Corregir las desigualdades sociales en salud: la reforma de la atención primaria como estrategia.

OBJECTIVES: To evaluate the impact of a policy to define priorities for the reform of primary health care services among small areas according to health and social indicators. DESIGN: Qualitative study of the changes in the provision of primary health care services after a priority setting exercise based in social and a health indicators. SETTING: The city of Barcelona (Catalonia, Spain). PARTICIPANTS: The 66 basic health areas in which the city is divided for health care planning. INTERVENTION: Areas are ranked according to their health and social indicators, giving greater priority to those areas with unfavorable indicators for the development of the reform of primary health care services and a associated allocation of resources. RESULTS: Although at first new investments were determined by preexisting processes based in opportunity criteria, clear changes are observed. Three years after, there are improvements in the provision for services in all priority areas, or they are in the midst of change. CONCLUSIONS: In a context of tightening resources and of resistance to change, it is possible to introduce objective criteria to set priorities to improve primary health care services selectively in areas with most unfavorable indicators. This process has the capacity to overrun obstacles and resistances.