Reform of primary health care: The case of Spain

Different approaches to health reform are proposed in many countries to overcome inefficiencies in care delivery. This paper assesses an incremental reform initiated in Spain IO years ago, which sought to improve the efficiency of the entire health system through changes in the organization and delivery of primary care. In this study, aspects of accessibility, comprehensiveness, longitudinality and technical quality of reformed versus unreformed care were assessed for respondents to a household interview survey conducted in the Basque Region of Spain in 1992. According to this study, aspects of care such as longitudinality and technical quality seemed improved with the reform, whereas other aspects such as accessibility and comprehensiveness remained unchanged. The authors conclude that system related characteristics (more associated with access and comprehensiveness) may be impeding the achievement of the goals of the reform and argue that attempts to encourage more autonomy of care delivery may be required. (C) 1997 Elsevier Science Ireland Ltd.