scholarly journals Budget-holding: The answer to Australian primary care reform?

1999 ◽  
Vol 22 (3) ◽  
pp. 78
Author(s):  
Paula Wilton ◽  
Richard D Smith
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Oecd Countries ◽  
Economic Cooperation ◽  
Managed Competition ◽  
Effective Strategy ◽  
Coordinated Care ◽  
Australian Health ◽  
Primary Care Reform

In common with other Organisation for Economic Cooperation and Development (OECD)countries, Australia is experiencing growth in expenditure on health care. However, while many other nations continue to pursue some variation of managed competition to address these problems, Australia has chosen a more incremental reform path, with initiatives such as the General Practice Strategy, restrictions in doctor supply and coordinated care trials. This article reviews the likely effectiveness of such initiatives in the light of experience and evidence of budget-holding in achieving similar objectives overseas. It concludes that budget-holding offers a more effective strategy than current 'piecemeal' reforms to contain costs and increase efficiency within Australian health care.

scholarly journals Tinkering at the margins: evaluating the pace and direction of primary care reform in Ontario, Canada

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Monica Aggarwal ◽  
A. Paul Williams
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Quantitative Methods ◽  
Audit And Feedback ◽  
Political Agenda ◽  
Care Providers ◽  
System Transformation ◽  
Primary Care Reform ◽  
Care Assessment

Abstract Background Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada’s most populous province. Methods Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario’s models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. Results There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario’s models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. Conclusions Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of “reform” and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.

Community Health and General Practice: The Impact of Different Cultures on the Integration of Primary Care

2001 ◽  
Vol 7 (1) ◽  
pp. 65 ◽  
Author(s):  
Hal Swerissen ◽  
Jenny Macmillan ◽  
Catuscia Biuso ◽  
Linda Tilgner
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Community Health ◽  
Community Health Centres ◽  
Care Services ◽  
Primary Health ◽  
Health Centres ◽  
The Relationship

This study examined the existing relationship between community health centres and General Practice Divisions in the State of Victoria, including the nature of joint working arrangements and the identification of barriers to greater collaboration. Improved integration of primary health care services has been advocated to improve consumer and population health outcomes and to reduce inappropriate use of acute and extended care services. General practitioners (GPs) and community health centres are two key providers of primary health care with potential for greater integration. The current study conducted telephone interviews with 20 community health centre CEOs and 18 Executive Officers of divisions, which were matched according to catchment boundaries. Results suggest, while some joint planning is occurring, especially on committees, working parties and projects, there is an overall low level of satisfaction with the relationship between community health centres and GPs and GP divisions. Major barriers to greater integration are the financial or business interests of GPs and misunderstanding and differences in perceived roles and ideology between GPs and community health centres. Improved communication, greater contact and referral and follow-up procedures are identified as a means of improving the relationship between GPs, GP divisions and community health centres. Community health centres and general practitioners (GPs) are key providers of primary care (Australian Community Health Association, 1990).

scholarly journals Improving Patient Care Through Workspace Renovation and Redesign: A Lean Approach

2020 ◽  
Vol 52 (6) ◽  
pp. 435-439
Author(s):  
Tommy Koonce ◽  
Dana Neutze
Keyword(s):  
Primary Care ◽  
Health Care ◽  
North Carolina ◽  
Physical Space ◽  
Effective Strategy ◽  
On Demand ◽  
The Us ◽  
The University ◽  
Improving Patient Care ◽  
Improve Patient

Background and Objectives: At a time when the US health care system needs greater access to comprehensive, on-demand primary care, the University of North Carolina Family Medicine Center found itself struggling to meet patient demands within the confines of an outdated facility. Clinic leadership sought to redesign the physical space to expand capacity, integrate other members of the care team, support extended hours of operation, and improve patient experience. Methods: Clinic leadership employed experienced lean coaches to train our entire department in lean methodology, to implement a comprehensive approach to redesigning our workflows, and to use those perfected workflows to redesign and renovate our new clinical workspace. Results: Upon completion of the renovation and redesign, the clinic experienced significant growth in patient volumes (24%) and unprecedented improvement in patient satisfaction (89th to 92nd percentile). Conclusions: Lean methodology proved to be an effective strategy for analyzing our current workflows and use of physical space. Moreover, lean strategies proved vital for redesigning and renovating our clinic.

scholarly journals Access to rural general practice and primary care: Time now for more equitable and sustainable solutions?

2004 ◽  
Vol 10 (3) ◽  
pp. 160
Author(s):  
Sam Heard
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Sustainable Solutions ◽  
Basic Service ◽  
Almost All

Australia has the resources to provide reasonable primary medical and health care to all of its population. It is a particularly worthwhile expense, with positive social and biophysical outcomes (Jarman et al., 1999; Starfield, 1998). In many aspects of health care, primary care provides most of the benefit and almost all of the value. Why, then, don?t we provide this basic service to all Australians?

scholarly journals Nursing in Australian general practice: directions and perspectives

2005 ◽  
Vol 29 (2) ◽  
pp. 156 ◽  
Author(s):  
Elizabeth J Halcomb ◽  
Patricia M Davidson ◽  
John P Daly ◽  
Rhonda Griffiths ◽  
Julie Yallop ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Policy Development ◽  
Health Care Services ◽  
Future Research ◽  
Australian Health ◽  
Care Services ◽  
Nurse Role ◽  
Australian General Practice ◽  
Role Of Nursing

Primary health care services, such as general practices, are the first point of contact for many Australian health care consumers. Until recently, the role of nursing in Australian primary care was poorly defined and described in the literature. Changes in policy and funding have given rise to an expansion of the nursing role in primary care. This paper provides a review of the literature and seeks to identify the barriers and facilitators to implementation of the practice nurse role in Australia and identifies strategic directions for future research and policy development.

scholarly journals Research and Survey on the Status of Hospital Graded Care System and its Related Industries

2021 ◽  
Vol 251 ◽  
pp. 01036
Author(s):  
Weijie Tang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Health Care Reform ◽  
Treatment System ◽  
Medical Reform ◽  
Medical Institutions ◽  
The Status ◽  
Different Levels ◽  
Medical Process

The graded treatment system refers to the gradation of diseases according to their priority and ease of treatment, with medical institutions at different levels undertaking the treatment of different diseases and gradually realizing the medical process from general practice to specialization. Since the “new medical reform”, China has been committed to promoting “primary care”, “two-way referral”, “separation of acute and slow treatment” The “new health care reform” has been implemented in China since the beginning of the reform. However, in the process of implementation, the effectiveness of the system has always been controversial due to the inadequate construction of primary medical institutions and the weak awareness of graded treatment among residents.

scholarly journals How to use interpreters in general practice: the development of a New Zealand toolkit

2012 ◽  
Vol 4 (1) ◽  
pp. 52 ◽  
Author(s):  
Ben Gray ◽  
Jo Hilder ◽  
Maria Stubbe
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
New Zealand ◽  
Limited English Proficiency ◽  
Ethical Behaviour ◽  
Patient Relations ◽  
Primary Care Practitioners ◽  
The Cost ◽  
Patient Resistance

BACKGROUND AND CONTEXT: New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. ASSESSMENT OF PROBLEM: The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behaviour) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. RESULTS: Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. STRATEGIES FOR IMPROVEMENT: We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. LESSONS: Primary care practitioners need understanding about when trained interpreters are required. KEYWORDS: Communication barriers; primary health care; New Zealand; quality of health care; professional–patient relations; cultural competency

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