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Europe's Strong Primary Care Systems Are Linked to Better Population Health But Also to Higher Health Spending

The Issue

To improve population health and reduce total health care costs, policymakers in the United States and abroad have taken steps to strengthen primary care, even though evidence supporting the benefits of these investments is somewhat limited. Commonwealth Fund–supported researchers analyzed data collected in Europe to see whether stronger primary care systems were associated with higher performance on measures of population health, efficiency, and socioeconomic inequality.

What the Study Found

Using data collected between 2009 and 2010 from 31 European countries, the authors found that total health care expenditures were higher in countries with stronger primary care infrastructures, although countries with comprehensive primary care service delivery had slower growth in total health care expenditures per capita. The authors speculate that while maintaining a strong primary care system drives costs higher in the short term, treating a broader range of health problems through primary care reduces overall growth in costs.

Stronger primary care systems were associated with lower rates of potentially avoidable hospitalizations and fewer deaths from ischemic heart disease, cerebrovascular disease, chronic asthma, bronchitis, and emphysema. Countries with better continuity of primary care―those that have created the conditions for enduring doctor–patient relationships―also reported lower levels of socioeconomic inequality. 


Strong primary care in Europe has had a positive impact on population health, socioeconomic inequalities in health, and avoidable hospitalizations. However, health care spending is higher in countries with relatively stronger primary care provisions, a finding that requires further investigation.

Publication Details



D. S. Kringos, W. Boerma, P. Groenewegen et al., "Europe's Strong Primary Care Systems Are Linked to Better Population Health But Also to Higher Health Spending," Health Affairs, April 2013 32(4):686–94.