Modelli di gestione dei servizi sanitari di base in una prospettiva di confronto tra sistemi sanitari europei: le peculiarità del caso spagnolo

Management models of primary care health services in a comparison among European health systems: the peculiarities of the Spanish case. Management models of primary care health services in a comparison among European health systems: the peculiarities of the Spanish case. The aim of this paper is to describe and compare European health systems with a special focus on the organization and articulation of the figure and role of the General Practitioner or primary care. Our interest stems from the existence of different models and the significant impact that they have on each system such as health investment, organizational patterns and hospital performance (i.e. the overload in emergency care due to a shortage of primary care network). Our description is limited to six European countries: United Kingdom, France, Germany, Italy, Denmark, and Spain. The United Kingdom, promoter of the Beveridge model in 1948, and then Denmark (1973), Italy (1978) and Spain (1986), have gradually moved from a social insurance system (Bismarck) to a universal system funded by taxation. In contrast, France and Germany have kept the Bismarck model, although France included the universal coverage for diseases in 2000. Other reasons why these countries were chosen for this comparative study are that the UK has served as the basis for the Italian system; France is considered to be the country with the best health care system; Germany is the country with the highest level of money invested in health; Spain has developed a very particular system of multidisciplinary primary health care team; and Denmark is characterized by the so-called flex-security welfare system lately identified as a possible model for reform in Italy. Finally, this paper focuses on the Spanish case as the most interesting model in primary care assistance.