Publication date

Primary care around the world.

Zee, J. van der, Boerma, W.G.W., Kroneman, M.W. Primary care around the world. In: R. Jones; N. Britten; L. Culpepper; D. Gass; R. Grol; D. Mant; C. Silagy. Oxford textbook of primary medical care: principles and concepts (Volume I). Oxford: Oxford University Press, 2004. 51-55
A health care system is the organized response to the health problems of a society. In mature economies, like the members of the Organization of Economies, like the members of the Organization of Economic Cooperation and Development (OECD), the health sector absorbs around 10 per cent of their gross domestic product (GDP) and it can be considered as a major force in the economies of these countries. Also in developing economies health (care) absorbs a subtantial, albeit lower proportion of a country's wealth; approcimately 5 per cent of the GDP. Health system analysis is the scientific approach to understanding the relationship between the structure of health care and a country's econonmic level of development, taking into account the needs of the population. In this chapter, first a section will be devoted to the 'system' part of the concept 'health system'. The following two sections will focus on the crucial relationship between 'health' and 'wealth' . The next section will describe the growth of health care systems, as part of the development of the modern welfare state. This historical approach is revelvant for those countries, and many are now in transition from mainly agricultural economie to industrial and service economies. At a certain stage in this transition process, these countries should decide what role the state should have, and what role should be played by social security and by private organiszations in health care funding and provision. The last section ends with an analysis of a secound important option: the choice between a primary care led or hospital-based health care system. (aut. ref.)