Over a span of four years we studied the number and type of patient contacts with the off-hour emergency service in a municipality in Western Norway. At the start of the period, the service was organised by each municipality, later more municipalities formed a regional service. At the end of the period, a list patient system was introduced.
All contacts from patients as well as activities performed by general practitioners on off-hour emergency duty were registered in four separate periods, from 1999 to 2002.
Simultaneously with shift from a local to a regional system, the proportion of home calls fell from 18% to less than 1%. The implementation of a list patient system combined with a regional system reduced the total number of contacts by 30%. Public expenditure was reduced by 66%.
The combination of a regional off-hour service and a list patient system gives an efficient organisation. The total work-load for doctors is significantly reduced and the quality of medical services improve; financial considerations also support a shift in off-hour emergency service towards regional organisation.
Despite of an insignificant track record of quasi-market models in Sweden, new models of this kind have recently been introduced in health care; commonly referred to as "choice of care". This time citizens act as purchasers; choosing the primary care centre or family physician they want to be treated by, which, in turn, generates a capitation payment to the chosen unit. Policy makers believe that such systems will be self-remedial, that is, as a result of competition the strong providers survive while unprofitable ones will be eliminated. Because of negative consequences of the fragmented health care delivery, policy makers at the same time also promote different forms of integrated health care arrangements. One example is "local health care", which could be described as an upgraded community-oriented primary care, supported by adaptable hospital services, fitting the needs of a local population. This article reviews if it is possible to combine this kind of integrated care system with a competition driven model of governance, or if they are incompatible. The findings indicate that some choice of care schemes could hamper the development of integration in local health care. However, geographical monopolies like local health care, enclosed in a non-competitive context, lack the stimulus of competition that possibly improves performance. Thus, it could be argued that if choice of care and local health care should be combined, patients ought to choose between integrated health care arrangements and not among individual health professionals.
The success of health policy initiatives can be strongly influenced by the political, social, and cultural context within which a health care system operates. This study explores the similarities and differences in the background context of the four countries considered in this supplement: Sweden, the United Kingdom, Germany, and the United States. It concludes that there are considerable differences in the background context among these four countries, which help to explain their differing structural and organizational approaches to issues of pharmaceutical and home care policy.
This paper describes the direction of health reform taking place in Saskatchewan. The rationale underlying the shift to a needs-driven, outcome-oriented, locally controlled health system is discussed. This shift is in concert with nationally recognized directions in improving health status, maintaining standards, ensuring a more cost-effective system, and providing a continuum of services characterized by a shift from institutional to community-based services, health-related public policy and health promotion. Included is a discussion of the process of change and some of the elements of the newly constituted delivery system, such as district boards, needs assessment, core services, and provincial components such as the Health Services Utilization Review Commission and the Provincial Health Council. Some implications for issues such as stroke prevention are noted.
To use industrial organisation and organisational ecology research methods to survey industry structures and performance in the markets for private dental services and the effect of competition.
Data on practice characteristics, performance, and perceived competition were collected from full-time private dentists (n = 1,121) using a questionnaire. The response rate was 59.6%. Cluster analysis was used to identify practice type based on service differentiation and process integration variables formulated from the questionnaire.
Four strategic groups were identified in the Finnish markets: Solo practices formed one distinct group and group practices were classified into three clusters Integrated practices, Small practices, and Loosely integrated practices. Statistically significant differences were found in performance and perceived competitiveness between the groups. Integrated practices with the highest level of process integration and service differentiation performed better than solo and small practices. Moreover, loosely integrated and small practices outperformed solo practises. Competitive intensity was highest among small practices which had a low level of service differentiation and was above average among solo practises.
Private dental care providers that had differentiated their services from public services and that had a high number of integrated service production processes enjoyed higher performance and less competitive pressures than those who had not.
The healthcare system in Canada is undergoing significant transformation in response to three major interrelated pressures: the overall burden of illness is rising, patients are getting poor quality of care and healthcare costs are inexorably rising. One idea to guide this change is to transform the primary care system into a community-based primary healthcare (CBPH) system. This paper discusses, in particular, the readiness of public health to participate in the transformation to a CBPH system.
Is the quality of primary healthcare services influenced by the healthcare centre's type of ownership?-An observational study of patient perceived quality, prescription rates and follow-up routines in privately and publicly owned primary care centres.
Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary healthcare services.
In this retrospective observational study (April 2011 to January 2014) the patient perceived quality, the use of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases were analysed for all primary care centres in Region Västra Götaland. The outcome measures were compared on a group level between privately owned (n?=?86) and publicly owned (n?=?114) primary care centres (PCC).
In comparison with the group of publicly owned PCCs, the group of privately owned PCCs were characterized by: a smaller, but continuously growing share of the population served (from 32 to 36%); smaller PCC population sizes (avg. 5932 vs. 9432 individuals); a higher fraction of PCCs located in urban areas (57% vs 35%); a higher fraction of listed citizens in working age (62% vs. 56%) and belonging to the second most affluent socioeconomic quintile (26% vs. 14%); higher perceived patient quality (82.4 vs. 79.6 points); higher use of antibiotics (6.0 vs. 5.1 prescriptions per 100 individuals in a quarter); lower use of benzodiazepines (DDD per 100 patients/month) for 20-74 year olds (278 vs. 306) and >74 year olds (1744 vs.1791); lower rates for follow-ups of chronic diseases (71.2% vs 74.6%). While antibiotic use decreased, the use of benzodiazepines increased for both groups over time.
The findings of this study cannot unambiguously answer the question of whether or not the quality is influenced by the healthcare centre's type of ownership. It can be questioned whether the reform created conditions that encouraged quality improvements. Tendencies of an (unintended) unequal distribution of the population between the two groups with disparities in age, socio-economy and geography might lead to unpredictable effects. Further studies are necessary for evidence-informed policy-making.
Cites: Scand J Prim Health Care. 2011 Jun;29(2):104-921413840
Cites: Health Econ Policy Law. 2011 Oct;6(4):549-6920701829
Cites: Health Policy. 2011 Nov;103(1):31-721703712
Following decades of stagnation, potentially transformative changes in primary healthcare are proceeding in several Canadian provinces. These changes - primarily collaborative and interdisciplinary models of care delivery and quality improvement programs - have been impelled by an improved fiscal climate, increased federal transfers (some earmarked for primary healthcare), pressure generated by the recommendations of the Romanow Commission and the Kirby Committee and growing political and public concern about healthcare access and quality. Transformation has begun, but much remains to be done to address Canada's poor primary healthcare performance relative to other wealthy industrialized countries. Processes are needed at the regional and provincial levels to collectively engage the full range of key stakeholders in providing policy advice and informing the articulation of clear policy direction for primary healthcare. Critical areas for investment include integrated health information systems, quality improvement processes, interdisciplinary primary healthcare teams and group practices, and systematic evaluation of primary healthcare innovations and ongoing system performance.