What are the advantages and disadvantages of restructuring a health care system to be more focused on primary care services? WHO/Europe 2004

Governments are searching for ways to improve the equity, efficiency, effectiveness, and responsiveness of their health systems. In recent years there has been an acceptance of the important role of primary health care in helping to achieve these aims. However, there have been no systematic reviews on primary care versus specialist-oriented systems, nor has the case for primary health care been firmly established.

This review presents the evidence for the advantages and disadvantages of restructuring a health care system on primary care services. It is based on a rapid but systematic review of key sources of published literature.

The available evidence demonstrates some advantages for health systems that rely relatively more on primary health care and general practice in comparison with systems more based on specialist care in terms of better population health outcomes, improved equity, access and continuity and lower cost. However, a stronger evidence base is needed to make the evidence available universally applicable.