NIVEL - Netherlands Institute for Health Services Research and Utrecht University, Dep. of Sociology and Dep. of Human Geography, NIVEL, PO Box 1568, 3500 BN Utrecht, The Netherlands.
Health Policy. 2013 Nov;113(1-2):170-9. doi: 10.1016/j.healthpol.2013.05.024. Epub 2013 Jul 26.
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.
欧洲的医疗保健系统正面临着各种挑战。在卫生政策方面，强大的初级保健被视为应对这些挑战的关键。欧洲各国的初级保健系统的强弱程度存在差异。传统上，有两组初级保健系统较弱。首先是西欧的一些社会医疗保险制度。在这些制度中，我们确定了通过小步骤加强初级保健的政策，其特点是激励措施薄弱，初级保健提供者和患者自愿参与。其次是中东欧转型国家（CCEE），它们在不同程度上把国有、以综合医院为基础的系统转变为以全科医生为基础的系统。在这篇政策综述文章中，我们描述了加强初级保健的政策。以德国、比利时和法国为例介绍了西欧的情况。CCEE 在一个完全不同的背景和问题紧迫性下转变了他们的系统。对于这个群体，我们描述了前苏联成员国爱沙尼亚和立陶宛以及非成员国白俄罗斯的情况。我们讨论了在政策的可接受性和（缺乏）欧洲政策的背景下，自愿方法的有用性。
