Preparing Primary Care for the Future—Perspectives from the Netherlands, England, and USA


The Issue

Modern health care systems face the common challenges of caring for aging populations, treating growing numbers of patients with chronic conditions, and meeting rising patient expectations. This study, coauthored by 2008–09 Commonwealth Fund Harkness Fellow Hubertus Vrijhoef, sought to understand how the Netherlands, England, and the United States—nations with different ways of organizing and financing care—are responding to these shared challenges.

What the Study Found

The Netherlands has focused on preventing chronic disease, while England has emphasized managing care for patients with multiple conditions, avoiding hospitalizations, and expanding access to primary care. Both nations have sought to organize care around the needs of patients. In comparison, the U.S. primary care system is weak; to meet the needs of its population, the U.S. will need to expand its primary care workforce and enhance resources devoted to primary care. All three countries are working to better coordinate care by setting care standards and bundling payments (the Netherlands); creating regional, clinician-led groups to manage resources and commission services for patients (England); and developing patient-centered medical homes and accountable care organizations (U.S.).


Despite the differences among these three health systems, improving coordination and integration of chronic disease care remains a common challenge.

Publication Details

Publication Date: March 15, 2012
Authors: Antje Erler, M.P.H., Thomas Bodenheimer, M.D., M.P.H., Richard Baker, M.D., Nick Goodwin, Ph.D., Cor Spreeuwenberg, M.D., Ph.D., Hubertus J. M. Vrijhoef, M.Sc., Ph.D., Ellen Nolte, Ph.D., and Ferdinand M. Gerlach, M.P.H.
Summary Writer: Martha Hostetter
A. Erler, T. Bodenheimer, R. Baker et al., “Preparing Primary Care for the Future—Perspectives from the Netherlands, England, and USA,” German Journal for Evidence and Quality in Health Care, 2011 105(8):571–80.
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