A comparison of primary care systems in the USA, Denmark, Finland and Sweden: lessons for Scandinavia?

In the United States large corporately owned health care delivery institutions, some of which are known as health maintenance organizations (HMOs), are assuming an increased prominence in the provision of primary care (PC). These private organizations are similar in many ways to the public-sector providers that have functioned for decades within the Scandinavian systems. This article explores the similarities and differences between these two PC approaches. This is accomplished by contrasting the governance, organization, financing and staffing of the PC systems of three Nordic countries (Denmark, Finland, and Sweden) to that of the US. Also provided is a critical analysis of the extent to which each model attains the ideal attributes of PC including; 1) accessibility, 2) comprehensiveness, 3) coordination and continuity, and 4) sensitivity to the patient's social milieu. For each facet of PC assessed, the American models offer approaches that are worthy of consideration by Scandinavian clinicians and planners. These include innovations in the areas of coordination between primary and secondary care, preventive care for adults and incentives for financial efficiency. Also, although successful in attaining many attributes of PC, this article discusses some perceived weaknesses of the Scandinavian systems.