Strong primary care and patients' survival

Sci Rep. 2019 Jul 26;9(1):10859. doi: 10.1038/s41598-019-47344-9.


Primary healthcare is the cornerstone of any healthcare system. A major health system reform to strengthen primary care has been implemented in Germany since 2008. Key components include: voluntary participation, intensive management of patients with chronic diseases, coordination of access to medical specialists, continuous quality improvement, and capitation-based reimbursement. The objective of this study was to assess the effect of this reform on survival of enrolled patients. We conducted a comparative cohorts study with 5-year follow-up, starting in the year 2012 in Baden-Wuerttemberg, Germany. Participants were 1,003,336 enrolled patients and 725,310 control patients. A Cox proportional hazards regression model was applied to compare survival of enrolled patients with a composed control cohort of non-enrolled patients, adjusted for a range of patient and physician characteristics. Average age of enrolled patients was 57.3 years and 56.1% were women. Compared to control patients, they had lower mortality (Hazard Ratio: 0.978; 95% CI: 0.968; 0.989). Participation in chronic disease management programs had independent impact on survival rate (Hazard Ratio 0.744, 95% CI: 0.734; 0.753). We concluded that strong primary care is safe and potentially beneficial in terms of patients' survival.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Chronic Disease / mortality*
  • Female
  • Follow-Up Studies
  • Germany
  • Health Services Accessibility*
  • Humans
  • Insurance, Health, Reimbursement
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Primary Health Care*
  • Quality Improvement
  • Survival Rate