The cost of putting primary care first
The EU-funded project 'Quality and costs of primary care in Europe' (EUPRIMECARE) developed methods allowing for transnational comparisons of EU primary care (PC) models. Focusing on Germany, Estonia, Spain, Italy, Lithuania, Hungary and Finland, the unique approach enabled the measurement of costs, and also quality assessments across different dimensions. The gathered information was then used to analyse the links between the two to develop a set of recommendations aimed at improving the value of PC. Descriptions of PC models were based on a framework covering several domains, including financing, regulation, payments, organisation and behaviour. Factors related to financing, ownership, facilities and access to specialists were considered for the classification of PC models. The initial investigation of systems for measuring macro costs revealed wide variations in accounting systems across countries, rendering comparable measurements a difficulty from the outset. For micro costs, a series of clinical situations (vignettes) were developed, while the different components of cost were identified using time-driven activity-based costing. This micro approach constituted an essential module for accurate cost comparisons of different countries or models. With regard to quality, the assessment process was initiated by gathering information from both patient and professional focus groups. Based on these discussions, a population and a professional survey were created to examine access, equity, appropriateness, and patient and professional satisfaction. To study the links between cost and quality, project members used previously collected information (micro vignettes, surveys and clinical records), and the stated goals of PC in each model. This enabled them to prove the capacity of improvement, accounting for stakeholder interests and costs of improvement. An important project outcome relevant for future analyses is that the effects of PC models on quality and cost effectiveness must be evaluated in relation to other levels of care. Simply put, good PC services will positively impact the whole health care system, thanks to earlier disease detection, fewer hospital admissions, lower health care costs and general good population health. Europe's health systems are hard-pressed to address common public expectations, the migration and mobility of patients and health professionals, and the practical implications of EU enlargement. As such, EUPRIMECARE has highlighted the need for a community framework for safe, high-quality and efficient health services, underlining the critical role PC plays in reforming such services.
