The Quality of Primary Care in a Country with Universal Health Care Coverage

  • Tinh-Hai Collet
  • Sophie Salamin
  • Lukas Zimmerli
  • Eve A. Kerr
  • Carole Clair
  • Michel Picard-Kossovsky
  • Eric Vittinghoff
  • Edouard Battegay
  • Jean-Michel Gaspoz
  • Jacques Cornuz
  • Nicolas Rodondi
Original Research



Standard indicators of quality of care have been developed in the United States. Limited information exists about quality of care in countries with universal health care coverage.


To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care coverage.


Retrospective cohort of a random sample of 1,002 patients aged 50–80 years followed for 2 years from all Swiss university primary care settings.


We used indicators derived from RAND’s Quality Assessment Tools. Each indicator was scored by dividing the number of episodes when recommended care was delivered by the number of times patients were eligible for indicators. Aggregate scores were calculated by taking into account the number of eligible patients for each indicator.


Overall, patients (44% women) received 69% of recommended preventive care, but rates differed by indicators. Indicators assessing annual blood pressure and weight measurements (both 95%) were more likely to be met than indicators assessing smoking cessation counseling (72%), breast (40%) and colon cancer screening (35%; all p < 0.001 for comparisons with blood pressure and weight measurements). Eighty-three percent of patients received the recommended care for cardiovascular risk factors, including >75% for hypertension, dyslipidemia and diabetes. However, foot examination was performed only in 50% of patients with diabetes. Prevention indicators were more likely to be met in men (72.2% vs 65.3% in women, p < 0.001) and patients <65 years (70.1% vs 68.0% in those ≥65 years, p = 0.047).


Using standardized tools, these adults received 69% of recommended preventive care and 83% of care for cardiovascular risk factors in Switzerland, a country with universal coverage. Prevention indicator rates were lower for women and the elderly, and for cancer screening. Our study helps pave the way for targeted quality improvement initiatives and broader assessment of health care in Continental Europe.


quality of health care insurance coverage primary health care primary prevention 



Research funding for the collection and analysis of these data was provided by an investigator-initiated unrestricted grant from Pfizer (Switzerland), but had no role in the study design, the choice of statistical analyses, or the preparation of the manuscript. Tinh-Hai Collet’s work was partially supported by a grant from the Swiss Heart Foundation. An oral presentation of preliminary results was given at the 32nd SGIM Annual Meeting, May 2009, Miami, FL, under the title “The quality of preventive care delivered to adults in European university primary care settings.”

Potential Conflicts of Interest

An investigator-initiated grant from Pfizer (Switzerland) was provided only for data collection and analysis, but had no role in the study design, the choice of statistical analyses, or the preparation of the manuscript.

Supplementary material

11606_2011_1674_MOESM1_ESM.pdf (308 kb)
ESM 1PDF 308 kb


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Tinh-Hai Collet
    • 1
  • Sophie Salamin
    • 1
  • Lukas Zimmerli
    • 2
    • 3
  • Eve A. Kerr
    • 4
  • Carole Clair
    • 1
  • Michel Picard-Kossovsky
    • 5
  • Eric Vittinghoff
    • 6
  • Edouard Battegay
    • 2
    • 3
  • Jean-Michel Gaspoz
    • 5
  • Jacques Cornuz
    • 1
  • Nicolas Rodondi
    • 1
  1. 1.Department of Ambulatory Care and Community MedicineUniversity of LausanneLausanneSwitzerland
  2. 2.Division of Internal MedicineUniversity Hospital of ZurichZurichSwitzerland
  3. 3.Medical Outpatient Department/Ambulatory Internal MedicineUniversity Hospital BaselBaselSwitzerland
  4. 4.Veterans Affairs Center for Clinical Management Research, HSR&D Center of Excellence; Department of Internal MedicineUniversity of MichiganAnn ArborUSA
  5. 5.Department of Community Medicine and Primary CareUniversity Hospitals of Geneva, and Faculty of MedicineGenevaSwitzerland
  6. 6.Department of Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoUSA

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