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Primary Care in Europe: Entering the Age of Austerity


Many European countries have well-developed health systems that offer universal access to health services and which have a strong primary care sector. Primary care physicians are the point of first contact with the health care system in such countries, providing open access to all patients, and dealing with most of the problems patients present with. Strong primary care sectors have allowed health systems in Europe to make efficient use of health care resources, for example, through the gatekeeping role of primary care physicians. However, as the financial crisis in Europe continues to progress, it is now starting to affect health and social services. In Ireland, for example, this has led to a reduction in the number of hospital beds and in recruitment to unfilled posts in the health service. In Italy, additional user charges have been imposed on patients. The potential impact of this new era of financial austerity were discussed in an article I published in the Journal of Ambulatory Care Management.

Countries such as Spain and Greece may see even more radical changes in their health systems.
In many European countries, physicians have come to expect annual real-term increases in spending on health. This era of steadily increased health spending has now ended for many countries and will not return for many years. Primary care physicians in Europe will have to learn to work in an environment where health care funding and resources will be much more limited than in the past. One way in which these resource constraints have already begun to impact on primary care physicians is through the effect that cuts in specialist service are having on their own workload. Primary care physicians in countries such as the UK are increasingly finding that they will have to find ways of dealing with work that was formerly undertaken provided by hospital physicians.

Another consequence of the new financial environment is the introduction of elements of a competitive market into health systems in the belief that markets in health care can improve quality of health services without increasing the costs of health care provision. This has been controversial with substantial criticism from both health professionals and patients; and has led to concerns about a potential trade-off between equity and choice in countries that have progressed down this route. Other concerns about the introduction of competition between health care providers include a belief that such changes could fragment health services and risk marginalising patients with complex health needs and high health care costs.

Primary care physicians are now working in a much more hostile financial environment and one in which new providers of care may compete for some of their roles and activities. The longer term effects of such changes, such as the impact they will have on primary care as a career choice for young physicians, remain to be seen.

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