title: Political, cultural and economic foundations of primary care in Europe.
abstract: This article explores various contributing factors to explain differences in the strength of the primary care (PC) structure and services delivery across Europe. Data on the strength of primary care in 31 European countries in 2009/10 were used. The results showed that the national political agenda, economy, prevailing values, and type of healthcare system are all important factors that influence the development of strong PC. Wealthier countries are associated with a weaker PC structure and lower PC accessibility, while Eastern European countries seemed to have used their growth in national income to strengthen the accessibility and continuity of PC. Countries governed by left-wing governments are associated with a stronger PC structure, accessibility and coordination of PC. Countries with a social-security based system are associated with a lower accessibility and continuity of PC; the opposite is true for transitional systems. Cultural values seemed to affect all aspects of PC. It can be concluded that strengthening PC means mobilising multiple leverage points, policy options, and political will in line with prevailing values in a country.
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Otterstraat 114-118, 3513 CR Utrecht, the Netherlands; Department of Social Medicine, Academic Medical Centre (AMC), University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: d.s.kringos@amc.uva.nl.
authors.forename: Dionne S
authors.initials: DS
authors.lastname: Kringos
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Otterstraat 114-118, 3513 CR Utrecht, the Netherlands. Electronic address: w.boerma@nivel.nl.
authors.forename: Wienke G W
authors.initials: WG
authors.lastname: Boerma
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Otterstraat 114-118, 3513 CR Utrecht, the Netherlands; Department of International Health, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Electronic address: j.vanderzee@nivel.nl.
authors.forename: Jouke
authors.initials: J
authors.lastname: van der Zee
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Otterstraat 114-118, 3513 CR Utrecht, the Netherlands; Department of Human Geography, Department of Sociology, University of Utrecht, P.O. Box 80140, 3508 TC Utrecht, The Netherlands. Electronic address: p.groenewegen@nivel.nl.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
mesh_terms: D003466:Cultural Characteristics; D003695:Delivery of Health Care / Q000458:organization & administration; D057217:Economic Development / Q000706:statistics & numerical data*; D005060:Europe; D006291:Health Policy; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D011057:Politics; D011320:Primary Health Care / Q000458:organization & administration*; D012945:Social Values
keywords: Culture; Economic development; Europe; Health policy; Healthcare systems; Politics; Primary healthcare