Design of primary health care

The study by Chan and others deals witht the problem of coordinating different "levels" of providers in the health system. This is one of the most complex challenges to tie the needs of patients with the capabilities of providers. Two extreme departures are systems of reference and counter-reference and the market. Each one has its own mechanisms to reduce or eliminate duplicate attentions, prevent hospitalizations, improve patient safety and reduce costs. Each has also shown its limitations, and each country has sought financial incentives to improve outcomes. One problem looming large is that in the absence of well-developed and standardized measures of care coordination it is not easy to link the conduct of doctors and hospitals with incentives. While there are expectations that electronic health records will support solutions, it will not be easy to identify the new forms of coordination, and not what has in the pre-digital era. For social insurance this is topic of central importance because it defines how to structure to primary health care and compensation to doctors and hospitals, as well as control how patients move or are moved within the health system.