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The impact of the financial crisis on the quality of care in primary care: an issue that requires prompt attention.

Health systems have transitioned, over the past few decades, from an era of expansion to an era of costcontainment and, more recently, an era of outcomes. Scarce resources and an ever-increasing number of healthcare innovations have resulted in the introduction of evaluation methods and mechanisms to prioritise the adoption of more effective interventions for achieving the desired outcomes. For primary care outcomes, it is more relevant to assess effectiveness jointly with quality. To that effect, the Institute of Medicine (IOM) has defined quality as ‘the degree to which health care services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge’. This emphasised the central role of the patient and expanded upon the notion of desirable outcomes two decades later: