Primary Care and the health spending/health costs issue

Primary care constitutes the entry point in the pathways to healthcare for most persons worldwide including in the United States. The quality of service delivery by primary care physicians therefore is an important element of the healthcare value chain. Thus, appropriately treated by the primary physician, an individual that might have ended up with the complications of an illness might not, and the illness might not be as prolonged as it would otherwise have been. The burden of the disease therefore would be less in both ill health and pecuniary terms, and for both the person and the health system at large. In other words, it is in the best interest of any country for its primary care system to be able to deliver the dual healthcare delivery objectives of providing qualitative health services simultaneously reducing health spending, which latter would ensue with healthcare costs, due to illnesses and their complications, lessening.

The results of a 2006 Commonwealth Fund International Health Policy Survey of Primary Care Physicians in Australia, Canada, Germany, New Zealand, the Netherlands, the United Kingdom, and the United States that shows prominent disparities in elements of health systems that underline quality, effectiveness, and efficiency are telling. The differences between these countries in clinical information systems and payment incentives that this study, published in the November 02, 2006, of the journal Health Affairs, reveals, including variations in their disease management capacities, could have significant implications for their abilities to achieve the dual healthcare delivery goals.

According to the study in which researchers interviewed 6000 primary care physicians (PCPs), U.S. physicians are unlikelier than those in the other countries are to have implement wide-ranging healthcare information and communication technologies (ICT) or quality-targeted incentives and the likeliest to report that their patients have problems with meeting out-of-pocket health care costs. The study shows that roughly 28% of U.S. PCPs used electronic health records (EHR), versus 98% in the Netherlands, 92% in New Zealand, 89% in the U.K, 79% in Australia and 42% in Germany, Canadian physicians, at 23%, the only ones utilizing EHRs at a lesser rate than U.S. doctors. Unlike Dutch doctors, about 93% of who implemented such systems, only 23% of U.S. PCPs had healthcare ICT to alert them to potential adverse drug interactions, the least rate among physicians in the countries studied apart from Canada.

Additionally, 15% of U.S. PCPs used computerized alerts to provide their patients with test findings, versus 53% of U.K. physicians, and 18% of U.S. PCPs used healthcare ICT-enabled reminders to their patients for preventive or follow-up treatment, versus 93% and 83% of New Zealand and U.K. physicians, respectively. Twenty percent of U.S. PCPs could produce patients’ lists for due/overdue tests or preventive care, versus 82% and 64% of New Zealand and German physicians, respectively, and roughly 19% of U.S. PCPs had healthcare ICT to help with seven or more healthcare delivery functions, versus 87% and 83% of New Zealand and U.K. physicians, respectively.

The study also shows that 30% of U.S. PCPs had financial inducements to improve care provision quality, versus 95% of U.K physicians, that 9% of U.S. doctors experienced long wait times for lab/other tests, versus 57% and 51% of U.K. and 51% of Canadian doctors’ respectively. Forty percent of U.S. PCPs made plans for after-hours care, versus 95%, 90%, 87%, 76%, and 47%, of Dutch, New Zealand, U.K, German and Canadian physicians, respectively, and 33% of U.S. PCPs customarily gave patients with chronic diseases written care management instructions, versus 63% and 14% of German and Canadian physicians, respectively.

The study doubtless indicates that U.S. PCPs have the least capacity to guarantee for its peoples accessible, qualitative and patient-focused healthcare delivery, than the other countries, despite that it spends far more on its health services than any of them. Does this study then not suggest the need for comprehensive policy changes, or in technical parlance, health sector reform? Given that the financing and administrative models of the health systems in these countries vary, some more centrally planned and controlled, others more privately financed and market-oriented, do these obviate the need for the U.S, and indeed, all other countries, to embark on a policy of perpetual health sector reform, including and in particular that of the primary healthcare domain?

Figures obtained from this study clearly indicate that none of the health systems is perfect, as indeed, no health system could ever be, due to the inherent instability of such systems that what some would consider the frenetic pace of advances in medical knowledge for example with its implications for change in practice and its model spawn. This is not to mention changes imposed from outside the health sector for examples those fiscal realities, and budgetary discipline would often impose. The goal of every health system should therefore, be to be as near perfect as possible. This necessarily implies continuous healthcare delivery quality appraisal and improvement efforts by the country, which would in the end, contribute towards improving the health of its peoples.

The U.S., and indeed, every other country needs to invest in the means for example, healthcare information and communication technologies, which would help improve the efficiency and effectiveness of the myriad of transactions that result in healthcare delivery. This upfront investment would by, helping to improve the quality of healthcare delivery, also help reduce healthcare costs, hence ultimately health spending. Is this initial health spending therefore not worth the benefits derivable thereof, including improving the parameters examined in this study, and indeed, the overall quality of healthcare delivery in the U.S. and in other countries?