Medicine
When U.S. health reformers were looking abroad last year, the health systems of Canada and the United Kingdom were the most commonly mentioned. In this blog, I've also compared our primary care to better-functioning systems in more out-of-the-way places: the former Soviet republic of Kazakhstan and the tiny island nation of Taiwan.
An article in the August issue of the journal Health Affairs took a closer look at the reform of the primary care system in Spain that began in the mid-1970s. Following the end of the Franco dictatorship, Spain moved rapidly to reorganize the way it provided health care to its citizens. Not only did it formally recognize family medicine as a distinctive medical specialty, Spain's central government dedicated public funds to guarantee primary care access within "Basic Health Zones" that were "organized around a single primary care team ... [to] coordinate prevention, promotion, treatment, and community care activities." They set a goal to establish a primary care center within a 15-minute drive of any residence in the country, and in 2007, 97 percent of all primary care visits were recorded on electronic health records.
The resulting health gains were impressive. Spain's life expectancy in 2007 was 84.3 years for women and 77.8 years for men, both considerably better than the U.S.'s 80.7 years for women at 75.4 years for men. And like other nations that have organized their health systems around primary care, Spain spends a much smaller fraction of its gross domestic product on health care than does the U.S.: just 8.5 percent compared to 16 percent.
Can lessons learned from the transformation of Spain's primary care system be applied to the U.S.? My answer is yes and no. We have made some recent, though comparatively modest, investments in strengthening the training of primary care physicians, and there are new incentives for physicians to accelerate their adoption of health information technology. In terms of access, it may always be difficult to recruit and retain talented physicians in rural underserved areas, as a recent Washington Post story illustrates. But improving the health of the country certainly won't happen if political leaders don't make universal primary care access - distinct from universal insurance coverage - a high priority over the coming decades.
- Universal Coverage And Primary Care: The Us Needs Both
. In “Reinventing Primary Care: Lessons from Canada for the United States” (Health Affairs, May2010;29(5):1030-5), the eminent scholar Barbara Starfield provides just that – lessons from Canada for the United States. For decades, advocates of comprehensive...
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- Getting Health Reform Done: The Taiwanese Experience
My parents were both born in Taiwan, and about every four years (most recently, last November), I travel there to visit relatives. Since I was a child, Taiwan always struck me as in the same league as the U.S. with respect to advanced technology - in...
- Primary Care In Developing Countries
While this blog focuses on health and the dysfunctional health care system in the U.S., it's worth noting that many other countries have problems providing their citizens with good primary care. Last year, the World Health Organization released a...
- Health Care Lessons From Astana
The city of Astana, the capital of the former Soviet republic of Kazakhstan, is well known to U.S. professional cycling fans as the team sponsor for Lance Armstrong and his rival Alberto Contador, who won this year's Tour de France. Earlier today...
Medicine
Spain: an unlikely primary care model for the U.S.
When U.S. health reformers were looking abroad last year, the health systems of Canada and the United Kingdom were the most commonly mentioned. In this blog, I've also compared our primary care to better-functioning systems in more out-of-the-way places: the former Soviet republic of Kazakhstan and the tiny island nation of Taiwan.
An article in the August issue of the journal Health Affairs took a closer look at the reform of the primary care system in Spain that began in the mid-1970s. Following the end of the Franco dictatorship, Spain moved rapidly to reorganize the way it provided health care to its citizens. Not only did it formally recognize family medicine as a distinctive medical specialty, Spain's central government dedicated public funds to guarantee primary care access within "Basic Health Zones" that were "organized around a single primary care team ... [to] coordinate prevention, promotion, treatment, and community care activities." They set a goal to establish a primary care center within a 15-minute drive of any residence in the country, and in 2007, 97 percent of all primary care visits were recorded on electronic health records.
The resulting health gains were impressive. Spain's life expectancy in 2007 was 84.3 years for women and 77.8 years for men, both considerably better than the U.S.'s 80.7 years for women at 75.4 years for men. And like other nations that have organized their health systems around primary care, Spain spends a much smaller fraction of its gross domestic product on health care than does the U.S.: just 8.5 percent compared to 16 percent.
Can lessons learned from the transformation of Spain's primary care system be applied to the U.S.? My answer is yes and no. We have made some recent, though comparatively modest, investments in strengthening the training of primary care physicians, and there are new incentives for physicians to accelerate their adoption of health information technology. In terms of access, it may always be difficult to recruit and retain talented physicians in rural underserved areas, as a recent Washington Post story illustrates. But improving the health of the country certainly won't happen if political leaders don't make universal primary care access - distinct from universal insurance coverage - a high priority over the coming decades.
- Universal Coverage And Primary Care: The Us Needs Both
. In “Reinventing Primary Care: Lessons from Canada for the United States” (Health Affairs, May2010;29(5):1030-5), the eminent scholar Barbara Starfield provides just that – lessons from Canada for the United States. For decades, advocates of comprehensive...
- The Best Recent Posts You May Have Missed
Every other month or so, I post a list of my top 5 favorite posts since the preceding "best of" list on this blog, for those of you who have only recently started reading Common Sense Family Doctor or don't read it regularly. Here are my favorites...
- Getting Health Reform Done: The Taiwanese Experience
My parents were both born in Taiwan, and about every four years (most recently, last November), I travel there to visit relatives. Since I was a child, Taiwan always struck me as in the same league as the U.S. with respect to advanced technology - in...
- Primary Care In Developing Countries
While this blog focuses on health and the dysfunctional health care system in the U.S., it's worth noting that many other countries have problems providing their citizens with good primary care. Last year, the World Health Organization released a...
- Health Care Lessons From Astana
The city of Astana, the capital of the former Soviet republic of Kazakhstan, is well known to U.S. professional cycling fans as the team sponsor for Lance Armstrong and his rival Alberto Contador, who won this year's Tour de France. Earlier today...