Philip Davies, Professor of Health Systems & Policy, School of Population Health, University of Queensland
In 1962 Decca Records in England famously declined to sign the Beatles on the grounds that “guitar groups are on the way out”. Despite the obvious hazards of crystal ball gazing it is important that researchers consider what might lie ahead for primary care.
Traditional, open-ended, fee-for-service payments are no longer fit for purpose as the sole (or even principal) basis for funding primary care.
We need to embrace multi-disciplinary care but if fee-for-service rebates, in their present form, were to be made widely available to non-medical practitioners, Medicare spending could spiral out of control.
Telephone and internet-based consultations are set to grow in importance but cannot easily be accommodated within the existing funding paradigm.
‘Pure’ fee-for-service doesn’t adequately reward preventative services; it can inhibit effective management of chronic conditions; and it has failed to bring sufficient services to rural and remote communities.
New approaches to primary care funding are likely to blend fee-for-service, capitation and pay-for-performance. But changes to how the money flows will drive broader developments in the sector.
Capitation and pay-for-performance both require a formal link between service providers and service users, so patient ‘enrolment’ or affiliation with practices seems inevitable. Practices will also need to interface with electronic health record systems and employ a more diverse range of professional and support staff.
In order to meet such challenges, practices will need to strengthen their management capacity and invest in new technologies. Novel forms of organisation can be expected to emerge as primary care becomes more complex and capital-intensive.
As far as the primary care research agenda is concerned, we can expect to see the focus shift from the processes of care to the business and institutional context in which services are delivered.
“Nothing’s gonna change my world”, sang the Beatles some eight years after their rejection by Decca. It’s doubtful whether the primary care community could make that same claim today.
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