The implementation and impact of different funding initiatives on access to multidisciplinary primary health care and policy implications

Abstract

Objective: To review the implementation and impact of different funding initiatives across the health systems of three different countries — England, New Zealand and Australia — on the achievement of multidisciplinary primary health care (PHC) and to reflect on policy implications for Australia. Methods: A systematic review of the literature involving three stages: (i) identification and description of initiatives; (ii) a systematic review of their implementation and impact from 1995 to mid 2006; and (iii) an updated review of published literature from mid 2006 to mid 2007. Results: Few studies employed control groups, and the results should therefore be interpreted with caution. In all three countries, funding has supported general practitioner access to a broad range of providers. In Australia, financial incentives have been the main mechanism for bringing about change, whereas in both England and New Zealand, they are part of a broader range of funding reforms including the introduction of capitation and practice‐based commissioning. The lack of patient data makes it difficult to assess the extent to which the Australian financial incentives have generally improved population access to a broader range of PHC providers. Conclusion: Individual, patient‐level, financial incentives may present significant impediments for population subgroups with complex needs. Alternative funding arrangements, such as capitation and contracting, could be more widely adopted in Australia to enhance access to care for vulnerable population groups without fundamentally changing the overall fee‐for‐service financing arrangements.

Bringing evidence to bear on policy processes: the challenge of the Australian Primary Health Care Research Institute

“… Chronic disease management ( Cranston et al, 6 Dennis et al 7 ); Integration, coordination and multidisciplinary care ( Jackson et al, 8 Mitchell et al, 9 Powell Davies et al 10 ); Innovative models for comprehensive primary health care delivery ( McDonald et al, 11 Naccarella et al, 12 Humphreys et al 13 ); Innovative models for the management of mental health in primary health care settings ( Griffiths and Christensen 14 ); Children and young Australians, health promotion and prevention ( McDonald et al, 15 Hearn et al 16 ); and Workforce (focus on competency‐based training) ( Glasgow et al 17 ). …”

Following the funding trail: Financing, nurses and teamwork in Australian general practice

“…A recent systematic review of the literature on funding incentives and multidisciplinary team care found only two published studies that used experimental or quasi-experimental design, with the remainder being descriptive studies; the authors were unable to find firm evidence on whether or not financial incentives of themselves improve health outcomes [17]. …”

Comprehensive Primary Health Care in Australia: findings from a narrative review of the literature

“…The most common definition sees primary health as a level of care provided at the first entry point to the health system by mainly General Practitioners and possibly some Nursing or Allied Health staff [8] . Others have broadened this definition to include first line services that move beyond individual treatment to incorporate measures that are preventative and have a population focus [9] . Systematic reviews using this definition of CPHC have been undertaken with a focus on accessibility, financing [9] and the various models delivered to Australians living in rural and remote areas [10;11] .…”

“…Others have broadened this definition to include first line services that move beyond individual treatment to incorporate measures that are preventative and have a population focus [9] . Systematic reviews using this definition of CPHC have been undertaken with a focus on accessibility, financing [9] and the various models delivered to Australians living in rural and remote areas [10;11] . However, this narrative review undertaken as part of the RHFA project is the first to examine CPHC across Australia as the approach outlined in Alma Ata [1] incorporating not only first line medical and allied health care with a range from treatment to prevention but also the other key elements of equity of access, collaboration across sectors beyond health and consumer and community empowerment and participation in the services.…”