Primary Care in the Driver's Seat? Organizational Reform in European Primary Care

Primary Care in the Driver's Seat? Organizational Reform in European Primary Care

Primary Care in the Driver's Seat? Organizational Reform in European Primary Care

Primary Care in the Driver's Seat? Organizational Reform in European Primary Care


What is the best way to structure primary care services? How can coordination between primary care and other parts of health care systems be improved? How should new technologies be integrated into primary care? There is considerable agreement among national policy makers across Europe that, in principle, primary care should be the linchpin of a well-designed health care system. This agreement, however, does not carry over into the organizational mechanisms best suited to pursuing or achieving this common objective. Across western, central and eastern Europe, primary care is delivered through a wide range of institutional, financial, professional and clinical configurations. This book is a study of the reforms of primary care in Europe as well as their impacts on the broader co-ordination mechanisms within European health care systems. It also provides suggestions for effective strategies for future improvement in health care system reform.

"Primary Care in the Driver's Seat" is key reading for students studying health policy, health economics, public policy and management, as well as health managers and policy makers.


European national policy makers broadly agree on the core objectives that their health care systems should pursue. the list is strikingly straightforward: universal access for all citizens, effective care for better health outcomes, efficient use of resources, high-quality services and responsiveness to patient concerns. It is a formula that resonates across the political spectrum and which, in various, sometimes inventive, configurations, has played a role in most recent European national election campaigns.

Yet this clear consensus can only be observed at the abstract policy level. Once decision makers seek to translate their objectives into the nuts and bolts of health system organization, common principles rapidly devolve into divergent, occasionally contradictory, approaches. This is, of course, not a new phenomenon in the health sector. Different nations, with different histories, cultures and political experiences, have long since constructed quite different institutional arrangements for funding and delivering health care services.

The diversity of health system configurations that has developed in response to broadly common objectives leads quite naturally to questions about the advantages and disadvantages inherent in different arrangements, and which approach is ‘better’ or even ‘best’ given a particular context and set of policy priorities. These concerns have intensified over the last decade as policy makers have sought to improve health system performance through what has become a Europe-wide wave of health system reforms. the search for comparative advantage has triggered – in health policy as in clinical medicine – increased attention to its knowledge base, and to the possibility of overcoming at least part of existing institutional divergence through more evidence-based health policy making.

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