Primary care has an important part to play within healthcare systems.1 The World Health Organization defines the main aim of healthcare systems as the improvement of health, but it notes that financing should be fair and systems of care ought to respond to people's expectations.2 Countries whose healthcare delivery focuses on the role of the specialist tend to fare less well in surveys that take account of these three goals.3 Primary care seems to offer important advantages within healthcare systems in terms of cost containment, health status of the population, and a range of other health related outcomes—the value of a strong primary care base within national healthcare systems is recognised by the WHO.4 How can cross national studies provide insight into the optimal organisation of health care?

In this week's BMJ, Bindman and colleagues5 use data from national surveys in Australia, New Zealand, and the United States to compare mix …