The Issue
In a 2008 report, the World Health Organization (WHO) set forth four policy reforms needed to elevate the role of primary care in health systems around the world. Among these were universal insurance coverage, health care delivery organized around primary care, the integration of public health initiatives with primary care delivery, and leadership for promoting dialogue with stakeholders. In this paper, a research team led by former Commonwealth Fund Harkness Fellow Robin Gauld, Ph.D., reports on how these high-level policies are being implemented in 12 wealthy health systems.
What the Study Found
In all 12 health systems—Australia, Canada, Germany, Japan, Hong Kong, the Netherlands, New Zealand, Singapore, South Korea, Taiwan, the United Kingdom, and the United States—there are substantial gaps between what the WHO envisions and how health care delivery systems actually function. Still, many initiatives are under way to strengthen primary care. These include efforts in the Netherlands to provide round-the-clock access to primary care and chronic care management through collaborations among primary care practices. Dutch health insurers have also set up prevention programs involving schools and providers. In the U.K., pay-for-performance incentives for general practitioners introduced in 2004 have improved primary care. Efforts are also being made to better integrate primary and specialty care and engage patients.
In the U.S., insurance and payment reforms are expected to strengthen primary care, particularly through the development of patient-centered medical homes and accountable care organizations.
Conclusions
The authors note that while primary health care deserves more attention from policymakers, the WHO’s vision for reform "is perhaps too idealistic and fails to address the fundamentals for successful policy adoption and implementation within member countries."
