The best of both worlds : how primary care can save lives and money

Abstract

Just imagine, for a moment, that you receive a request from a newly independent country, anywhere in the world, appointing you to devise a health care system. You have an absolutely free hand to design it as you wish. Where would you start? Most of us would start by determining exactly what outcomes we wanted for our system. It is hard to believe that many thinking people would opt for anything other than improved health outcomes for their population, and a reduction in health inequalities. What else could be more important? And so it is mystifying that so very many countries have healthcare systems that do the very opposite, that appear to have as their main reason for existence the provision of jobs for clinicians, or the acquisition of increasing levels of high technology equipment. Do their populations realize this? More importantly, do the health ministers, and their civil servants realize this? Sadly, one suspects that they do not. Because the evidence is remarkably clear that high quality primary care is the secret to effective health care. Primary care is the first point of contact for the majority of people who need to access health services, and is able to meet 90-95% of all health and personal social service needs.