Primary care: a comparison across five nations (part 1 of 6)

BMiedema 1Baukje (Bo) Miedema is Professor and Director of Research at the Dalhousie University Family Medicine Teaching Unit and Adjunct Professor in the Sociology Department, University of New Brunswick

 “The constitution” of primary health internationally, as a core component of the structure of health, care can be traced back to the Declaration of Alma-Ata (1978), even though its origins go much further back in time: 1941 in the Netherlands and 1948 in the United Kingdom. The Declaration states that governments have to be responsible for the health of their people. Primary health care is seen as an important vehicle to deliver health care to the population, and is defined as care that “addresses the main health problems in the community, providing promotive, preventative, curative and rehabilitative services accordingly.” The Declaration of Alma-Ata also states that by the year 2000 there should be “health for all.”

Many countries are struggling to provide “health for all.” Universal access to health care is available to few; most global citizens do not have access to primary health care, or any type of health care. The World Health Organization has been promoting universal primary health care models for decades. Nevertheless, some countries have achieved universal health care, even though many now struggle to maintain it. Other nations, such as the United States, have a health care system based on free market principles and are now cautiously moving towards a more universal model of primary health care. Conversely, some European countries, mainly the Netherlands, have moved to a more free market–driven delivery model.

In the fall of 2010, during the North America Primary Care Research Group meetings in Seattle, a forum on the delivery of primary care in five different countries was held. The intent of the forum was to provide the audience with a flavour of the variety of the delivery models and payment structures between nations. In this series of blog posts, we will discuss primary health care delivery models in the countries that participated in the forum: New Zealand, Australia, the Netherlands, the United Kingdom and Canada.

The delivery of primary care in each of these countries varies greatly. The systems range from private health insurance to governments paying the majority of primary care’s cost. Obviously, there is no one-size-fits-all formula for the delivery of primary care. Different countries, based on historical and current political climates, have developed country-specific systems. Nevertheless, the described nations have two issues in common: (i) the provision of universal primary care and (ii) the sustainability of their health care systems. Perhaps countries can learn from each other to ensure universal primary care’s sustainability; as the late Barbara Starfield has conclusively shown, countries with universal primary care systems have better population health outcomes than countries that reject universal health care.

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