Jens Holst and Markus Herrm
Abstract
The role and strength of primary health care (PHC) varies considerably between countries although it has been on the global health-policy agenda for almost three decades since the Conference of Alma-Ata in 1978. A rapid international overview suggests the hypothesis that state-run or tax-borne health system tend to face less difficulties to implement strong primary care compared to those where non-state actor play a more important or even predominant role. This paper aims at contributing to empirical evidence and system understanding of the underlying causes for countries’ difficulties to strengthen PHC. Germany is an example for a healthcare system with long tradition and universal coverage of quality health services that has not yet managed to strengthen PHC. For assessing the reasons why, the paper starts with a general overview of relevant features and the rather complex structure of stakeholders in the German healthcare system, including medical training. It follows an analysis of potential system obstacles on the way towards strengthening PHC and particularly towards reforming medical training in order to better prepare future physicians for general practice and rural health. Finally, the paper briefly presents an innovative approach launched by the medical faculty of Magdeburg for promoting the recruitment of rural health professionals and upcoming system obstacles.