Responsive access structures – changes of perspective and border shifts in primary care

The way in which citizens and patients gain access to healthcare is central. Who can they turn to if they have an acute health problem and need professional help? Where can they find answers to their questions and alleviate their suffering? Is this place easily accessible or are there organisational and financial barriers? How is the transition between (free) informal care and support from family caregivers and the (paid) services of health professionals organised? 

This interface, i.e. the first point of contact between users and the professional health system, is the subject of this report. It deals with the front line of primary care. This embraces outpatient structures in which health professionals provide paid services for a fee in primary care. This includes consultations on acute health issues, but also interventions in the long-term care of chronically ill patients.

The term primary care appears to be too narrow since it is rooted in a specific model of medical practice. For this reason, the term “responsive access structures” seem more adequate. It is intended to focus on the perspective of users who actively use professional service providers and structures.

The report summarises the results of a literature review on the subject of border shifts in primary care. The starting point was the assumption that priorities will change in the future: while the inpatient sector will become relatively less important as a result of health policy, medical progress and changes in patient behaviour, primary care services will become more important. The aim of the study was to provide an interpretation of changes needed in health system development. It clarifies concepts and terms to realign with potential models, user expectations, patterns of use and changes in supply through international comparisons. The aim is to anticipate the presumed developments in the Swiss health care system. It is assumed that in the course of globalisation and internationalisation of the health care markets, innovative foreign care models will certainly also find their way into Switzerland, and thus lead to new forms of primary care.