall strength of primary care
  • 4.4. The efficiency of primary care
  • 4.5. The role of wealth, culture, type of health care system and politics
  • 4.6. The contribution of strong primary care to health care system performance
  • 4.7. Conclusion and observations
  • References
• 5. Overview and future challenges for primary care
  Wienke Boerma, Yann Bourgueil, Thomas Cartier, Toralf Hasvold, Allen Hutchinson, Dionne Kringos, and Madelon Kroneman.
  • 5.1. Primary care in Europe today
  • 5.2. Implications
  • 5.3. Primary care in Europe: diversities and similarities
  • 5.4. Further observations
  • 5.5. Options for primary care monitoring
  • 5.6. Conclusion
  • References
• Appendix I. The European Primary Care Monitor
• Appendix II. Scoring of indicators for the European Primary Care Monitor

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The European Observatory on Health Systems and Policies supports and promotes evidence based health policy-making through comprehensive and rigorous analysis of health systems in Europe. It brings together a wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing on experience from across Europe to illuminate policy issues.

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