A strong primary care system is good for a nation's health

A study by researchers at the Johns Hopkins Bloomberg School of Public Health has demonstrated that the stronger a country's network of primary care providers, the lower the health care costs and the better a population's health are generally. Primary care physicians are those who establish long-term personal relationships with patients and coordinate their overall care. The study appeared in the June 2002 issue of Health Policy.

Lead author Barbara Starfield, MD, MPH, University Distinguished Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, said, "Weak primary care systems have higher health care costs and worse population health outcomes almost across the board."

Using international data sets from the early and mid-1990s, the researchers characterized 13 industrialized nations, all with populations of at least five million, by the relative strength of their primary care infrastructures. Countries were also ranked as to smoking levels within each population (since smoking is a major behavioral determinant of health, and one that can be influenced by policy interventions) and as to the degree of national income inequality.

The study results indicated that the stronger a country's orientation towards primary care, the lower the health care costs. Countries with weak primary care infrastructures (e.g., Belgium, France, Germany, and the United States) showed poorer performance on major aspects of health such as life expectancy and child survival. Those nations with the most robust systems of primary care (e.g., Denmark, Finland, Netherlands, Spain, and the United Kingdom) boasted the most favorable health indicators at young ages and countries that approached them in primary care strength did well at older ages.

The authors also found that a strong primary care system is particularly crucial to the health of children. "Although countries that are intermediate in the strength of their prima

Contact: Tim Parsons
Johns Hopkins University Bloomberg School of Public Health

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