Healthier populations in countries with stronger primary care
European countries with stronger primary care have a healthier population. This is a major outcome of a NIVEL study in 31 European countries, on the basis of which Dionne Kringos obtained the doctor of philosophy (Ph.D.) degree on Monday November 12th at Utrecht University, the Netherlands.
This comparative study has been the first to show for Europe that countries with stronger, better developed primary care functions have a healthier population. People suffering from chronic conditions that can for a large part be managed in primary care (e.g. ischaemic heart disease, cerebrovascular disease, and asthma) loose fewer years of their total life expectancy due to these conditions when they are treated in health care systems with a strong primary care structure, where a broad range of care services are available at the primary level and where these services are well coordinated. Examples of countries with strong primary care are Finland, Denmark, the Netherlands, Portugal, Spain, and the United Kingdom.
European Primary Care Monitor
Dionne Kringos and colleagues across Europe developed the European Primary Care Monitoring Instrument measuring the strength of primary care by means of 99 (qualitative and quantitative) indicators. The application of the instrument in 31 countries enabled the researchers to identify the stronger and weaker features of primary care in each country. Such features referred to the health policies and financial mechanisms in place, the organisation and service package of primary care practices and the educational and working conditions of professionals. In addition, conditions for accessibility for patients, cooperation and coordination of care among health care workers, and the scope of services provided within primary care were measured.
Starting point for reflection
Countries in Europe vary in the way primary care systems are positioned within their health care systems. The country specific results presented in this thesis show the details of these differences in terms of structure, organisation and outcomes of primary care, both at national level and, in comparison with other countries. This thesis may serve as a starting point for policymakers, primary care providers and researchers in each of the countries to reflect on those aspects of primary care that need further attention.
Costs
The study shows that strong primary care is conducive to reaching important health care system goals. Strong primary care is associated with better population health, less disparities in self-assessed health, and less unnecessary hospitalizations. Contrary to the past, countries with strong primary care now have higher total health care expenditures than countries with weaker primary care. According to Dionne Kringos: “We have no straightforward explanation for this, but this finding could be the result of flourishing economies in the eighties and nineties and the national health policy agenda of these countries, rather than the strength of primary care.”
Information infrastructure
“It was challenging to collect with so many people comprehensive information on the performance of primary care in 31 countries”, Kringos continues. “We have discovered that information infrastructure in most countries needs to be improved to facilitate comparative performance studies on primary care in Europe. Also individual countries will benefit from better information infrastructures as these will allow them to better evaluate and monitor the state of their primary care, and to identify areas needing improvement.”
Funding
The study has been funded by the European Commission (DG SANCO) and NIVEL. It was carried out in collaboration with partner institutes of NIVEL in the PHAMEU project (see www.phameu.eu) and with support of the World Health Organisation Regional Office for Europe, and the Dutch Ministry of Education, Culture and Science.
Contact
Dionne Kringos, Tel.+31(0)20-5667633 / +31(0)30 - 2729652