ry care [e.g., Australia, Canada, Japan, and Sweden] generally had levels of health at least as good as those with high levels of primary care, this is not the case in early life, when the impact of strong primary care is greatest," said author Leiyu Shi, DrPH, an associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. Primary care scores, for instance, were highly and significantly related to the postneonatal mortality rate, and inversely related to low birthweight.

Interestingly, the researchers found no consistent relationship between income inequality, smoking, and health levels, as measured by various indicators in different age groups.

The authors stress that a certain level of health care spending may be required to achieve overall good health levels, even in the presence of strong primary care infrastructures. "Very low costs may interfere with achievement of good health, particularly at older ages, although very high levels of costs may signal excessive and potentially health-compromising care," said Starfield. Five policy-relevant characteristics appear to be related to better population health levels, including efforts to distribute resources to where they are most needed, a government-sponsored national health insurance or system, and low of no cost-sharing for primary care, as well as practice characteristics such as comprehensiveness of primary care services and a family orientation.

"Within the past 15 years, almost all countries have undergone some type of health care reform, mostly directed at conserving costs," notes Starfield. "But except for the general finding that there is little association between costs of a health system and population health, more extensive analyses have not been done. This study indicates that a strong primary-care orientation within health service systems continues to exert a positive effect, particularly for indicators early in life."

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Contact: Tim Parsons
paffairs@jhsph.edu
410-955-6878
Johns Hopkins University Bloomberg School of Public Health
24-Jun-2002

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