Table 1.

Key Characteristics of Primary Health Care Systems

CharacteristicNational Primary Care Strategy (Australia) (6)Primary Health Care Strategy (New Zealand) (11)Patient Centered Medical Home (USA) (12)Royal College of General Practice (England) (13)
Clinical care
    Population health–based focusVoluntary patient enrolmentEnrolled populationsEnrolled populations
    Identifies and aims to reduces health inequalities
    Delivers uniformly accessible, patient-centered, continuity of careBetter access to primary health care services
There are key issues in relation to relocation of hospital service models
Offer access to comprehensive services to improve, maintain, and restore people's healthEnhanced access is available through systems, eg, open scheduling, expanded hours, and new options for communicationProvide access including urgent care
Major after-hours problems
    Clinical care well integrated and coordinated with secondary careExplicit statements on integration of primary/secondary services to improve coordination, continuity, and collaborationCoordinate care across service areas
Low level coordination and integration to date
Care is coordinated and/or integrated across all elements of health care
Personal physician
Whole-person orientation
Practices collaborating and working together
    Must have a primary care workforce appropriate to local conditions and needGP led most appropriate and accessible blend of multidisciplinary team careDevelop the primary health care workforcePhysician-directed medical practice, ie, the physician leads a team of individuals who collectively provide careGP-led, integrated, and expanded multidisciplinary teams
    Provides high-quality, safe, evidence-based careIntegrated quality and safety toolsContinuously improve quality using good informationQuality and safety are hallmarks of the medical homeCulture of quality and safety of care
Education and training
    Appropriately resourced and vertically integrated professional development and trainingCommitment across PHC teams to training and educationLimited commitment to training and educationCulture of education, teaching, and training
    Has ICT systems that integrate information effectively across the health care systemImproved ICT to support continuity of care via personally controlled EHRNot includedICT infrastructure to support care
    Has an appropriate governance model with local engagement, responsibility, and appropriate decision-making capacity, accepting of and managing local diversity and complexityMeso-level primary care organizations to facilitate: Local engagement, patient and community participation; and provider representation
Linkage between micro- and macrosectors of the system divisions (n = 111 in 2010); transitioning to larger “Medicare locals” in 2011
Meso-level primary health care organizations (n = 32 in 2011) who have shared governance with clinicians, community, and Maori groups
There is limited ability to accept responsibility for complex decision making
An expectation of accountable care organizations but untested, which currently limits population focus and inequality reductionMeso-level Primary Care Trusts (n = 152 in 2010) are transitioning to smaller GP consortia led and championed by local clinicians
    Uses a funding model that encourages maximal management of complex disease in the community, an outcomes focus, and health promotion/disease preventionNon–fee-for-service physician payment (capitation)
Correct funding signals and incentives across the system to maintain care within the community
Variety of funding models to fit local circumstance and priorities
Mixed funding model with government funding applied by variation of capitation
Patients pay fees for services
Some limited quality and performance payments
Payment reform recognizing the added value provided to patients who have a patient-centered medical homeCommissioning, resource management, and coordination of care
  • EHR, electronic health record; GP, general practitioner; ICT, information communication technology; PHC, primary health care.