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author = {Espinosa-González, AB and Delaney, BC and Marti, J and Darzi, A},
doi = {10.1016/j.healthpol.2020.11.008},
journal = {Health Policy},
pages = {168--176},
title = {The role of the state in financing and regulating primary care in Europe: a taxonomy},
url = {},
volume = {125},
year = {2021}

RIS format (EndNote, RefMan)

AB - Traditional health systems typologies were based on health system financing type, such as the well-known OECD typology. However, the number of dimensions captured in classifications increased to reflect health systems complexity. This study aims to develop a taxonomy of primary care (PC) systems based on the actors involved (state, societal and private) and mechanisms used in governance, financing and regulation, which conceptually represents the degree of decentralisation of functions. We use nonlinear canonical correlations analysis and agglomerative hierarchical clustering on data obtained from the European Observatory on Health Systems and Policy and informants from 24 WHO European Region countries. We obtain four clusters: 1) Bosnia Herzegovina, Czech Republic, Germany, Slovakia and Switzerland: corporatist and/or fragmented PC system, with state involvement in PC supply regulation, without gatekeeping; 2) Greece, Ireland, Israel, Malta, Sweden, and Ukraine: public and (re)centralised PC financing and regulation with private involvement, without gatekeeping; 3) Finland, Norway, Spain and United Kingdom: public financing and devolved regulation and organisation of PC, with gatekeeping; and 4) Bulgaria, Croatia, France, North Macedonia, Poland, Romania, Serbia, Slovenia and Turkey: public and deconcentrated with professional involvement in supply regulation, and gatekeeping. This taxonomy can serve as a framework for performance comparisons and a means to analyse the effect that different actors and levels of devolution or fragmentation of PC delivery may have in health outcomes.
AU - Espinosa-González,AB
AU - Delaney,BC
AU - Marti,J
AU - Darzi,A
DO - 10.1016/j.healthpol.2020.11.008
EP - 176
PY - 2021///
SN - 0168-8510
SP - 168
TI - The role of the state in financing and regulating primary care in Europe: a taxonomy
T2 - Health Policy
UR -
UR -
UR -
UR -
VL - 125
ER -