How Modelling could Contribute to Reforming Primary Care—Tweaking “the Ecology of Medical Care” in Australia

Joachim P Sturmberg; Geoff M McDonnell; Joachim P Sturmberg; Geoff M McDonnell

doi:10.3934/medsci.2016.3.298

AIMS Medical Science

2016, Volume 3, Issue 3: 298-311. doi: 10.3934/medsci.2016.3.298

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Research article Special Issues

How Modelling could Contribute to Reforming Primary Care—Tweaking “the Ecology of Medical Care” in Australia

Joachim P Sturmberg ^{1
,
,},
Geoff M McDonnell ²

1.
The University of Newcastle, Department of General Practice, PO Box 3010, Wamberal, NSW, AUS 2260
2.
University of NSW, Centre for Medical Informatics, PO Box 308, Waverley, NSW, AUS 2024

Received: 28 August 2016 Accepted: 18 October 2016 Published: 29 October 2016

Background: The Australian Ecology of Medical Care indicates that 255/1,000 Australians consult a GP 1.8 times/month (466 consultations/month) resulting in 42 specialist, 1.4 ED and 1.9 hospital referrals, 478 prescriptions, 220 pathology and 48 radiology tests, costing the Government $ 72,009 (2012–13). Government believes this to be unsustainable and controllable by setting price signals. Objectives: To investigate the impact of ‘small changes’ to health service utilisation and/or resource use. Method: Modelling the impact of increases and decreases to healthcare utilisation/resource use over a 5-year period. Results: Strategies targeting only one variable had a small and linear impact on healthcare expenditure (± 0.6–7.2%); combining changes had an exponential effect, achieving an up to 15% reduction or an over 20% rise in expenditure. Discussion: Change invariably results in trade-offs; modelling is a tool that can provide a basis to engage in shared discussions about the ‘yes, but/yes, and’ considerations of reform propositions
- ecology of medical care,
- modelling,
- primary care reform,
- leadership,
- complex adaptive systems
Citation: Joachim P Sturmberg, Geoff M McDonnell. How Modelling could Contribute to Reforming Primary Care—Tweaking “the Ecology of Medical Care” in Australia[J]. AIMS Medical Science, 2016, 3(3): 298-311. doi: 10.3934/medsci.2016.3.298

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Abstract

Background: The Australian Ecology of Medical Care indicates that 255/1,000 Australians consult a GP 1.8 times/month (466 consultations/month) resulting in 42 specialist, 1.4 ED and 1.9 hospital referrals, 478 prescriptions, 220 pathology and 48 radiology tests, costing the Government $ 72,009 (2012–13). Government believes this to be unsustainable and controllable by setting price signals. Objectives: To investigate the impact of ‘small changes’ to health service utilisation and/or resource use. Method: Modelling the impact of increases and decreases to healthcare utilisation/resource use over a 5-year period. Results: Strategies targeting only one variable had a small and linear impact on healthcare expenditure (± 0.6–7.2%); combining changes had an exponential effect, achieving an up to 15% reduction or an over 20% rise in expenditure. Discussion: Change invariably results in trade-offs; modelling is a tool that can provide a basis to engage in shared discussions about the ‘yes, but/yes, and’ considerations of reform propositions

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