Export file:

Format

  • RIS(for EndNote,Reference Manager,ProCite)
  • BibTex
  • Text

Content

  • Citation Only
  • Citation and Abstract

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

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

Special Issues: Complexity Science for Health and Health Systems

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
  Figure/Table
  Supplementary
  Article Metrics

Keywords 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. AIMS Medical Science, 2016, 3(3): 298-311. doi: 10.3934/medsci.2016.3.298

References

  • 1. Harrison D (2014) Health minster Peter Duton says Medicare spending unsustainable. Sydney Morning Herald. Sect. http://www.smh.com.au/federal-politics/political-news/medicare-unsustainable-without-overhaul-says-peterdutton-20140103-309ss.html.
  • 2. Owens J (2014) Price signal needed to make Medicae sustaibable, says Dutton. The Australian. Sect. http://www.theaustralian.com.au/national-affairs/price-signal-needed-to-make-medicare-sustainable-says-dutton/story-fn59niix-1227136552889.
  • 3. Owens J (2015) Government abandons plan to cut Medicare rebate for short GP visits. The Australian. Sect. http://www.theaustralian.com.au/national-affairs/health/government-abandons-plan-to-cut-medicare-rebatefor-short-gp-visits/story-fn59nokw-1227185738483.
  • 4. Horn RE, Weber RP (2007) New Tools For Resolving Wicked Problems: Mess Mapping and Resolution Mapping Processes. San Francisco: Strategy Kinetics L.L.C..
  • 5. Rittel HWJ, Webber MM (1973) Dilemmas in a General Theory of Planning Policy Sciences. Pol Sci 4: 155-169.    
  • 6. Fortmann-Roe S (2014) Insight Maker: A general-purpose tool for web-based modeling & simulation. Simulation Model Practice Theory 47: 28-45.    
  • 7. White K, Williams F, Greenberg B (1961) The Ecology of Medical Care. N Engl J Med 265: 885-892.    
  • 8. Green L, Fryer G, Yawn B, et al. (2001) The Ecology of Medical Care Revisited. N Engl J Med 344: 2021-2025.    
  • 9. Johansen ME, Kircher SM, Huerta TR (2016) Reexamining the Ecology of Medical Care. N Engl J Med 374: 495-496.    
  • 10. Sturmberg JP, O'Halloran DM, Martin CM (2014) Health Care Reform—The Need for a Complex Adaptive Systems Approach. In: Sturmberg JP, Martin CM, editors. Handbook of Systems and Complexity in Health. New York: Springer; p. 827-853.
  • 11. Britt H, Miller GC, Henderson J, et al. (2013) General practice activity in Australia 2012–13. Sydney: 2013 Contract No.: General practice series no.33.
  • 12. Australian Institute of Health and Welfare. (2014) Australian hospital statistics 2012–13. Canberra: Australian Institute of Health and Welfare, Cat. No. HSE 145.
  • 13. Australian Institute of Health and Welfare. (2014) Australian hospital statistics 2012–13. Emergency department care. Canberra: Australian Institute of Health and Welfare, Cat. No. HSE 142.
  • 14. Medicare Australia. (http://wwwmedicareaustraliagovau/cgi-bin/brokerexe?_PROGRAM=sasmbs_group_standard_reportsas&_SERVICE=default&DRILL=on&_DEBUG=0&GROUP=1&VAR=services&STAT=count&RPT_FMT=by+state&PTYPE=finyear&START_DT=201207&END_DT=201306).
  • 15. Department of Health. http://wwwhumanservicesgovau/corporate/statistical-information-and-data/pharmaceutical-benefits-schedule-statistics/.
  • 16. Nissen SE (2015) Reforming the continuing medical education system. JAMA 313: 1813-1814.    
  • 17. Alper J, Geller A (2015) How modeling can inform strategies to improve population health: Workshop summary. National Academies of Sciences, Engineering, and Medicine. Washington, DC: The National Academies Press.
  • 18. Howie J, Heaney D, Maxwell M, et al. (1999) Quality at general practice consultations: cross sectional survey. Br Med J 319: 738-743.    
  • 19. Howie JGR, Porter AMD, Heaney DJ, et al. (1991) Long to short consultation ratio: a proxy measure of quality of care for general practice. Br J Gen Pract 41: 48-54.
  • 20. Freeman G, Horder J, Howie J, et al. (2002) Evolving general practice consultation in Britain: issues of length and context. Br Med J 324: 820-822.
  • 21. Hart JT (1998) Expectations of health care: promoted, managed or shared? Health Expect 1: 3-13.    
  • 22. Hjortdahl P, Borchgrevink CF (1991) Continuity of care—influence of general practitioners' knowledge about their patients on use of resources in consultations. Br Med J 303: 1181-1184.    
  • 23. Hjortdahl P (1992) The Influence of General Practitioners' Knowledge about their Patients on the Clinical Decision-Making Process. Scand J Prim Health Care 10: 290-294.    
  • 24. Reeve J, Blakeman T, Freeman G, et al. (2013) Generalist solutions to complex problems: generating practice-based evidence—the example of managing multi-morbidity. BMC Family Practice 14: 112.    
  • 25. Stange KC, Ferrer RL (2009) The Paradox of Primary Care. Ann Fam Med 7: 293-299.    
  • 26. Martin CM, Grady D, Deaconking S, et al. (2014) Complex adaptive chronic care—typologies of patient journey: a case study. J Eval Clin Pract 17: 520-524.
  • 27. Sturmberg JP, O’Halloran DM, Martin CM (2010) People at the centre of complex adaptive health systems reform. Med J Aust 193: 474-478.
  • 28. Heifetz R (1994) Leadership Without Easy Answers. Cambridge, Ma: Harvard University Press.

 

This article has been cited by

  • 1. Hirofumi Namiki, Tadashi Kobayashi, Sungwoo Lim, The ecology of medical care on the westernmost remote island, Yonaguni Island, Japan: A cross-sectional study, PLOS ONE, 2018, 13, 6, e0199871, 10.1371/journal.pone.0199871

Reader Comments

your name: *   your email: *  

Copyright Info: 2016, Joachim P Sturmberg, et al., licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution Licese (http://creativecommons.org/licenses/by/4.0)

Download full text in PDF

Export Citation

Copyright © AIMS Press All Rights Reserved