Intended for healthcare professionals


The strength of primary care systems

BMJ 2013; 346 doi: (Published 13 June 2013) Cite this as: BMJ 2013;346:f3777
  1. Jeannie L Haggerty, associate professor1,
  2. Jean-Frédéric Lévesque, chief operating officer2,
  3. William Hogg, professor3,
  4. Sabrina Wong, associate professor4
  1. 1Department of Family Medicine, McGill University, Montreal, QC, Canada H3T 1M5
  2. 2Bureau of Health Information, Sydney, NSW, Australia
  3. 3CT Lamond Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, ON, Canada
  4. 4School of Nursing, University of British Columbia, Vancouver, BC, Canada
  1. jeannie.haggerty{at}

Stronger systems improve population health but require higher levels of spending

A recent article in Health Affairs by Kringos and colleagues seems destined to take its place alongside other seminal studies that support the importance of investing in a strong system of primary care for a well functioning health system, better population health, and perhaps even greater health equity.1 2 3

The team of researchers from the Netherlands Institute for Health Research used statistical databases and government reports from 31 European countries to measure the strength of five primary care dimensions—structure, access, coordination, continuity, and comprehensiveness. They looked at the association between each dimension and healthcare spending, patient perceived quality of care, potentially avoidable admissions to hospital, population health, and health inequality according to socioeconomic status.

They found that population health was better in countries that had a strong primary care structure and robust mechanisms to support coordination and comprehensiveness. The strength of primary care systems was measured by the density of primary care providers and the quality of their work environment. Stronger systems were associated with lower rates of avoidable admissions to hospital and fewer potential years of life lost …

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