title: Renewing primary care: lessons learned from the Spanish health care system.
abstract: From 1978 on, Spain rapidly expanded and strengthened its primary health care system, offering a lesson in how to improve health outcomes in a cost-effective manner. The nation moved to a tax-based system of universal access for the entire population and, at the local level, instituted primary care teams coordinating prevention, health promotion, treatment, and community care. Gains included increases in life expectancy and reductions in infant mortality, with outcomes superior to those in the United States. In 2007 Spain spent $2,671 per person, or 8.5 percent of its gross domestic product on health care, versus 16 percent in the United States. Despite concerns familiar to Americans--about future shortages of primary care physicians and relatively low status and pay for these physicians--the principles underlying the Spanish reforms offer lessons for the United States.
authors.affiliation: Department of Family Medicine at the Alpert Medical School, Brown University, in Providence, Rhode Island, USA. jeffrey_borkan@mhri.org
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Borkan
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.forename: David
authors.initials: D
authors.lastname: Novillo-Ortiz
authors.forename: Pablo
authors.initials: P
authors.lastname: Rivero Corte
authors.forename: Alejandro R
authors.initials: AR
authors.lastname: Jadad
mesh_terms: D003362:Cost-Benefit Analysis; D018166:Health Care Reform; D006801:Humans; D017146:Models, Organizational; D009936:Organizational Innovation; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration*; D013030:Spain; D014481:United States; D019472:Universal Health Insurance / Q000331:legislation & jurisprudence