Towards Comprehensive Health Care Systems for Latin America

Abstract

In Latin American countries there are misgivings regarding the so-called “primary care” for health, even though in many of them the essential resources for its implementation are available and, also, in spite of a considerable measure of agreement concerning the comprehensive or integral model of health care to be provided by the national public health care systems. It is generally acknowledged that front-line care should not be regarded as second class care nor as a separate segment of the health sector, essentially different from the hospital component. Neither should the doctors working in the front-line be considered as a different kind of doc- tors. The clinical effectiveness of “primary care”, about which there are complaints in almost all countries, can be improved by using several methods: one of these is to include in the front-line clinics a limited proportion of specialists or –even better – of specialists in training. Opinions from several countries and a relevant project implemented in Chile are contributions that throw light on that particular proposal. This and other relevant methods should strengthen the synergy between the front line and the hospitals and reduce the waiting times endured by such front-line patients as are referred for consultation by specialists or for in-patient treatment. Such concepts as care system, public health, medical professionalism, team work; and such practices as health services research, planning, clinical management and epidemiology, are indispensable tools for improving quality in the implementation of the model of comprehensive health care in all components of the system and particularly in the front-line clinics.