To the Editor.
—In a recent issue of JAMA, Starfield1 concludes that the development of a nation's primary care sector is related to the health of its population. Her analysis compares seven Western nations in terms of (1) an unvalidated composite measure of primary care emphasis within each country (primary care score); (2) the ratio of popular satisfaction with a nation's health system to its per capita health expenditures (satisfaction-expense index); and (3) 12 relatively standard indicators of health in each country, such as neonatal and infant mortality, life expectancy at ages 1, 20, and 65 years, age-adjusted death rate, and the like (health indicator status). The data presented are said to show that greater emphasis on primary care is associated with higher health indicator status and health satisfaction. That the nation with the highest primary care score (the United Kingdom) had the lowest health indicator status and satisfaction-expense
Gorman PN, Martinez MG. Primary Care and Health: A Cross-National Comparison. JAMA. 1992;268(15):2032. doi:10.1001/jama.1992.03490150084022