Bad Hofgastein, 2 October 2014 – Primary Health Care (PHC) is a key to optimising health care systems, and should not be seen as standing in the way of patients‘ freedom of choice. Rather, experts discussing various PHC models at the European Health Forum Gastein concluded, well- planned and properly-implemented primary care led to more efficient supply structures and continuity in patient care.
„A strong Primary Health Care approach has a number of advantages. It allows, for instance, the proper implementation of a planned portfolio of primary prevention and screening services. It ensures continuity and longitudinality in the sense of a well-defined ‘patient itinerary’. For this purpose, health professionals are appropriately coordinated for the benefit of the patient, who is at the centre of the system”, Prof José M. Martin-Moreno from Valencia University told the EHFG. “The alternative is a complex, fragmented system of specialists who do not necessarily communicate in a structured way.”
Primary Health Care should be based on the principles of social equity, nation-wide coverage, self-reliance, inter-sectoral coordination, and people’s involvement in the planning and implementation of health programs, the expert added. “This participation ensures the possibility of providing a voice to patients and thereby some freedom of choice”, Prof Martin-Moreno said. “But if the concept is interpreted as the possibility of going directly to any specialist without previous advise from a health professional, gatekeeping may certainly be considered a relative restriction to free choice of patients.”
Attractive offers rather than gate-keeping
“Reorganising primary health care is a topical political issue in Austria and a central element in our health care reform,“ Dr Josef Probst, Director-General of the Federation of Austrian Social Insurance Institutions told the EHFG. “A crucial issue is how to structure access to the different levels of health care. We do not want to introduce gate-keeping, instead hoping that our new model of primary care will be so attractive to those supplying health services and patients alike that we will not need any hurdles as far as access is concerned.“
Primary care in Austria is now frequently inadequate in key areas due to the very fragmented health care system, Dr Clemens Martin Auer, Director General at the Austrian Ministry of Health pointed out. “It is true that there is coordination in some cases, but not systematically or reliably. There are a number of unwelcome consequences, such as a large number of patients being hospitalised, and no more than average outcomes for those who are chronically ill. The clear goal of reforming primary care in Austria must therefore be primary care networks which are accessibility at appropriate hours, and extend to the entire population. This will involve promoting efficiency through coordination and cooperation, and most important of all improving the success of medical, nursing, and therapeutic care.”
Communication versus fragmentation
“In an ideal world, with high medical literacy, one could conceive a context where we would not need the advice of any gatekeeper to select the most appropriate care”, Prof Martin-Moreno said. “However, this is not usually the case, particularly when the health literacy level is low and/or heterogeneous, or when patients have multiple comorbidities that can complicate the make-up of a multidisciplinary team. Moreover, even when health literacy is very high, the gatekeeping approach offered by solidly planned PHC, allows good registry systems, proper work programming and protocols, and more reliable, multidisciplinary training and research activities.”
“Electing Health – The Europe We Want” is the motto for this year’s EHFG. Around 600 participants from more than 50 countries are attending the most important health policy conference in the EU to exchange view on key issues affecting European health systems. The future direction of European health policy is the key topic on the conference agenda.
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