Primary health care and family medicine at the core of health care: challenges and priorities in how to further strengthen their potential

SUMMARY This paper analyses the paradigm shift from the disease to the person with the disease against the background of the changes of health systems toward primary health care. The structural changes from hospital to the community and the specialist to the generalist approach are essential to enable this different approach. As a consequence, any assessment of health status, risks, and needs starts with an engagement with an individual. This engagement is the basis from which diagnostic, preventive, and therapeutic interventions are planned, over time, in the continuous working relation primary health care entertains with individuals and populations. Key to the functioning of primary health care is an ongoing renewal or actualization of this working relation, in this paper referred to as the “initial estimate,” that makes it possible to direct resources to those in highest need and at the same time makes it possible to exempt from costly and risky interventions those who have little to gain from it. This “initial estimate” is a major determinant of cost-effective and efficient healthcare, but there is hardly any insight into the process of how professionals in primary health care come to estimate individuals’ risk. This in turn presents a number of challenges and priorities for primary health care research: