Spain: an unlikely primary care model for the U.S.

When U.S. health reformers were looking abroad last year, the health systems of Canada and the United Kingdom were the most commonly mentioned. In this blog, I've also compared our primary care to better-functioning systems in more out-of-the-way places: the former Soviet republic of Kazakhstan and the tiny island nation of Taiwan.

An article in the August issue of the journal Health Affairs took a closer look at the reform of the primary care system in Spain that began in the mid-1970s. Following the end of the Franco dictatorship, Spain moved rapidly to reorganize the way it provided health care to its citizens. Not only did it formally recognize family medicine as a distinctive medical specialty, Spain's central government dedicated public funds to guarantee primary care access within "Basic Health Zones" that were "organized around a single primary care team ... [to] coordinate prevention, promotion, treatment, and community care activities." They set a goal to establish a primary care center within a 15-minute drive of any residence in the country, and in 2007, 97 percent of all primary care visits were recorded on electronic health records.

The resulting health gains were impressive. Spain's life expectancy in 2007 was 84.3 years for women and 77.8 years for men, both considerably better than the U.S.'s 80.7 years for women at 75.4 years for men. And like other nations that have organized their health systems around primary care, Spain spends a much smaller fraction of its gross domestic product on health care than does the U.S.: just 8.5 percent compared to 16 percent.

Can lessons learned from the transformation of Spain's primary care system be applied to the U.S.? My answer is yes and no. We have made some recent, though comparatively modest, investments in strengthening the training of primary care physicians, and there are new incentives for physicians to accelerate their adoption of health information technology. In terms of access, it may always be difficult to recruit and retain talented physicians in rural underserved areas, as a recent Washington Post story illustrates. But improving the health of the country certainly won't happen if political leaders don't make universal primary care access - distinct from universal insurance coverage - a high priority over the coming decades.