Building Primary Care In A Changing Europe - News
38This volume analyses the way how primary care is organised and delivered across Europeancountries, looking at governance, financing and workforce aspects and the breadth of the serviceprofiles. It describes wide national variations in terms of accessibility, continuity andcoordination. Relating these differences to health system outcomes the authors suggest somepriority 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 theperformance of the health system overall and explores how primary care is challenged byemerging financial constraints, changing health threats and morbidity, workforce developmentsand the growing possibilities of technology.In a second, companion volume, that is available on-line, structured summaries of the state ofprimary care in 31 European countries are presented. These summaries explain the context ofprimary care in each country; governance and economic conditions; the development of theprimary care workforce; how primary care services are delivered; and the quality and efficiencyof 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) andco-funded by the European Commission (Directorate General Health & Consumers).Edited by Dionne S. Kringos, Wienke G.W. Boerma,Allen Hutchinson, Richard D. SaltmanThe editorsDionne S. Kringos is a postdoctoral health system researcher at the Academic MedicalCentre, Department of Social Medicine, University of Amsterdam, Netherlands.Wienke G.W. Boerma is a senior researcher at NIVEL, the Netherlands Institute for HealthServices Research, Utrecht, Netherlands.Allen Hutchinson is professor in Public Health Medicine and now emeritus professor at theSchool of Health and Related Research at the University of Sheffield, United Kingdom.789289 0503199ISBN 9289050319Richard B. Saltman is Associate Head of Research Policy at the European Observatory onHealth Systems and Policies, and Professor of Health Policy and Management at the RollinsSchool of Public Health, Emory University, Atlanta, United States of America.Buildingprimary care ina changing EuropeEdited byDionne S. KringosWienke G.W. BoermaAllen HutchinsonRichard B. Saltman38ObservatoryStudies SeriesBUILDING PRIMARY CARE IN A CHANGING EUROPEFor many citizens primary care is the first point of contact with their health care system, wheremost of their health needs are satisfied but also acting as the gate to the rest of the system. Inthat respect primary care plays a crucial role in how patients value health systems as responsiveto their needs and expectations.
Building primary care in achanging Europe
The European Observatory on Health Systems and Policies supports and promotes evidence based healthpolicy-making through comprehensive and rigorous analysis of health systems in Europe. It brings togethera wide range of policy-makers, academics and practitioners to analyse trends in health reform, drawing onexperience from across Europe to illuminate policy issues.The European Observatory on Health Systems and Policies is a partnership between the World HealthOrganization Regional Office for Europe, the Governments of Austria, Belgium, Finland, Ireland, Norway,Slovenia, Sweden, the United Kingdom and the Veneto Region of Italy, the European Commission, the WorldBank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics andPolitical Science, and the London School of Hygiene & Tropical Medicine.
Building primary care in achanging EuropeEdited byDionne S. KringosWienke G.W. BoermaAllen HutchinsonRichard B. Saltman
KeywordsDELIVERY OF HEALTH CAREHEALTH CARE SYSTEMSPRIMARY CAREPRIMARY HEALTH CAREPUBLIC HEALTH World Health Organization 2015 (acting as the host organization for, and secretariat of, the EuropeanObservatory on Health Systems and Policies).All rights reserved. The European Observatory on Health Systems and Policies welcomes requests forpermission to reproduce or translate its publications, in part or in full.Address requests about publications to: Publications, WHO Regional Office for Europe, UN City,Marmorvej 51, DK-2100 Copenhagen Ø, Denmark.Alternatively, complete an online request form for documentation, health information, or forpermission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest).The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of the European Observatory on Health Systems andPolicies concerning the legal status of any country, territory, city or area or of its authorities, or concerningthe delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border linesfor which there may not yet be full agreement.The mention of specific companies or of certain manufacturers’ products does not imply that they areendorsed or recommended by the European Observatory on Health Systems and Policies in preference toothers of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietaryproducts are distinguished by initial capital letters.All reasonable precautions have been taken by the European Observatory on Health Systems and Policies toverify the information contained in this publication. However, the published material is being distributedwithout warranty of any kind, either express or implied. The responsibility for the interpretation and useof the material lies with the reader. In no event shall the European Observatory on Health Systems andPolicies be liable for damages arising from its use. The views expressed by authors, editors, or expert groupsdo not necessarily represent the decisions or the stated policy of the European Observatory on HealthSystems and Policies or any of its partners.ISBN 978 92 890 50 319Printed in the United KingdomTypeset by Steve StillCover design by M2M
ContentsPrefaceixList of tables and figuresxiChapter 1IntroductionWienke Boerma and Dionne Kringos271.1 Health care systems facing a diversity of challenges1.2 What strong primary care is1.3 Is strong primary care an answer to current challenges?1.4 Conceptual framework1.5 Methods of the PHAMEU study1.6 What this book adds to current knowledge1.7 Structure of this bookReferencesChapter 2Structure and organization of primary careMargus Lember, Thomas Cartier, Yann Bourgueil, Toni Dedeu,Allen Hutchinson, Dionne Kringos2.1 Governance2.2 Economic conditions2.3 Workforce development2.4 Overall structure of primary care2.5 Good practices and challenges for structuring primary care2.6 ConclusionReferencesChapter 3The delivery of primary care servicesAndrew Wilson, Adam Windak, Marek Oleszczyk,Stefan Wilm, Toralf Hasvold, Dionne Kringos3.1 Access to primary care3.2 Continuity of primary care3.3 Coordination of primary care3.4 Comprehensiveness of services provided in primary care3.5 Overall service delivery in primary care3.6 76777829298101
vi Building primary care in a changing EuropeChapter 4Diversity of primary care systems analysedDionne Kringos, Wienke Boerma, Yann Bourgueil, Thomas Cartier,Toni Dedeu, Toralf Hasvold, Allen Hutchinson, Margus Lember,Marek Oleszczyk, Danica Rotar Pavlicˇ4.1 Diversity in structural aspects4.2 Diversity in the process of care delivery4.3 Diversity in the overall strength of primary care4.4 The efficiency of primary care4.5 The role of wealth, culture, type of health care system and politics4.6 The contribution of strong primary care to health caresystem performance4.7 Conclusion and observationsReferencesChapter 5Overview and future challenges for primary careWienke Boerma, Yann Bourgueil, Thomas Cartier, Toralf Hasvold,Allen Hutchinson, Dionne Kringos, Madelon Kroneman1031031071091121121141141195.1 Primary care in Europe today5.2 Implications5.3 Primary care in Europe: diversities and similarities5.4 Further observations5.5 Options for primary care monitoring5.6 ConclusionReferences120124126128130133Appendix I – The European Primary Care Monitor135Appendix II – Scoring of indicators for theEuropean Primary Care MonitorReferences149
viiVolume 2: Country reports on primary care(separately published and available online, see Building primary carein a changing Europe – Case studies – vatory/publications/studies)I.1 AustriaM. Redaèlli, S. Wilm, D. Simic, M. SprengerI.17 LithuaniaV. Kasiulevičius, M. LemberI.2 BelgiumT. Cartier, L. Ryssaert, Y. BourgueilI.18 LuxembourgD.S. Kringos, M. Aubart, J. Leners, R. SteinI.3 BulgariaD.S. Kringos, P. SalchevI.19 MaltaD. Rotar Pavlič, J.K. Soler, M.R. SammutI.4 CyprusG. Samoutis, P. TedeschiI.20 NetherlandsD.S. Kringos, J. van Riet Paap, W.G.W. BoermaI.5 Czech RepublicA. Windak, M. Oleszczyk, B. SeifertI.21 NorwayT. Hasvold, B. ChristensenI.6 DenmarkT. HasvoldI.22 PolandA. Windak, M. OleszczykI.7 EstoniaK. Põlluste, M. LemberI.23 PortugalC. Fonseca, T. Dedeu, L. Pisco, A. GouveiaI.8 FinlandK. Winell, T. DedeuI.24 RomaniaD. Rotar Pavlič, R. Miftode, A. Balan,Z. Farkas PallI.9 FranceT. Cartier, Y. BourgueilI.10 GermanyD. Simic, S. Wilm, M. RedaèlliI.11 GreeceC. Lionis, P. Tedeschi, A. SaridakiI.12 HungaryS. Wilm, P. Vajer, I. RurikI.13 IcelandA. HutchinsonI.14 IrelandA. HutchinsonI.15 ItalyP. TedeschiI.16 LatviaS. Veide, M. Lember, K. PõllusteI.25 SlovakiaA. Windak, M. Oleszczyk, E. JurgovaI.26 SloveniaD. Rotar Pavlič, I. Švab, R. Brinovec PribakovićI.27 SpainT. Dedeu, B. Bolibar, J. Gené, C. Pareja,C. ViolanI.28 SwedenT. HasvoldI.29 SwitzerlandT. Cartier, N. Senn, J. Cornuz, Y. BourgueilI.30 TurkeyD.S. Kringos, M. Akman, W.G.W. BoermaI.31 United KingdomA. Wilson
PrefaceThis book is a product from the PHAMEU study (Primary Health CareActivity Monitor for Europe) that was carried out from 2007 until 2010.The study has been developed and coordinated by NIVEL, the NetherlandsInstitute for Health Services Research, in collaboration with other institutesin European countries. The following members of this partnership havecontributed to this book. Their names and affiliations are listed below. NIVEL, the Netherlands Institute for Health Services Research, Utrecht,the Netherlands: Dionne Sofia Kringos and Wienke Boerma University of Tartu, Estonia: Margus Lember IRDES, Institute for Research and Information in Health Economics,Paris, France: Yann Bourgueil and Thomas Cartier Heinrich Heine University and University Witten/Herdecke, Düsseldorf,Germany: Stefan Wilm and Harald Abholz Bocconi University CERGAS, Milan, Italy: Paolo Tedeschi University of Tromsø, Norway: Toralf Hasvold Jagiellonian University Medical College, Krakow, Poland: Adam Windakand Marek Oleszczyk University of Ljubljana, Slovenia: Danica Rotar Pavlič and Igor Švab IDIAP Jordi Gol, Barcelona, Spain: Toni Dedeu and Bonaventura Bolibar University of Sheffield, ScHARR & University of Leicester, UnitedKingdom: Allen Hutchinson and Andrew Wilson The PHAMEU study was co-funded by the European Commission(Directorate General SANCO).The project was supported by the WHO Regional Office for Europe, theEuropean Forum for Primary Care, the European Public Health Association,and the European General Practice Research Network.Experts in each country who contributed to the data and information onwhich this study is based, are kindly acknowledged. Their names havebeen listed with each country chapter. Finally, the authors are grateful tocolleagues at NIVEL for their review of a previous version of the manuscript.
List of tables and figuresTables Table 2.1Governance of primary care system, overview of selection of results by country 43Economic conditions of primary care, overview of selection ofresults by country 51Primary care workforce development, overview of selection ofresults by country 56Accessibility of primary care services, overview of selection ofresults by country 69Continuity of primary care services, overview of selection of results by country 78Coordination of primary care services, overview of selection ofresults by country 84Comprehensiveness of primary care services, overview of selection of results by country 93Table 2.2Table 2.3Table 3.1Table 3.2Table 3.3Table 3.4pageTable 4.1Overview of variables by country 105Table 4.2Correlation of primary care structure and process variables with outcome variables 115Figures pageFig. 1.1A system framework for primary care 34Fig. 2.1Total governance of primary care score by country (scale 1 (low) – 3 (high)) 48Total economic conditions of primary care score by country (scale 1 (low) – 3 (high)) 54Total primary care workforce development score by country (scale 1 (low) – 3 (high)) 62Overall (high/medium/low) level of the governance, workforcedevelopment and economic conditions of primary care by country 63Fig. 2.2Fig. 2.3Fig. 2.4
xii Building primary care in a changing EuropeFigures Fig. 3.1Total access to primary care score by country (scale 1 (low) – 3 (high)) 76Total continuity of primary care score by country (scale 1 (low) – 3 (high)) 83Total coordination of primary care score by country (scale 1 (low) – 3 (high)) 91Total comprehensiveness of primary care score by country (scale 1 (low) – 3 (high)) 99Overall (high/medium/low) level of accessibility, continuity and coordination of primary care by country 100Ranking of countries on the combined scores for structural aspects of primary care 108Fig. 4.2Variation in the overall strength of primary care in Europe 110Fig. 4.3Overview of efficiency scores on relationships between(A) structure–process and (B) process–outcome 111Involvement of GPs in first-contact care in Europe in 1993; range of involvement 1 (low) – 4 (high) 123Fig. 3.2Fig. 3.3Fig. 3.4Fig. 3.5Fig. 4.1Fig. 5.1page
List of tables and figures xiiiVolume 2: Country reports on primary careAustriaTable A1.1 Development of health care resources and utilizationTable A1.2 GPs’ involvement in delivery of various primary care servicesFig. A1.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A1.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A1.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A1.4 Shared practiceFig. A1.5 Number of hospital admissions per 100 000 population with a primary caresensitive diagnosis in most recent yearBelgiumTable A2.1 Development of health care resources and utilizationTable A2.2 GPs’ involvement in delivery of various primary care servicesFig. A2.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A2.2a The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A2.2b The development in supply of primary care professionals (medicalspecialists only) per 100 000 inhabitantsFig. A2.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A2.4 Number of hospital admissions per 100 000 population with a primary caresensitive diagnosis in most recent year
xiv Building primary care in a changing EuropeBulgariaTable A3.1 Development of health care resources and utilizationTable A3.2 Referrals to hospitalTable A3.3 GPs’ involvement in delivery of various primary care servicesFig. A3.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A3.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A3.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A3.4 Patient satisfaction with aspects of care provisionFig. A3.5 Shared practiceFig. A3.6 Estimated number of hospital admissions per 100 000 population with aprimary care sensitive diagnosis in most recent yearCyprusTable A4.1 Development of health care resources and utilizationTable A4.2 GPs’ involvement in delivery of various primary care servicesCzech RepublicTable A5.1 Development of health care resources and utilizationTable A5.2 GPs’ involvement in delivery of various primary care servicesFig. A5.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A5.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A5.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A5.4 Shared practiceFig. A5.5 Number of hospital admissions per 100 000 population with a primary caresensitive diagnosis in most recent year
List of tables and figures xvDenmarkTable A6.1 Development of health care resources and utilizationTable A6.2 GPs’ involvement in delivery of various primary care servicesFig. A6.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A6.2 The development in supply of primary care professionals per 100,000inhabitants in the most recent available five-year periodFig. A6.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A6.4 Patient satisfaction with aspects of care provisionFig. A6.5 Shared practiceEstoniaTable A7.1 Development of health care resources and utilizationTable A7.2 GPs’ involvement in delivery of various primary care servicesFig. A7.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A7.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A7.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A7.4 Patient satisfaction with aspects of care provisionFig. A7.5 Shared practiceFig. A7.6 Number of hospital admissions per 100 000 population with a primary caresensitive diagnosis in most recent yearFinlandTable A8.1 Development of health care resources and utilizationTable A8.2 GPs’ involvement in delivery of various primary care servicesFig. A8.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?
xvi Building primary care in a changing EuropeFig. A8.2 The development in supply of (selection of) primary care professionals per100 000 inhabitants in the most recent available five-year periodFig. A8.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A8.4 Patient satisfaction with aspects of care provisionFig. A8.5 Shared practiceFig. A8.6 Number of hospital admissions per 100 000 population with a primary caresensitive diagnosis in 2008FranceTable A9.1 Development of health care resources and utilizationTable A9.2 GPs’ involvement in delivery of various primary care servicesFig. A9.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A9.2 The development in supply of primary care professionals per 100 000inhabitantsFig. A9.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A9.4 Number of hospital admissions per 100,000 population with a primary caresensitive diagnosis in most recent yearGermanyTable A10.1 Development of health care resources and utilizationTable A10.2 GPs’ involvement in delivery of various primary care servicesFig. A10.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A10.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A10.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A10.4 Patient satisfaction with aspects of care provision
List of tables and figures xviiFig. A10.5 Shared practiceFig. A10.6 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearGreeceTable A11.1 Development of health care resources and utilizationTable A11.2 GPs’ involvement in delivery of various primary care servicesFig. A11.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A11.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A11.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A11.4 Patient satisfaction with aspects of care provisionFig. A11.5 Shared practiceHungaryTable A12.1 Development of health care resources and utilizationTable A12.2 GPs’ involvement in delivery of various primary care servicesFig. A12.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A12.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A12.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A12.4 Patient satisfaction with aspects of care provisionFig. A12.5 Shared practiceIcelandTable A13.1 Development of health care resources and utilizationTable A13.2 GPs’ involvement in delivery of various primary care services
xviii Building primary care in a changing EuropeFig. A13.1 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A13.2 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A13.3 Shared practiceFig. A13.4 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearIrelandTable A14.1 Development of health care resources and utilizationTable A10.2 GPs’ involvement in delivery of various primary care servicesFig. A14.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A14.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A14.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A14.4 Patient satisfaction with aspects of care provisionFig. A14.5 Shared practiceItalyTable A15.1 Development of health care resources and utilizationTable A15.2 GPs’ involvement in delivery of various primary care servicesFig. A15.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A15.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A15.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A15.4 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent year
List of tables and figures xixLatviaTable A16.1 Development of health care resources and utilizationTable A16.2 GPs’ involvement in delivery of various primary care servicesFig. A16.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A16.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A16.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A16.4 Patient satisfaction with aspects of care provisionLithuaniaTable A17.1 Development of health care resources and utilizationTable A17.2 GPs’ involvement in delivery of various primary care servicesFig. A17.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A17.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A17.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A17.4 Patient satisfaction with aspects of care provisionFig. A17.5 Shared practiceFig. A17.6 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearLuxembourgTable A18.1 Development of health care resources and utilizationTable A18.2 GPs’ involvement in delivery of various primary care servicesFig. A18.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A18.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year period
xx Building primary care in a changing EuropeFig. A18.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A18.4 Shared practiceMaltaTable A19.1 Development of health care resources and utilizationTable A19.2 GPs’ involvement in delivery of various primary care servicesFig. A19.1 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A19.2 Shared practiceThe NetherlandsTable A20.1 Development of health care resources and utilizationTable A20.2 GPs’ involvement in delivery of various primary care servicesFig. A20.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A20.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A20.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A20.4 Patient satisfaction with aspects of care provision (year 2007)Fig. A20.5 Shared practiceFig. A20.6 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearNorwayTable A21.1 Development of health care resources and utilizationTable A21.2 GPs’ involvement in delivery of various primary care servicesTable A21.3 Average number of prescriptions by GPs per 1000 contacts by agein 2009
List of tables and figures xxiFig. A21.1 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A21.2 Number of consultations (incl. home visits) in 2006 per habitant by ageand sexFig. A21.3 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearPolandTable A22.1 Development of health care resources and utilizationTable A22.2 GPs’ involvement in delivery of various primary care servicesFig. A22.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A22.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A22.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A22.4 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearPortugalTable A23.1 Development of health care resources and utilizationTable A23.2 GPs’ involvement in delivery of various primary care servicesFig. A23.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A23.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A23.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A23.4 Patient satisfaction with aspects of care provisionFig. A23.5 Shared practice
xxii Building primary care in a changing EuropeRomaniaTable A24.1 Development of health care resources and utilizationTable A24.2 GPs’ involvement in delivery of various primary care servicesFig. A24.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A24.2 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A24.3 Patient satisfaction with aspects of care provisionFig. A24.4 Shared practiceSlovakiaTable A25.1 Development of health care resources and utilizationTable A25.2 GPs’ involvement in delivery of various primary care servicesFig. A25.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A25.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year periodFig. A25.3 The extent to which organizational arrangements commonly exist inprimary care practices or primary care centresFig. A25.4 Patient satisfaction with aspects of care provisionFig. A25.5 Number of hospital admissions per 100 000 population with a primarycare sensitive diagnosis in most recent yearSloveniaTable A26.1 Development of health care resources and utilizationTable A26.2 GPs’ involvement in delivery of various primary care servicesFig. A26.1 How does the average income of mid-career health professionals relate tothat of a mid-career GP?Fig. A26.2 The development in supply of primary care professionals per 100 000inhabitants in the most recent available five-year period
List of tables and figures xxiiiFig. A26.3 The extent to which organizational arrangements commonly ex
2.4 Overall structure of primary care 61 2.5 Good practices and challenges for structuring primary care 63 2.6 Conclusion 65 References Chapter 3 The delivery of primary care services 67 Andrew Wilson, Adam Windak, Marek Oleszczyk, Stefan Wilm, Toralf Hasvold, Dionne Kringos 3.1 Access to primary care 67 3.2 Continuity of primary care 77
Principles of Primary Health Care Although the name of the program team reflects key service elements, it functions based on the principles of Primary Health Care. Primary health care is integrated and inter-sectoral. Primary health care emphasizes health promotion. Primary health care views the individual as a whole being.
4 Figure 1. The Ecology of Medical Care, 2001 2.2. What Are the Benefits of Primary Care There is strong evidence of the benefits of primary care for both populations and personal health.6-17 Studies show that robust systems of primary care can improve health.6 Access to primary care can lower overall health care utilizat
3,070 primary care practices Multi-payer Payment model: Track 1 FFS, Care management fee, performance based payment Track 2 -Comprehensive Primary Care Payment, reduced FFS, performance based payment Care delivery requirements and milestones Comprehensive Primary Care Plus Primary Care First 5 year demonstration
Primary Health Care Providers Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and
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Mental health in primary care A briefing for Clinical Commissioning Groups 5 One in four of us will experience a mental health problem in any given year, but most of us don’t get professional help. Of those of us who do get treatment, the majority are treated within primary care.10 This is why good mental health support in primary care is so important. Local GPs and other primary care staff .
Primary Care Physicians HEALTH CARE SYSTEMS 217 PRIMARY CARE PHYSICIANS KEY FINDINGS Supply of Primary Care Physicians The supply of primary care physicians per 100,000 population in the Appalachian Region is 12 percent lower than the national average. Central Appalachia (33 percent lower) and Southern Appalachia (21 percent lower) both .
To my Mom and Dad who taught me to love books. It's not possible to thank you adequately for everything you have done for me. To my grandparents for their
