Primary Care and Health Reform Concepts, Confusions, and Clarifications

Health reform debate understandably focuses on large system design. We should not omit attention to the “last mile” problem of physician payment theory. Achieving fundamental goals of integrative, patient-centered primary care depends on thoughtful financial support. This commentary describes the nature and importance of innovative primary care payment programs.

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Something old, something new, something borrowed, something blue? Reviewing the evidence on commissioning and health services

Australian Journal of Primary Health ◽

10.1071/py15037 ◽

2016 ◽

Vol 22 (1) ◽

pp. 9 ◽

Cited By ~ 7

Author(s):

Suzanne Robinson ◽

Helen Dickinson ◽

Learne Durrington

Keyword(s):

Primary Care ◽

Health Services ◽

Health Reform ◽

International Literature ◽

Health Networks ◽

Technical Aspects ◽

Australian Health ◽

Primary Health ◽

Evidenced Based ◽

Is Value

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning.

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Health Reform Must Boost Primary Care

Internal Medicine News ◽

10.1016/s1097-8690(09)70342-7 ◽

2009 ◽

Vol 42 (10) ◽

pp. 1-4

Author(s):

MITCHEL L. ZOLER

Keyword(s):

Primary Care ◽

Health Reform

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Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?

Medical Care Research and Review ◽

10.1177/1077558716669432 ◽

2016 ◽

Vol 75 (1) ◽

pp. 33-45 ◽

Cited By ~ 3

Author(s):

Edwin S. Wong ◽

Matthew L. Maciejewski ◽

Paul L. Hebert ◽

Adam Batten ◽

Karin M. Nelson ◽

...

Keyword(s):

Primary Care ◽

Health Insurance ◽

Health Services ◽

New England ◽

Healthcare System ◽

Administrative Data ◽

Health Reform ◽

Veterans Affairs ◽

Difference In Difference ◽

Difference Methods

Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.

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