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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
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