Primary Care Reform: Implications for Public Health

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  •  Medico-legal
  • Training
  • Power structures & role definitions
  • Payment methods
  • Lack of information systems
  • Inadequate use of evidence-based guidelines/protocols and quality improvement
  • Fear of losing resources (public health, physicians)
  • Lack of vision and effective leadership:
    • ‘plurality’ solutions – a thousand points of light
    • Much thinking and dithering – no action
    • No political will to make the necessary investments in change management and IT
    • No appropriate organisational structure

How to move ahead?

  • Common vision & mental model– improving the health of the population together
  • Improved training
  • Organisational change, build on successes, top-down/bottom-up approach
  • Different payment scheme – FFS + capitation + ?performance incentives
  • Sort out medico-legal issues & professional roles
  • Information systems
  • Evidence

Implications for public health

  • Better integration with primary care
  • Better information technology/systems
  • Protected funding & resources