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Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries


  • Groenewegen, Peter P.
  • Dourgnon, Paul
  • Greß, Stefan
  • Jurgutis, Arnoldas
  • Willems, Sara


European health care systems are facing diverse challenges. In health policy, strong primary care is seen as key to deal with these challenges. European countries differ in how strong their primary care systems are. Two groups of traditionally weak primary care systems are distinguished. First a number of social health insurance systems in Western Europe. In these systems we identified policies to strengthen primary care by small steps, characterized by weak incentives and a voluntary basis for primary care providers and patients. Secondly, transitional countries in Central and Eastern Europe (CCEE) that transformed their state-run, polyclinic based systems to general practice based systems to a varying extent. In this policy review article we describe the policies to strengthen primary care. For Western Europe, Germany, Belgium and France are described. The CCEE transformed their systems in a completely different context and urgency of problems. For this group, we describe the situation in Estonia and Lithuania, as former states of the Soviet Union that are now members of the EU, and Belarus which is not. We discuss the usefulness of voluntary approaches in the context of acceptability of such policies and in the context of (absence of) European policies.

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  • Groenewegen, Peter P. & Dourgnon, Paul & Greß, Stefan & Jurgutis, Arnoldas & Willems, Sara, 2013. "Strengthening weak primary care systems: Steps towards stronger primary care in selected Western and Eastern European countries," Health Policy, Elsevier, vol. 113(1), pages 170-179.
  • Handle: RePEc:eee:hepoli:v:113:y:2013:i:1:p:170-179
    DOI: 10.1016/j.healthpol.2013.05.024

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    References listed on IDEAS

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    Cited by:

    1. Akman, Mehmet & Sakarya, Sibel & Sargın, Mehmet & Ünlüoğlu, İlhami & Eğici, Memet Taşkın & Boerma, Wienke G.W. & Schäfer, Willemijn L.A., 2017. "Changes in primary care provision in Turkey: A comparison of 1993 and 2012," Health Policy, Elsevier, vol. 121(2), pages 197-206.
    2. Kelly, Niall & Garvey, John & Palcic, Dónal, 2016. "Health policy and the policymaking system: A case study of primary care in Ireland," Health Policy, Elsevier, vol. 120(8), pages 913-919.
    3. Kok, Lucy & Boyle, Seán & Lammers, Marloes & Tempelman, Caren, 2015. "Remuneration of medical specialists. Drivers of the differences between six European countries," Health Policy, Elsevier, vol. 119(9), pages 1188-1196.
    4. Igor Sheiman & Vladimir Shevski, 2017. "Two Models of Primary Health Care Development: Russia vs. Central and Eastern European Countries," HSE Working papers WP BRP 06/PSP/2017, National Research University Higher School of Economics.


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