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EXPH; Barry, MM
Definition of a Frame of Reference in Relation to Primary Care with a Special Emphasis on Financing Systems and Referral Systems
DG SANCO European Commission
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In this opinion the Expert Panel on effective ways of investing in Health (EXPH), considers primary care to be the provision of universally accessible, person-centered, comprehensive health and community services, provided by a team of professionals accountable for addressing a large majority of personal health needs. These services are delivered in a sustained partnership with patients and informal care givers, in the context of family and community and play a central role in the overall coordination and continuity of people's care. The Expert Panel notes that strong primary care systems contribute to equity and improved health outcomes but emphasizes that primary care needs to continuously evolve if it is to respond to changing challenges in society. A strong primary care system can be the starting point for effective referral systems, insuring integration between different levels of care. Gate-keeping can offer advantages to patients, providers and the health system so long as important organisational and patient management factors are taken into account. The Expert Panel emphasizes the importance of ensuring that primary care services are accessed by the population without facing financial hardship and notes that there is little evidence that user charges lead to more appropriate use and cost control. When user charges are present, there should be protecting mechanisms for people with low incomes and people who regularly use health care. European Union (EU) health systems show a trend towards blended provider payment systems in primary care, combining risk-adjusted capitation with some fee-for-service reimbursement. For pay-for-performance (P4P), usually an add-on to another payment system, the Expert Panel describes factors that may contribute to the effectiveness of P4P programs and implementation features that may weaken the effectiveness of financial incentives. Finally, the Expert Panel formulates general research questions in relation to the development of primary care in Europe, specific research questions in relation to referral and financing and strategic directions at different levels.
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