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Survey of Five European Countries Suggests That More Elements of Patient-Centered Medical Homes Could Improve Primary Care

The Issue

Within the European Union, the share of adults age 65 and older is expected to rise from 17 percent in 2010 to 27 percent by 2040. Likewise, the number of people with multiple chronic diseases will rise as well. The U.S. medical home model represents a possible solution to the primary care needs of Europe’s aging populations, as evidence suggests it can enhance access to care, improve the management and coordination of chronic disease care, and contain costs. This Commonwealth Fund–supported study surveyed patients with chronic illness and primary care providers in five European countries to assess the extent to which care delivery systems already have features of the patient-centered medical home and to identify gaps.

What the Study Found

A large majority (87%–98%) of patients in Belgium, Denmark, Germany, and the Netherlands have a personal primary care physician. The percentage is lower in England (74%), where most primary care tasks are typically delegated to nurses. Respondents reported that their personal physician coordinated their care, ranging from 76 percent of respondents in Denmark to 88 percent in Belgium. Financial barriers to access were not evident in any country.

Accounts of the doctor–patient relationship were less favorable. Up to 40 percent of patients said their expectations of care were not met by the end of the consultation or that their primary care physician did not show interest in either their psychosocial well-being or their home life. In addition, the practice of providing patients with written guidance on self-managing their chronic condition does not seem to have been broadly adopted, and communication among care providers appears weak.


"[D]espite strong organizational structures, European primary care systems need additional efforts to recognize chronically ill patients as partners in care," the authors state. Embracing the patient-centered medical home model may improve care for all patients, they conclude.

Publication Details


M. Faber, G. Voerman, A. Erler et al., “Survey of Five European Countries Suggests That More Elements of Patient-Centered Medical Homes Could Improve Primary Care,” Health Affairs Web First, published online March 21, 2013.