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The Crisis in Primary Care: A Diagnosis and Proposals for Change

Maria Jose Gonzalez

May 24, 2023 | 9:30 a.m.

La primary care (PC), an essential pillar of our health system, faces a crisis that is vital to address. Recent data indicates a progressive deterioration in several key indicators, reflecting a system under pressure and stress.

The Primary Care Thermometer

The data paints an alarming picture: the citizen evaluation of PC services has fallen from 7,38 to 6,19 in the last decade, according to the CIS Health Barometer. He wait time for an appointment with a family doctor has doubled since 2017, with a notable impact on the use of emergency services. In addition, professionals point out that the assigned budget the AP does not allow it to offer a quality service.

These data suggest an untenable situation. It is necessary to understand why this crisis is taking place and, above all, how can we remedy it.

Why the pressure on Primary Care?

Examining the data by autonomous community, we see that the regions with the highest pressure are Murcia, Melilla and the Community of Madrid, while Catalonia, Aragon and Castilla y León show lower pressure. The intra-regional variation is also notable, with health areas in the same autonomous community experiencing different levels of pressure.

We identified several socioeconomic and demographic factors that correlate with pressure of care. The health areas with lower income, higher unemployment rates, more population and fewer doctors per capita are under greater pressure. At the local level, a 1% increase in GDP per capita is correlated with a 0,5% increase in the percentage of the population with private health insurance coverage.

In addition, in places like the Community of Madrid, the most pressured centers tend to show worse health indicators. Thus, 1% more pressure on care is related to 0,11% to 0,16% fewer patients with good control of diabetes and hypertension.

Proposals to Relieve the Pressure

In view of these challenges, we propose six concrete measures to relieve the pressure on Primary Care:

  1. Economic and career incentives For professionals who work in positions of difficult coverage and performance.
  2. Reduce temporary in PC hiring to guarantee continuity in the relationship between patient and doctor.
  3. redistribute demand within the Health Areas taking into account criteria such as healthcare pressure.
  4. Redistribute the load between professionals to, for example, reduce the bureaucratic burden on health personnel.
  5. full digitization to share the clinical history of patients between all areas of the health system.
  6. Sufficient and transversal training in Family and Community Medicine at all medical universities.

With the implementation of these proposals, we believe that we can take significant steps to reverse the deterioration of Primary Care in Spain and guarantee a quality service for all citizens, as indicated by ESADE.

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