[EQ] Toward international primary care reform

Toward international primary care reform
Barbara Starfield, University Distinguished Professor, Johns Hopkins University, Baltimore, Maryland, USA.
CMAJ • May 26, 2009; 180 (11). doi:10.1503/cmaj.090542.
Available online at: http://www.cmaj.ca/cgi/content/full/180/11/1091?etoc
“….Primary care reform is now a worldwide imperative. National health care systems with strong primary care infrastructures have healthier populations, fewer health-related disparities and lower overall costs for health care. 1 In the World Health Organization’s 2008 World Health Report, 2 all countries were encouraged to orient their health care systems toward strengthened primary care. Such reforms are unlikely to improve overall population health, equalize distribution of health care resources or reduce costs unless they address both the systemic and clinical characteristics of primary care. 3 …..”
Related paper:

Research

Capitation and enhanced fee-for-service models for primary care reform: a population-based evaluation

Richard H. Glazier, Julie Klein-Geltink, Alexander Kopp, and Lyn M. Sibley
From the Institute for Clinical Evaluative Sciences (Glazier, Klein-Geltink, Kopp, Sibley), Toronto, Ont., St. Michael’s Hospital Centre for Research on Inner City Health (Glazier), Toronto, Ont., the Department of Family and Community Medicine and the Dalla Lana School of Public Health (Glazier), University of Toronto, Toronto, Ont.
CMAJ • May 26, 2009; 180 (11). doi:10.1503/cmaj.081316.

Available online at: http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72

‘…….Primary health care is facing a number of serious challenges internationally, with questions being raised about whether it will even survive in some settings. 1 Fundamental issues include shortages in human resources and maldistribution of physicians; dissatisfaction on the part of providers and patients; gaps between guideline-recommended care and provided care; and a preference of trainees to choose specialty careers. Close to 4 million Canadians do not have a family physician, and more than 2 million report difficulties in accessing routine or ongoing care at any time of day as well as immediate care for minor health problems at any time of day. 2 Canadians in rural areas face geographic barriers to care, fewer available health care professionals than in urban areas and higher rates of disease. 3
In response to these challenges, policy-makers in Canada and elsewhere are considering or are implementing interdisciplinary teams, new organizational structures, new governance and reimbursement models, requirements for after-hours care, provision of after-hours advice by telephone, electronic health records and other information technology, and pay-for-performance initiatives. Many of these directions are incorporated in the Medical Home concept in the United States 4 and in the Quality and Outcomes Framework in the United Kingdom. 5 Although there is evidence for the effectiveness of some of these initiatives, most have not been rigorously evaluated. Reimbursement models, perhaps the best-studied aspect of primary care reform, seem to influence some aspects of physician behaviour. However, there is a lack of evidence about their ultimate impact on patient outcomes. 6 ….”

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