Resumen

VAN DER STUYFT, Patrick  y  DE VOS, Pol. The relationship among the various care levels is a key health determinant. Rev Cubana Salud Pública [online]. 2008, vol.34, n.4. ISSN 0864-3466.

On the basis of concrete examples of health systems, several elements and arguments are added to the international debate about the importance of health care levels and their optimal interrelationship. The first level has three main functions: being the entry point to the system, facilitating and coordinating the itinerary of a patient within the system, and guarantee the integration and summary of health information on each patient. By describing the various obstacles and possible problems, mainly the commercial logics that is being introduced in many systems, the authors defined points of attention and suggested adjustments to assure universal access, equity, efficiency and efficacy, and sustainability of a health care system.

Palabras clave : Health service organization; health levels; functions of the primary care level; accessibility; quality; efficacy; efficiency; health determinants; public health.