Table 1.

The Finnish and Dutch primary care systems

	Finland	The Netherlands
Organisation	Primary care is delivered through public healthcare centres and through occupational health facilities.37–39 Companies offer occupational health facilities to their employees, including both preventive and curative health services, delivered through semiprivate healthcare centres that work with nurses in a similar fashion to the public centres.	General practices or small healthcare centres. In most general practices, continuity of care is ensured by allocating the patient to one (GP).
Main focus	Primary care has a strong position and important gatekeeper function. Health promotion and disease prevention have been the main focus of healthcare policy for decades.	Access to care for everyone and solidarity through medical insurance.40 41 GPs are gatekeepers of the healthcare system and provide acute, chronic and preventive care.
Accessibility	Often, healthcare centres cover large geographical areas that are sparsely populated and often have staff shortages, contributing to long waiting lists and lack of personal continuity of care. Due to these waiting lists, many employees go to their occupational health service instead.	Since the Netherlands is densely populated, people often live within a short distance of their general practice. Access to GPs is efficient; there are no waiting lists.42
Role of primary care nurses	Important position: nurses work in close collaboration with GPs and have their own consulting hours to assess patients. Regarding cardiovascular prevention, they monitor patients with diabetes, hypertension and dyslipidaemia, as described in national guidelines.43–45	Important position: for several decades, GPs have delegated tasks to practice nurses in chronic disease management. Currently, nurses provide a substantial part of cardiovascular risk management care, including diabetes care, following regional and national guidelines and work descriptions.9 46–48
Patient autonomy and eHealth culture to date	The first European country to introduce a law (in 1993) defining the patient’s right to access to all medical information and the right to autonomy (patient’s informed consent for any medical treatment). All healthcare centres use electronic medical records. A national patient data repository is under development to provide patients complete access to their own electronic medical record.49	Informed consent is ensured by law, but in daily practice, consent is often assumed and only explicitly discussed when treatment options can have far-reaching consequences.41 Almost all GPs use electronic medical records. Patients have the right to inspect their medical records, but do not have complete access to them.

GP, general practitioner.