title: Primary care in Switzerland gains strength.
abstract: BACKGROUND
  Although there is widespread agreement on health- and cost-related benefits of strong primary care in health systems, little is known about the development of the primary care status over time in specific countries, especially in countries with a traditionally weak primary care sector such as Switzerland.
  
  
  OBJECTIVE
  The aim of our study was to assess the current strength of primary care in the Swiss health care system and to compare it with published results of earlier primary care assessments in Switzerland and other countries.
  
  
  METHODS
  A survey of experts and stakeholders with insights into the Swiss health care system was carried out between February and March 2014. The study was designed as mixed-modes survey with a self-administered questionnaire based on a set of 15 indicators for the assessment of primary care strength. Forty representatives of Swiss primary and secondary care, patient associations, funders, health care authority, policy makers and experts in health services research were addressed. Concordance between the indicators of a strong primary care system and the real situation in Swiss primary care was rated with 0-2 points (low-high concordance).
  
  
  RESULTS
  A response rate of 62.5% was achieved. Participants rated concordance with five indicators as 0 (low), with seven indicators as 1 (medium) and with three indicators as 2 (high). In sum, Switzerland achieved 13 of 30 possible points. Low scores were assigned because of the following characteristics of Swiss primary care: inequitable local distribution of medical resources, relatively low earnings of primary care practitioners compared to specialists, low priority of primary care in medical education and training, lack of formal guidelines for information transfer between primary care practitioners and specialists and disregard of clinical routine data in the context of medical service planning.
  
  
  CONCLUSIONS
  Compared to results of an earlier assessment in Switzerland, an improvement of seven indicators could be stated since 1995. As a result, Switzerland previously classified as a country with low primary care strength was reclassified as country with intermediate primary care strength compared to 14 other countries. Low scored characteristics represent possible targets of future health care reforms.
authors.affiliation: Institute of Primary Care and Health Services Research, University Hospital of Zurich, Zurich, Switzerland. sima.djalali@usz.ch.
authors.forename: Sima
authors.initials: S
authors.lastname: Djalali
authors.affiliation: Institute of Primary Care and Health Services Research, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Meier
authors.affiliation: Institute of Primary Care and Health Services Research, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Susann
authors.initials: S
authors.lastname: Hasler
authors.affiliation: Institute of Primary Care and Health Services Research, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rosemann
authors.affiliation: Institute of Primary Care and Health Services Research, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tandjung
mesh_terms: D003431:Cross-Cultural Comparison; D019538:Health Care Surveys; D006292:Health Priorities; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D058007:Physicians, Primary Care / Q000191:economics* / Q000193:education / Q000600:supply & distribution; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards / Q000639:trends*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012456:Salaries and Fringe Benefits; D013557:Switzerland
keywords: Benchmarking; Switzerland.; general practice; organization and administration; primary health care; quality indicators