Profiles of General Practice in Europe

Differences in the tasks and activities of general practitioners (GPs) do not only exist
between individual GPs but also, at a higher level, between countries. The diversity in... (More) Differences in the tasks and activities of general practitioners (GPs) do not only exist
between individual GPs but also, at a higher level, between countries. The diversity in
patterns of provision between individual GPs within a single health care system, is a wellstudied phenomenon (Wilkin and Smith, 1987; Knottnerus et al., 1990; Van de Lisdonk
and Schellevis, 1994; Delnoij and Spreeuwenberg, 1997). Variation at this level is related to individual characteristics of GPs, and the circumstances and population of the practice.
Sources of variation between countries lie in the features of the health care system, such as organisation and mode of financing and regulation (Anderson, 1963; Mechanic, 1972;
McPherson, 1981; Fleming, 1993; Gervas et al., 1994; Van den Brink-Muinen et al., 2000).
Precise information on international differences in the provision of tasks by GPs is scanty, however, and little is known about the possible influence of features of health care systems, as a consequence. The study reported in this book is an attempt to fill the need for information on the diversity in the provision of services in general practice. Task profiles, crisply typifying the GPs' supply of services, have been compiled in European countries, and the differences will be explained by relating them to relevant characteristics of the health care systems in these countries, taking individual features of GPs and their practices into
account.
The need for comparative information on primary care and general practice has been
fostered by developments in European health care systems during the late 1980s and the
1990s. Western European countries were confronted with sharply rising expenditure on
health care while, at the same time, the systems were experiencing difficulties in responding to the changing health care needs of the population (Saltman and Figueiras, 1997; McKee and Healy, 2002a). New needs for health care resulted from demographic, medicotechnological
and societal developments. A major change has been the growing prevalence
of chronic conditions resulting from the ageing of populations. The coordinative capacity of many health care systems was inadequate to enable the flexible involvement of various health care services and providers and to cope with demand for different long-term care arrangements. A coherent primary care system, with general practice as its integrative core, was thought to have the potential to improve cost-effectiveness as well as coordination and responsiveness (Starfield, 1996, 1998; Boerma and Fleming, 1998; Delnoij et al., 2000; Shi et al., 2002).
The situation in the countries of central and eastern Europe was even more urgent. Freed
from communism, they had no choice but to fundamentally restructure their extensive but
not very effective health care systems. As happened in other sectors, they looked to the
West for models of provision and financing of health care. Whichever models these countries chose, the choice implied a structure of health care with a firm base of primary care, including GPs in a more or less central role and a simultaneous reduction of the hospital sector (Goldstein et al., 1996; Marrée and Groenewegen, 1997; McKee et al.,
2002b). The results of the European Study on GP Task Profiles will show the state of affairs
in general practice in the transitional countries and the diversity in the position of GPs in Europe as it was in the years 1993/4.
The aim of this first chapter is to provide an introduction and background. The problem
and research questions of the study will be stated, the relevant influences on the activities of GPs described, and details given of the study design, instruments, methods, response and analysis. Chapters 2 to 9 contain articles that resulted from the study. The book will end with a summary of the results, a discussion and the implications for science, practice and policy. (Less)

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Upload Date:	03/10/2009
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