Table 1.

Primary Care System Score Components

Component	Indicator	Rationale	Scoring
Regulation	Do specific national policies exist that regulate the distribution of primary care providers and facilities?	These policies are intended to improve equity in distribution of primary care services.	0=no overall primary care regulation
			1=limited (only some regions or populations)
			2=entire system regulated
Financing	What is the method of financing health care for the majority of the population?	Scored by level of progressivity, tax-based systems considered most progressive.	0=primarily private
			1=social security
			2=primarily tax-based
Primary care provider	What is the predominant type ofprimary care provider?	Generalists (general practitioners, family doctors) considered best providers of primary care.	0=majority are specialists1=majority are pediatricians, internists
			2=majority are generalists
Access	What is the level of cost-sharing for	High primary care copays areaccess.	0=high copay
	primary care visits?	considered to be a barrier to	1=moderate
			2=none or very low
Longitudinality	Are individual patient lists required	Patient lists considered optimal way	0=never required
	for all primary care units?	to track patients over time.	1=limited use (or group lists only)
			2=mandatory and ubiquitous
First contact	Is there a requirement that primary care practitioners serve as gatekeepers to other levels of care?	First contact is an essential if primary care is to attend to the majority of health problems.	0=never required
			1=required but not enforced or required for limited population only
			2=always required
Comprehensiveness	Is a full range of primary care services and procedures available for all age groups?	Specific list of services includes: prevention, mental health, minor surgery, and routine obstetric care.	0=not comprehensive (some ser-vices offered only in specialty care)
			1=somewhat (all offered but not in every primary care unit)
			2=comprehensive (all offered in most locations)
Coordination	Are guidelines for the transfer ofinformation between primary care and other levels available and required?	Data transfer (either through electronic means or through client-held records) is essential for coordinating care between levels.	0=no guidelines present1=guidelines present but not widely used
			2=guidelines present and required
Family-centered	Is there a requirement that client records be organized by family as opposed to by individual?	Indicator that primary care considers patient's family environment indiagnosis and treatment.	0=never required
			1=required for only some regions or populations
			2=generally required
Community-oriented	Is there a policy that requires use of community-based data and/or presence of community members in primary care management or priority-setting?	Primary care is more effective when it treats patients in their larger social context.	0=never required1=required for limited population only2=generally required

Source: Adapted from Starfield and Shi 2002; Starfield 1998.