Implementing Primary Care Reform: Barriers and Facilitators

K.V. Nagarajan is a professor in the Department of Economics at
Laurentian University.

This book, a collection of papers that were presented at a conference in
Kingston, Ontario, in November 2003, marks out the terrain of primary
care reform. We learn about primary care reform efforts in the United
Kingdom and New Zealand—efforts that help put Canadian initiatives
into perspective.

The book makes clear the reasons for the slow pace of reform. Almost at
every turn, there are ambiguities, uncertainties, and politics. There is
no accepted definition of primary care, nor is there any consensus on
what constitutes reform. The evidence in support of positive benefits
from reform is also not strong. Furthermore, the course of many reform
measures depends on the whims of party politics. In short, neither the
problem nor the solution can be clearly marked out.

In the summing up at the end of the book, Barbara Starfield makes a
persuasive case that primary care promotes equity and is needed to
better coordinate patient care, especially for those with
co-morbidities. She may be exaggerating when she writes that “the
world stands on the cusp of a revolution in health services delivery,”
but primary care is certainly evolving and changing. This book, however,
does not provide a road map for primary care reform.