Contribution of primary care to health systems and health

Barbara Starfield, Leiyu Shi, James Macinko

Research output: Contribution to journalReview articlepeer-review


Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.

Original languageEnglish (US)
Pages (from-to)457-502
Number of pages46
JournalMilbank Quarterly
Issue number3
StatePublished - 2005


  • Health outcomes
  • Population health
  • Primary care

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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