Political, cultural and economic foundations of primary care in Europe

• Published in: Social science & medicine (1982) Vol. 99; pp. 9 - 17
• Main Authors: Kringos, Dionne S., Boerma, Wienke G.W., van der Zee, Jouke, Groenewegen, Peter P.
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-12-2013; Elsevier; Pergamon Press Inc
• Subjects: Biological and medical sciences; Comparative analysis; Cultural Characteristics; Cultural Values; Culture; Delivery of Health Care - organization & administration; Delivery Systems; Development Policy; Economic development; Economic Development - statistics & numerical data; Economic growth; Europe; Health care access; Health care delivery; Health Care Services; Health Policy; Health Services Accessibility - statistics & numerical data; Healthcare systems; Humans; Income; Medical sciences; Miscellaneous; Politics; Primary care; Primary Health Care; Primary Health Care - organization & administration; Primary healthcare; Public health. Hygiene; Public health. Hygiene-occupational medicine; Social Values; Values; Europe; Healthcare systems; Health policy; Primary healthcare; Europe; Politics; Economic development; Culture; Human; Health system; Primary health care; Political aspect; Social medicine; Cultural aspect; Economic aspect; Social aspect; Public health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2013.09.017

This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country.
•Countries differ in primary care strength due to variation in wealth, politics, culture, and healthcare system type.•Eastern European countries have used their gains in wealth to strengthen primary care unlike Western European countries.•Left-wing governed countries are associated with better primary care services delivery.•Social health insurance countries are associated with having a relatively low accessibility and continuity of primary care.•Cultural values seem to affect both the structure of primary care, and all aspects of primary care services delivery.