Achieving higher performing primary care through patient registration: A review of twelve high-income countries

Gregory P. Marchildon*, Shuli Brammli-Greenberg, Mark Dayan, Antonio Giulio De Belvis, Coralie Gandré, David Isaksson, Madelon Kroneman, Stefan Neuner-Jehle, Ingrid Sperre Saunes, Steven Thomas, Karsten Vrangbæk, Wilm Quentin

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


Background: Patient registration with a primary care providers supports continuity in the patient-provider relationship. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of countries; and identifies challenges and ongoing reform efforts. Methods: 12 jurisdictions (Denmark, France, Germany, Ireland, Israel, Italy, Netherlands, Norway, Ontario [Canada], Sweden, Switzerland, United Kingdom) were selected for analysis. Information was collected by national researchers who reviewed relevant literature and policy documents to report on the establishment and evolution of patient registration, the requirements and benefits for patients, providers and payers, and its connection to primary care reforms. Results: Patient registration emerged as part of major macro-level health reforms linked to the introduction of universal health coverage. Recent reforms introduced registration with the aim of improving quality through better coordination and efficiency through reductions in unnecessary referrals. Patient registration is mandatory only in three countries. Several countries achieve high levels of registration by using strong incentives for patients and physicians (capitation payments). Conclusion: Patient registration means different things in different countries and policy-makers and researchers need to take into consideration: the history and characteristics of the registration system; the use of incentives for patients and providers; and the potential for more explicit use of patient-provider agreements as a policy to achieve more timely, appropriate, continuous and integrated care.

Original languageAmerican English
Pages (from-to)1507-1516
Number of pages10
JournalHealth Policy
Issue number12
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021 Elsevier B.V.


  • Patient enrollment
  • Patient registration
  • Patient rostering
  • Patient-provider agreements
  • Physician gate-keeping
  • Primary care reform


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