Building primary health care systems: a case study from Sweden

Health policy planners have discussed for some years how to transform existing hospital-based health delivery systems into primary-care-driven systems. Although this policy goal has been adopted in a number of western European nations, the actual process of implementing such a major change has proven stubborn and complex. In particular, efforts to transfer existing resources out of the hospital sector for use in building primary care activities have proven difficult. This paper examines the effort to design and implement a primary health care strategy in Sweden. It is divided into two segments. The first section sketches the broad health system context within which the Swedish primary care effort is being conducted. The second section focuses directly on Sweden's primary care strategy, detailing both its conceptual foundation and the organizational obstacles that have impeded the policy's implementation. This discussion is punctuated with findings from a 1981 survey of county council administrators' attitudes toward this primary care strategy. The paper concludes with a short discussion of several alternative organizational approaches that might speed the development of a primary-care-driven health system.