The Necessary Return of Comprehensive Primary Health Care

Bitton, Asaf

doi:10.1111/1475-6773.12817

Cited by 10 publications

(12 citation statements)

References 14 publications

(25 reference statements)

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“…Studies have revealed that the service scope of PCFs is declining despite their potential benefits [ 11 , 12 ], which might exacerbate current geographic disparities in healthcare services availability and utilization [ 13 ]. Moreover, comprehensiveness of care received less resources and attention than other elements of primary care, such as access or continuity of care [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

Zhong

Hung

et al. 2020

Int J Equity Health

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Background: Comprehensive primary care practices, through preconception, preventive, curative, and rehabilitative care, have been a global priority in the promotion of health. However, the scope of primary care services has still been in decline in China. Studies on the factors for primary care service scope have centred on human resources and infrastructure; the role of direct government subsidies (DGS) on services scope of primary care facilities were left unanswered. This study aimed to explore the association between the DGS and services scope of primary care facilities in China. Methods: A multi-stage, clustered cross-sectional survey using self-administrated questionnaire was conducted among primary care facilities of 36 districts/counties in China. A total of 770 primary care facilities were surveyed with 757 (98.3%) valid respondents. Of the 757 primary care facilities, 469 (62.0%) provided us detailed information of financial revenue and DGS from 2009 to 2016. Therefore, 469 primary care facilities from 31 counties/districts were included in this study. Sasabuchi-Lind-Mehlum tests and multivariate regression models were used to examine the inverted U-shaped relationship between the DGS and service scope. Results: Of 469 PCFs, 332 (70.8%) were township health centres. Proportion of annul DGS to FR arose from 26.5% in 2009 to 50.5% in 2016. At the low proportion of DGS to financial revenue, an increase in DGS was associated with an increased service scope of primary care facilities, whereas the proportion of DGS to financial revenue over 42.5% might cause narrowed service scope (P = 0.023, 95% CI 11.59-51.74%); for the basic medical care dimension, the cut point is 42.6%. However, association between DGS and service scope of public health by primary care facilities is statistically insignificant. Conclusion: While the DGS successfully achieved equalization of basic preventive and public health services, the disproportionate proportion of DGS to financial revenue is associated with narrowed service scope, which might cause underutilization of primary care and distorted incentive structure of primary care. Future improvements of DGS should focus on the incentive of broader basic medical services provision, such as clarifying service scope of primary care facilities and strategic procurement with a performance-based subsidies system to determine resource allocation.

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Section: Introductionmentioning

confidence: 99%

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

Zhong

Hung

et al. 2020

Int J Equity Health

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“…[12][13][14] To date, comprehensiveness has received less attention than other key elements of primary care, such as access or continuity, which are more easily measured, and coordination, which is now the focus of a variety of new payment models. 15,16 Without explicit measurement and support for its improvement, comprehensiveness may wither as other aspects of primary care (e.g., access, coordination) receive more resources and attention. 6,16 Survey research suggests that comprehensiveness is declining in the United States 17-21 despite prior evidence suggesting numerous benefits.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Without explicit measurement and support for its improvement, comprehensiveness may wither as other aspects of primary care (e.g., access, coordination) receive more resources and attention. 6,16 Survey research suggests that comprehensiveness is declining in the United States 17-21 despite prior evidence suggesting numerous benefits. This decline is not the inevitable result of advances in modern medicine, but is largely a consequence of flawed incentives.…”

Section: Introductionmentioning

confidence: 99%

New approaches to measuring the comprehensiveness of primary care physicians

O’Malley

Rich

Shang

et al. 2019

Health Services Research

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Objective To develop claims‐based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting A total of 5359 PCPs caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices. Study Design We developed Medicare claims‐based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings Each measure varied across PCPs and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose PCPs’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.

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“…1,2 In this way, several studies have been done to document evidence about the relevance of Alma Ata Declaration in the context of developing countries. [3][4][5][6][7][8][9][10][11][12] Primary health care (PHC) are essential services based on practical, evidence-based, socially and religiously acceptable, and scientifically approved processes, made accessible uniformly to populations at an affordable cost. 13 Furthermore, PHC is the initial level of contact for individuals and community by bringing health care services as near as possible to places where people live and work and develops the first component of the continuous and preventive health care process.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 In this way, several studies have been done to document evidence about the relevance of Alma Ata Declaration in the context of developing countries. 3-12…”

Section: Introductionmentioning

confidence: 99%

Challenges and Patterns of Seeking Primary Health Care in Slums of Karachi: A Disaster Lurking in Urban Shadows

Aleemi

Khaliqui

Faisal

2018

Asia Pac J Public Health

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This study aimed to evaluate the challenges and patterns of seeking primary health care services in slums of Karachi, where about 60% of the population lives in various informal settlements. We surveyed 8 largest slums of the metropolitan, and analyzed the data both descriptively and inferentially to evaluate the factors associated with health care seeking behavior. Significantly positive association of quality health care seeking behavior and various socioeconomic indicators were found. In addition, substantial insights about the conditions of slum dwellers and health challenges of the population, such as low immunization and low vaccinations, among others, were reported. Thus, the role of policymakers is emphasized to strategize for the inclusion of these people in national health plans and to develop health infrastructure near these communities. Furthermore, there is a strong need to increase awareness of the population about hygiene practices, importance of immunization, and importance of utilizing appropriate health care services.

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The Necessary Return of Comprehensive Primary Health Care

Cited by 10 publications

References 14 publications

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

Association between direct government subsidies and service scope of primary care facilities: a cross-sectional study in China

New approaches to measuring the comprehensiveness of primary care physicians

Challenges and Patterns of Seeking Primary Health Care in Slums of Karachi: A Disaster Lurking in Urban Shadows

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