Primary Care and Equity in Health: The Importance to Effectiveness and Equity of Responsiveness to Peoples' Needs

A consensus exists that health systems undergirded by primary health care principles achieve better health and greater equity in health than systems with a specialty care orientation. Primary Health Care (as a set of principles and policies) and Primary Care (as a set of clinical functions) are now sufficiently well understood to define their components and facilitate measurement and evaluation. A key component is recognition, by the health system and by clinical practitioners, of the health related needs and problems of populations and patients, respectively. While “patient-centered” is touted as an important goal, there is little agreement on what it is, how it should be achieved, or how it is related to population health services. This paper reviews evidence for the benefits of primary care-oriented health systems and shows how “patient-focus” and “problem recognition” are key to successful primary health care. I argue for focusing on meeting peoples' needs, as expressed by them, rather than by professionals, in their own terms. Several high-profile attempts to improve services appear to run counter to this principle, and deserve attention by those who would frame the health services reform debate only as an issue of access to disease-oriented technical quality of care.