title: Preparing primary care for the future - perspectives from the Netherlands, England, and USA.
abstract: BACKGROUND
  All modern healthcare systems need to respond to the common challenges posed by an aging population combined with a growing number of patients with (complex) chronic conditions and rising patient expectations. Countries with 'stronger' primary care systems (e.g. the Netherlands and England) seem to be better prepared to address these challenges than countries with 'weaker' primary care (e.g. USA). The role of primary care in a health care system is strongly related to its organisation and funding, thus determining the starting point and the possibilities for change.
  
  
  METHODS
  We selected the Netherlands, England, and USA as examples for the diversity of approaches to organise and finance health care. We analysed the main problems for primary care and reviewed strategies and practice models used to meet the challenges described above.
  
  
  RESULTS
  The Netherlands aim to strengthen prevention for chronic diseases, while England strives to improve the management of patients with multimorbidity, prevent hospital admissions to contain costs, and to satisfy the increased demand of patients for access to primary care. Both countries seek to reorganise care around the patient and place their needs at the centre. The USA has to provide sufficient workforce, organisation, and funding for primary care to ensure better access, prevention, and provision of chronic care for its population. Strategies to improve (trans-sectoral) cooperation and care coordination, a main issue in all three countries, include the implementation of standards of care and bundled payments for chronic diseases in the Netherlands, GP commissioning, federated and group practice models in England, and the introduction of the Patient-Centred Medical Home and accountable care organisations in the USA.
  
  
  CONCLUSIONS
  Organisation and financing of health care differ widely in the three countries. However, the necessity to improve coordination and integration of chronic disease care remains a common and core challenge.
authors.affiliation: Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. erler@allgemeinmedizin.uni-frankfurt.de
authors.forename: Antje
authors.initials: A
authors.lastname: Erler
authors.forename: Thomas
authors.initials: T
authors.lastname: Bodenheimer
authors.forename: Richard
authors.initials: R
authors.lastname: Baker
authors.forename: Nick
authors.initials: N
authors.lastname: Goodwin
authors.forename: Cor
authors.initials: C
authors.lastname: Spreeuwenberg
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Ellen
authors.initials: E
authors.lastname: Nolte
authors.forename: Ferdinand M
authors.initials: FM
authors.lastname: Gerlach
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D003363:Cost Control / Q000191:economics / Q000458:organization & administration / Q000639:trends; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004739:England; D005544:Forecasting; D005858:Germany; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration / Q000639:trends; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration / Q000639:trends; D006801:Humans; D009313:National Health Programs / Q000191:economics / Q000458:organization & administration* / Q000639:trends*; D009426:Netherlands; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration / Q000639:trends; D011157:Population Dynamics; D011314:Preventive Health Services / Q000191:economics / Q000458:organization & administration / Q000639:trends; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000639:trends*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000458:organization & administration / Q000639:trends; D014481:United States