Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries

Abstract

European health care systems are facing diverse challenges. In health policy, strong primary care is seen as key to deal with these challenges. European countries differ in how strong their primary care systems are. Two groups of traditionally weak primary care systems are distinguished. First a number of social health insurance systems in Western Europe. In these systems we identified policies to strengthen primary care by small steps, characterized by weak incentives and a voluntary basis for primary care providers and patients. Secondly, transitional countries in Central and Eastern Europe (CCEE) that transformed their state-run, polyclinic based systems to general practice based systems to a varying extent. In this policy review article we describe the policies to strengthen primary care. For Western Europe, Germany, Belgium and France are described. The CCEE transformed their systems in a completely different context and urgency of problems. For this group, we describe the situation in Estonia and Lithuania, as former states of the Soviet Union that are now members of the EU, and Belarus which is not. We discuss the usefulness of voluntary approaches in the context of acceptability of such policies and in the context of (absence of) European policies.

Nursing – problems with its position in the health care system

“…For the groups of patients referred to in the contract, the capitation rate is adjusted using the relevant coefficient increasing the funding for benefits. Some counselling and visits within preventive programmes, services provided to non-patients and some sanitary transportation, are funded according to unit prices determined separately for these services [36].…”

Health policy and the policymaking system: A case study of primary care in Ireland

“…In recent years, however, a considerable number of countries have moved to integrate specialised nursing and additional professions with GP services to form more comprehensive and coordinated primary care teams in the community. The content and extent of primary care reform policies across European countries differs substantially as a result of the historical development and institutional structure of each country's health care system [12,13]. In addition, macroeconomic conditions, as well as labour and social policies in each country, can also enhance or diminish the effectiveness of a primary care reform policy.…”

Remuneration of medical specialists. Drivers of the differences between six European countries

“…Although most countries have some form of numerus clausus, entrance in medical education is less restricted in Belgium, Denmark and Germany, than in England, France and the Netherlands [18]. The selection of students in the Netherlands is determined by a lottery.…”

“…Patients are encouraged -through lower copayments -to register with a GP. The systems also give financial incentives for GPs to register patients [18].…”