Editorials

Shifting the balance from secondary to primary care

Countries with more highly developed systems of primary care tend to have lower health care costs,¹ and policies designed to shift the balance from secondary to primary care have therefore been a common theme in health service reforms. But financial motives are not the only reason. Starfield's definition of primary care--"first-contact, continuous, comprehensive, and coordinated care provided to populations undifferentiated by gender, disease or organ system"¹--encapsulates the main elements that such policies aim to preserve. A health care system dominated by secondary, tertiary, and emergency care will tend to be fragmented, discontinuous, uncoordinated, and costly.

In Britain, boundaries are already shifting. Some procedures are being transferred from hospital to community settings. For example, triage systems and hospital at home schemes are being established to avoid hospital admissions and facilitate early discharge; attempts are being made to reduce the number of patients referred inappropriately to . . . [Full text of this article]

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