The reform of primary care, between the last refuge of adventure and innovation. SESPAS report 2012

Primary care reforms started thirty years ago, but not fully developed their potential. Improvements should be suggested to be accompanied by adequate funding, operational capacity and organization and clinical skills adapt to upgrading and trivialized demand, bureaucracy and medicalization. Organizational-suggested reforms have not shown conclusive differences yet. On the other hand, neither pro-content nor pro-coordination reforms have shown any impact on the derived demand, the cost of care attention or the health outcomes. Thanks to the support of the information systems, bureaucracy has been reduced and care continuity may be promoted. In the middle management level, some measures have been suggested to promote accessibility, restore capitation by payment systems, perform and resolve capacity, improve integration of social care and health care resources, actively engage professionals with the health system-objectives of quality and efficiency and, finally, add more clinical, preventive and community collaboration-contents.