A compelling article that explores some of the current challenges facing the integration of primary care within the health systems of 10 high income countries. The data comes from the 18th annual Commonwealth Fund International Health Policy Survey of Primary Care Physicians which was completed in 2015 in Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. While primary care physicians reported being well prepared for multiple chronic medical conditions, several health areas such as mental health and addiction were noted for being weak points for providers. A frequent challenge was a lack of communication with other parts of the health care system as well as with social services although there was significant variation between countries. An important finding of the study was “that having an electronic health record does not ensure electronic flow of information with doctors outside of one’s practice.” It is not surprising then that “this and past international surveys of both primary care doctors and patients have found that care coordination failures are common in all ten health systems.” There were four countries that stood out for reporting the most problems, namely Canada, the United States, Norway and Germany. All four rely on fee-for-service payment for primary care although Switzerland which also uses a fee-for-service system and the Netherlands which has recently moved to “bundled” payments offer examples of systems where these or similar reimbursement structures have translated into a positive coordination experience for patients and providers.
