Key Characteristics of Primary Health Care Systems
| Characteristic | National 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 focus | Voluntary patient enrolment | Enrolled populations | Enrolled populations | |
| Identifies and aims to reduces health inequalities | ✓ | ✓ | ✓ | |
| Delivers uniformly accessible, patient-centered, continuity of care | Better 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 health | Enhanced access is available through systems, eg, open scheduling, expanded hours, and new options for communication | Provide access including urgent care Major after-hours problems Responsiveness |
| Clinical care well integrated and coordinated with secondary care | Explicit statements on integration of primary/secondary services to improve coordination, continuity, and collaboration | Coordinate 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 need | GP led most appropriate and accessible blend of multidisciplinary team care | Develop the primary health care workforce | Physician-directed medical practice, ie, the physician leads a team of individuals who collectively provide care | GP-led, integrated, and expanded multidisciplinary teams |
| Provides high-quality, safe, evidence-based care | Integrated quality and safety tools | Continuously improve quality using good information | Quality and safety are hallmarks of the medical home | Culture of quality and safety of care |
| Education and training | ||||
| Appropriately resourced and vertically integrated professional development and training | Commitment across PHC teams to training and education | Limited commitment to training and education | Culture of education, teaching, and training | |
| ICT | ||||
| Has ICT systems that integrate information effectively across the health care system | Improved ICT to support continuity of care via personally controlled EHR | Not included | ICT infrastructure to support care | |
| Governance | ||||
| Has an appropriate governance model with local engagement, responsibility, and appropriate decision-making capacity, accepting of and managing local diversity and complexity | Meso-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 reduction | Meso-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 prevention | Non–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 home | Commissioning, resource management, and coordination of care |
EHR, electronic health record; GP, general practitioner; ICT, information communication technology; PHC, primary health care.