ArticleFrontiers in health services2026
Understanding functional diversity in public primary health care: a cluster analysis of utilization patterns.
Article in Frontiers in health services, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Primary health care (PHC) systems are typically organized using uniform administrative models that assume functional similarity across facilities. In practice, however, PHC units differ substantially in how services are delivered. In Greece, despite ongoing reforms, empirical evidence on the functional heterogeneity of public PHC units remains limited. This study aims to classify PHC units based on observed service utilization patterns and to identify the organizational and geographical determinants shaping these functional typologies. Methods: This cross-sectional study analyzed administrative data from 649 public PHC units in Greece (2024). Visit compositions (regular, emergency, prescription, and other) were analyzed using compositional data analysis with centered log-ratio transformation. K-means clustering was applied to identify utilization-based functional typologies. Associations between cluster membership and unit characteristics (size, organizational type, and geography) were examined using ANOVA and chi-square tests. Results: Three distinct functional typologies emerged. Cluster 1 ("balanced, generalist units", Conclusion: PHC is functionally heterogeneous, with distinct utilization profiles that are not captured by existing administrative classifications. These findings reveal a structural misalignment between formal organizational labels and actual service delivery. A utilization-based typology provides a practical tool for health policy and management, supporting more targeted approaches to resource allocation, workforce planning, and regional service design. Incorporating functional differentiation into PHC governance can enhance efficiency, equity, and system responsiveness.
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