Australia is not the only country with a health system under pressure from rising health care costs and increasing demand from a growing and ageing population. A spate of recent research and policy papers from Europe shows that this part of the world is debating many of the same issues that confront governments, policy makers and health service managers here. For those interested in how these issues are playing out overseas, the following provides links and some key extracts from recent research and relevant reports on the primary health care debate in Europe.
The EXPH (EXpert Panel on effective ways of investing in Health), is an independent expert panel set up by the European Commission. On July 10 2014 it released its Report on Definition of a frame of reference in relation to primary care with a special emphasis on financing systems and referral systems. In this report the EXPH argued strongly for a primary-care system that is “universally accessible, integrated, person-centred, comprehensive…and provided by a team of professionals accountable for addressing a large majority of personal health needs”. The following is a key passage from the Report:
The scientific evidence base that strong primary care contributes to improved health system performance has significantly increased over time….The most recent study (Kringos et al 2013a), performed across 31 European countries, looked at the ‘strength’ of primary care. Countries are commonly considered to have a strong primary care system when the key functions of primary care are well developed, and they are supported by essential conditions….. The study showed that at the present time, strong primary care is associated with better population health, lower rates of unnecessary hospitalizations and relatively lower socioeconomic inequality in self perceived health…. The study also showed that countries with a relatively strong primary care structure have higher total health care expenditures than countries with a relatively weak primary care system. However, countries with more comprehensive primary care had a slower growth in health care spending, compared with countries that provided less comprehensive services.
The EXPH was heavily influenced by the research referred to above (Kringos et al 2013a), which involved collecting and analysing comparative primary care data collected in 2009–10 as part of a European Union– funded project, the Primary Health Care Activity Monitor for Europe. The following paragraph summarises the main findings of this research:
Our analysis showed that strong primary care was associated with better population health; lower rates of unnecessary hospitalizations; and relatively lower socioeconomic inequality, as measured by an indicator linking education levels to self-rated health. Overall health expenditures were higher in countries with stronger primary care structures, perhaps because maintaining strong primary care structures is costly and promotes developments such as decentralization of services delivery.
Building on these research findings, an advocacy group for community pharmacy in the UK, Pharmacy Voice, has developed a policy paper on primary health care ‘We are Primary Care’, in conjunction with key primary health care stakeholders. The paper sets out an agenda for primary health care that involves breaking down current funding and professional silos between primary, hospital and aged care and between medical and non-medical disciplines. The paper has a strong focus on consumer-led care pathways and on the need to integrate population health and preventive health policies and programs with the provision of primary health care. The four key principles outlined in the document for the provision of primary health care are as follows:
If the NHS is to be sustainable as a high quality service that is free at the point of need, we need to think differently about how health and social care is funded and delivered. Four driving principles must come into play:
• self care;
• care outside hospital;
• professional collaboration around improved patient pathways;
• preventing illness by tackling public health issues such as smoking and obesity.
All require extended and reshaped models of primary care delivery and funding to support them.
Finally, in commenting on the state of the primary health care debate, a strongly worded editorial in The Lancet calls on primary health care leaders to drive major and systemic changes to place primary health care in the centre of the health system, as follows:
The boundaries between primary and secondary care need to be rethought. Specialists working in hospitals should provide advice, teaching, and specialised patient care within the primary-care setting, to the benefit of patients who will not have to wait for, and travel to, oversubscribed hospital outpatient appointments. For children and the elderly, it would be excellent if all primary care centres had paediatricians and geriatricians to deliver appropriate care. Hospital-based clinics should be reserved for those with rare and complex diseases that need special expertise and equipment for management and diagnosis…….. Primary care needs to be reshaped to truly function as the most important pillar for people-centred health and wellbeing in the 21st century. Primary care leadership needs to wake up and start a revolution.
