Monday, 5 December 2016

The dream team of primary care in Europe

Tino Martí

The WHO Europe has published "Building Primary Care in a changing Europe". It is a very well prepared document written by a cast of first class minds (Kringos, Boerma, Hutchinson and Saltman) based on the information collected in the European project PHAMEU (Primary Healthcare Activity Monitor in Europe) reflecting indicators of structure, process and result of all the countries of the European Union provided by either accredited local points of contact (in Catalonia IDIAP). The project has been funded by the European Commission and supported by WHO Europe, the European Forum for Primary Care, the European Public Health Association and the European General Practice Research Network.

The paper analyzes the strengths and weaknesses of the existing multiple configurations of primary care in Europe, overcoming the usual classifications of Bismark versus Beveridge systems intended to relate their performance and results to develop rankings of countries. The systems reaching the top are considered as possessing an attribute of a "strong" Primary Care.

An interesting exercise based on the published information would be to design the most robust way for creating create a dream team of primary care settings in Europe.

This is the result:

In structure, the Dutch stand out for its governance and the British for their economic conditions and professional development. In the process, the Slovenes have the best accessibility, Lithuanians the widest range of services, better continuity of care Danes and Swedes better coordination. In the dimension of performance, efficiency data are somewhat equivocal and no performance rankings shown, so better let the position vacant.

Seeing the dream team gives us the feeling that our primary care is badly broken. However, a close reading of the document reveals that we scored high in all dimensions without ever abandoning the "high" box, a fact that neither the British nor the Dutch achieve. As in many other things, we have a good product with bad marketing.

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