[health-vn] Toward international primary care reform

[Vern Weitzel]

Subject: 	[EQ] Toward international primary care reform
Date: 	Thu, 28 May 2009 09:08:47 -0400
From: 	Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at PAHO.ORG>
Reply-To: 	Equity, Health & Human Development <EQUIDAD at LISTSERV.PAHO.ORG>
To: 	EQUIDAD at LISTSERV.PAHO.ORG



     *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
<http://www.cmaj.ca/cgi/content/full/180/11/1091?etoc#R1-3#R1-3> In the
World Health^ Organization’s 2008 World Health Report, ^2
<http://www.cmaj.ca/cgi/content/full/180/11/1091?etoc#R2-3#R2-3> 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
<http://www.cmaj.ca/cgi/content/full/180/11/1091?etoc#R3-3#R3-3> …..”

*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
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R1-32#R1-32>
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
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R2-32#R2-32>
Canadians in rural areas^ face geographic barriers to care, fewer
available health care^ professionals than in urban areas and higher
rates of disease.^ 3
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R3-32#R3-32>

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
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R4-32#R4-32> and in
the Quality and Outcomes Framework in^ the United Kingdom. ^5
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R5-32#R5-32>
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
<http://www.cmaj.ca/cgi/content/full/cmaj;180/11/E72#R6-32#R6-32> ….”