Hawkins House Presentation on Irish Primary care Statistics
Thursday 24th January 2013 @ 3 pm by GP Dr William Behan to senior HSE and Department of Health staff based on Dr William Behans 2013 FEMPI (Financial Emergency Measures in the Public Interest Act) submission
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on the Irish Heal...DrWilliamBehan
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on the Irish Health Systems and the Missed Opportunity of Promoting General Practice and Primary Care in favour of Overly Bureaucratic, Commoditised, Fragmented Corporate Healthcare and Public Servants Pay and Conditions
Vasco Da Gama Dublin 2015 plenary 1 economic crisis introduction william behanDrWilliamBehan
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on European Health Systems and the Missed Opportunity of Promoting General Practice and Primary Care in favour of Overly Bureaucratic, Commoditised, Fragmented Corporate Healthcare
What brings value to healthcare delivery? DrWilliamBehan
A presentation given by GP William Behan to a private audience in September 2013 on the importance on focusing on the clinician-patient interaction when trying to improve total outcomes and value in healthcare delivery
Hawkins House Presentation on Irish Primary care Statistics
Thursday 24th January 2013 @ 3 pm by GP Dr William Behan to senior HSE and Department of Health staff based on Dr William Behans 2013 FEMPI (Financial Emergency Measures in the Public Interest Act) submission
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on the Irish Heal...DrWilliamBehan
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on the Irish Health Systems and the Missed Opportunity of Promoting General Practice and Primary Care in favour of Overly Bureaucratic, Commoditised, Fragmented Corporate Healthcare and Public Servants Pay and Conditions
Vasco Da Gama Dublin 2015 plenary 1 economic crisis introduction william behanDrWilliamBehan
Vasco Da Gama 2015 Dublin The Effect of the Economic Crisis on European Health Systems and the Missed Opportunity of Promoting General Practice and Primary Care in favour of Overly Bureaucratic, Commoditised, Fragmented Corporate Healthcare
What brings value to healthcare delivery? DrWilliamBehan
A presentation given by GP William Behan to a private audience in September 2013 on the importance on focusing on the clinician-patient interaction when trying to improve total outcomes and value in healthcare delivery
Structure and governance of financing - Tamas Evetovits, WHOOECD Governance
This presentation was made by Tamas Evetovits, WHO, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Health is of central importance to well-being. The standard and reach of health services have improved in Ireland over recent decades as indeed have health outcomes. However, not all of this progress has been experienced equally by all sections of the population. In particular, there are significant and persistent disparities in healthcare outcomes adjusted for socio-economic status. Similar disparities in the level of access to healthcare and the scope of healthcare provision point to a systemic problem. This paper considers a policy approach that could deliver a single, universal, comprehensive and integrated health service fit for purpose and one to which all people can have access on the basis of need and not ability to pay. Our costing exercise demonstrates that health system transition and reform will entail additional demands on public resources with implications for fiscal policy.
Catastrohpic out-of-pocket payment for health care and its impact on househol...Jeff Knezovich
Henry Lucas presents briefly on findings from a study on catastrophic out-of-pocket payments for health care in West Bengal, India at the 2011 iHEA conference in Toronto, Canada.
This OECD report, launched on January 10, 2017, systematically reviews strategies put in place by countries to limit ineffective spending and waste. Further information: http://www.oecd.org/health/health-systems/tackling-wasteful-spending-on-health-9789264266414-en.htm.
DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia H...OECD Governance
This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Facts, figures and views on health and social care: A pack prepared for repor...Nuffield Trust
This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
Adapting revenue policies to health needs and expenditure projections - Tamas...OECD Governance
This presentation was made by Tamas Evetovits and Sarah Thomson, WHO, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
Medibank Managing Director speaks at Amercian Chamber of CommerceLaura Harris
Medibank Managing Director, George Savvides presented at the American Chamber of Commerce in Melbourne about Medibank’s approach to primary care and its integrated care pilots.
Budgeting for healthcare - Camila Vammalle, OECDOECD Governance
This presentation was made by Camila Vammalle, OECD, at the 11th Annual Meeting of Central, Eastern and South-Eastern Senior Budget Officials (CESEE SBO) held in Warsaw, Poland, on 21-22 May 2015.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
Structure and governance of financing - Tamas Evetovits, WHOOECD Governance
This presentation was made by Tamas Evetovits, WHO, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Health is of central importance to well-being. The standard and reach of health services have improved in Ireland over recent decades as indeed have health outcomes. However, not all of this progress has been experienced equally by all sections of the population. In particular, there are significant and persistent disparities in healthcare outcomes adjusted for socio-economic status. Similar disparities in the level of access to healthcare and the scope of healthcare provision point to a systemic problem. This paper considers a policy approach that could deliver a single, universal, comprehensive and integrated health service fit for purpose and one to which all people can have access on the basis of need and not ability to pay. Our costing exercise demonstrates that health system transition and reform will entail additional demands on public resources with implications for fiscal policy.
Catastrohpic out-of-pocket payment for health care and its impact on househol...Jeff Knezovich
Henry Lucas presents briefly on findings from a study on catastrophic out-of-pocket payments for health care in West Bengal, India at the 2011 iHEA conference in Toronto, Canada.
This OECD report, launched on January 10, 2017, systematically reviews strategies put in place by countries to limit ineffective spending and waste. Further information: http://www.oecd.org/health/health-systems/tackling-wasteful-spending-on-health-9789264266414-en.htm.
DELSA/GOV 3rd Health meeting - Gijs VAN DER VLUGT, Camila VAMMALLE, Claudia H...OECD Governance
This presentation by Gijs VAN DER VLUGT, Camila VAMMALLE and Claudia HULBERT was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Facts, figures and views on health and social care: A pack prepared for repor...Nuffield Trust
This presentation was created for reporters looking for key facts, figures and views on health and social care in the run up to the general election in 2015 in the UK. It was compiled by Leonora Merry and references Nuffield Trust research and analysis throughout.
Adapting revenue policies to health needs and expenditure projections - Tamas...OECD Governance
This presentation was made by Tamas Evetovits and Sarah Thomson, WHO, at the 4th meeting of the Joint DELSA/GOV-SBO Network on Fiscal Sustainability of Health Systems, held in Paris on 16-17 February 2015.
Medibank Managing Director speaks at Amercian Chamber of CommerceLaura Harris
Medibank Managing Director, George Savvides presented at the American Chamber of Commerce in Melbourne about Medibank’s approach to primary care and its integrated care pilots.
Budgeting for healthcare - Camila Vammalle, OECDOECD Governance
This presentation was made by Camila Vammalle, OECD, at the 11th Annual Meeting of Central, Eastern and South-Eastern Senior Budget Officials (CESEE SBO) held in Warsaw, Poland, on 21-22 May 2015.
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
As the financial and demographic landscape changes, our healthcare services need to provide something significantly different to meet the needs of the Scottish population. In this session Gerry Marr talks about how do we make best use of the resources we have and what are we already doing that is transforming healthcare.
International Health Policy and Practice: Comparing the U.S. and Canada on Ac...The Commonwealth Fund
Dr. Eric Schneider's presentation on international health policy and practice. This presentation was delivered at the 2015 AcademyHealth Annual Research Meeting on June 14, 2015.
Medibank Managing Director speaks at Amercian Chamber of CommerceLaura Harris
Medibank Managing Director, George Savvides presented at the American Chamber of Commerce in Melbourne about Medibank’s approach to primary care and its integrated care pilots.
Population Health Management & Volume To Value Based CareIFAH
A session by Amish Purohit, CEO and CMO, US Health Systems on the topic of 'Population Health Management & Volume To Value Based Care' at IFAH USA 2019 held at Caesars Palace, 18-20 June, 2019.
The goal of this webinar is to help healthcare professionals improve care coordination for patients with advanced illness and to reduce hospital readmissions and length of stay (LOS).
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
Why Emplyers care about Pimary care 2008Paul Grundy
Employers are beginning to recognize that investing in the primary care foundation of the health care system may help address their problems of rising healthcare costs and uneven quality. Primary care faces a crisis as a growing number of U.S. medical graduates are avoiding primary care careers because of relatively low reimbursement and an unsatisfying work life. Yet a strong primary care sector has been associated with reduced health care costs and improved quality. Through the and other efforts, some large employers are engaged in initiatives tostrengthen primary care. [Health Affairs 27, no. 1 (2008): 151–158;
Improving quality of care, using existing assets better and reducing medical ...NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Prof David Hunter - Meeting the Challenge - Does the new NHS promote or hinde...Cumbria Partnership
'Meeting the Challenge of Long Term Conditions: Does the new NHS promote or hinder cooperation and integration?' - Professor David Hunter (Professor of Health Policy and Management at Durham University) from the Cumbria Neuroscience Conference
Analysis of 2018 OECD Calculation of Irish Doctors Consultations(in all setti...DrWilliamBehan
The OECD definition of doctors’ consultations that is published on its Health Statistic is quite precise. It is designed to include both GP and also non-GP consultations in the community, out patients departments and ambulatory care centres.
However, the 2018 data on Irish Doctors Consultations rate per head of population is greatly reduced compared to the 2016 figure. This is because it only includes GP data and is missing the non-GP doctors’ consultations.
The 2018 OECD figure for Irish Doctors Consultations (in all settings) is currently stated as 3.8 consultations per head of national population. This figure is clearly taken from the 2018 Healthy Ireland GP consultation rates.
The 2018 Irish data is missing the non-GP activity. When the most recent data available were utilised (CSO population survey, CSO 2015 HBS and 2017 HIPE data published in ‘Health in Ireland; Key Trends 2018’) it produces a figure of 1.1 non-GP consultations per head of population per annum. This is a plausible calculation as it is similar to the 2016 Healthy Ireland 1.2 non-GP doctor visits per head of national population.
There appears to be 2 options for Eurostat in dealing with the recording of the 2018 OECD figure for Irish Doctors Consultations. It could either be recorded as 4.9 (3.8 GP + 1.1 non-GP) with the non-GP proportion referred to as an estimate. Otherwise the 2018 figure of 3.8 should be retracted from the OECD database. Future national health surveys can include a question to inform the proper calculation.
I will be very disappointed if Health at a Glance is published this November with the current incorrect data.
William behan analysis 2018 dper and tcd 2017 reports on general practiceDrWilliamBehan
A Critical Analysis of 2018 DPER report and 2017 TCD report on Irish General Practice Reviewing:
1. The public spend on general practice
2. The private spend on general practice
3. Points 1. and 2. deliver a total spend on Irish general practice
4. Comparison of the Irish annual payment per GMS patient and UK NHS payment
5. The mis-calculation of the UK nurse activity rates relative to Irish GP nurse workload
6. The extrapolated savings benefits from utilising nurse triage is unreliable.
7. Suggesting a lack of proof of the efficiency of Irish general practice is a result of the ignorance of the authors
Irish Private GP Fees William 2003-2015 Behan 2018DrWilliamBehan
An explanation of how Irish GP private fee payments should be calculated for comparison with other countries. There is a culture of exaggerating the mean cost of attending the Irish GP service in the academic literature by health economists from Trinity College Dublin and the ESRI which dates back to the 2009 publication by The European Observatory on Health Systems and Policies of:
"Health Systems in Transition, Ireland. Health system review." https://www.esri.ie/pubs/BKMNEXT151.pdf
Icgp gp trainees conference 2017.william behan.finalDrWilliamBehan
The Solution to Bending the Irish Healthcare Value Curve
Is General Practice - The evidence supporting continuity of care from a personal GP team as opposed to a corporate primary care organisation
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
QA Paediatric dentistry department, Hospital Melaka 2020
The paradox between current models of Primary Care and evolving Evidence Based Medicine concepts
1. The paradox between current models of
Primary Care and evolving Evidence Based
Medicine concepts – International
comparisons
William Behan
November 2014
National Primary Care Conference
Lyrath Estate, Kilkenny, Ireland
twitter@DrWilliamBehan
2. Health vs Healthcare Activity
WHO definition of Health
Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity (1948)
Determinants of health
Income and social status, Education, Gender,
Physical environment, Social support, Genetics, Personal
behaviour and coping, Health services - access and use of
services that prevent and treat disease influences health
3. Health vs Healthcare Activity
Health industry related activities
Clinical: Acute and Chronic including long term care,
Education, Research, Administrative, Pharma, Infrastructure
Development, Insurance, Promotion/Public Relations, Legal
(Defensive Medicine)
What does the payment model reward?
Marginal cost vs Marginal Benefit
Opportunity Cost: benefit, profit, or value of something that
must be given up to acquire or achieve something else
Price vs Cost vs Value eg. Pandemic Influenza
Finite Budget – Good or Bad?
4. U.S. Hospital Administration Costs Exceed All Others by Far
• 25 percent of total U.S. hospital spending = Administrative costs
• Reducing U.S. spending for hospital administration to Scottish or
Canadian levels would have saved more than $150 billion in 2011
Monopolizing medicine: Why hospital consolidation may
increase healthcare costs
• Financial incentives in the current payment system: Same Doctor Visit,
Double the Cost: “Facility Fees”
• Survey by American Medical Association: 58% of family physicians and
50% of internists are employees.
Eg.: In 2011 Medicare spent €1.5 billion more on only two services alone:
evaluation and management visits and ECHO fees due to changes alone
9. Marc Jamoulle: Quaternary Prevention 1986
Combine Narrative and Evidence Based Medicine
Too Much Medicine Campaign, BMJ 2002 & 2013
Highlight the threat to human health posed by over-diagnosis and the
waste of resources on unnecessary care
Measuring Low-Value Care in Medicare JAMA 2014
Australian Study:150 Potentially Low-Value Health Care Practices:
Cervical & Prostate cancer screening in elderly. Back imaging for patients
with low back pain
The low-value services accounted for 0.6% to 2.7% of overall spending but
these findings may be just the ‘tip of the ice berg’
General health checks don’t work Editorial: BMJ 2014;348:g3680
Screenings and Executive Physicals: Hazardous to Your Health JACC 2014
10. THE INVERSE CARE LAW
Julian Tudor Hart 1971 Lancet
• The availability of good medical care tends to vary inversely
with the need for it in the population served
• Operates more completely where medical care is most
exposed to market forces, and less so where such exposure is
reduced
• BMJ Editorial 2012: Doctor-patient relationship more
adversely affected in deprived areas by the lack of time
11. Recent International Evidence Supporting Primary Care
2009 Annals of Family Medicine editorial; ‘The Paradox of Primary Care’
• “Different levels of analysis yield different views”
• The Paradox of primary care is that primary care provides poorer quality
disease specific care but better overall patient outcomes and at lower costs
compared to specialty care
2012 Barbara Starfields SESPAS Report
Adding one more one primary care physician per 10,000 population reduces
• death rates from 2% to 6%, particularly reducing health inequality
• inpatient admissions by 6%, outpatient visits by 5%, emergency room visits
by 10%, and surgeries by over 7%
12. Recent International Evidence Supporting Primary Care
2014 Annals Family Medicine editorial:
‘Health Is Primary: Family Medicine for America’s Health
• 2007-11 Rhode Island increased primary care spending from
5.4% to 8.0%: 23% increase in primary care spending = 18%
reduction in total spending:
• 15-fold return on investment. (Commonwealth Fund 6-fold)
BMJ 2014 Review 48 studies:
• Seeing the same GP each time can reduce emergency
department attendance BMJ 2014;349:g4847
13. Small US Primary Care Physician Practices Have Low Rates
of Preventable Hospital Admissions
Survey of 1,045 primary care practices found that:
• Practices with three to nine physicians had 27 percent lower unnecessary
admission rates compared to larger practices
• One or two doctor owned practices had 33% lower preventable hospital
admission rates than practices with 10 to 19 physicians
• The largest practices had in place significantly more patient-centered
medical home processes which were not associated with lower rates of
preventable hospital admissions
• Small practices have unmeasured characteristics that may contribute to
their lower rates of preventable hospital admissions (Patient-staff relatnshp)
• Practices owned by physicians had significantly lower ambulatory care–
sensitive admission rates than those owned by hospitals.
14. Irish Health Policy Development Time Line
2001 Department of Health: Health strategy document ‘Primary Care; A New
Direction’ - 1978 Declaration of Alma Ata
2003 Brennan Report: health service administration & financial accountability
2003 the World Health Report “health systems with strong, integrated primary
care are associated with better outcomes probably because they provide for
more comprehensive, longitudinal and coordinated care”
2004 Irish College of General Practice attributes of primary care: personal, first
contact, continuous, comprehensive, co-ordinated, cost effective, high quality,
equitably distributed, community orientated & accountable (WONCA)
2014 – HSE/DoH ignores all recent evidence on what makes public health care
more equitable, cheaper and effective but refers to 1978 Alma Ata
15. Quality of Healthcare in Ireland
Comparing the USA, UK and 17 Western countries' efficiency and
effectiveness in reducing mortality 1979-2005: JRSM 2011
First Ireland
2nd UK
17th USA
Perceived and reported access to the general practitioner: An
international comparison of universal access and mixed
private/public systems
K Galway, A Murphy, A Kelly, A Gilliland, AW Murphy, D O'Reilly, T O’Dowd, C O'Neill, E Shryane, K Steel, G Bury
Ir Med J. 2007 Jun;100(6):494-7
How quickly do you get to see
a PARTICULAR doctor? n (%)
Country NI ROI
Same day 12.7% 40.1%
Next day 18.4% 32.5%
2 working days 19.0% 13.6%
3+ working days 45.0% 8.1%
16. Universal Health Insurance Ireland
Costs?
Cover current private budget = €5.5 billion
+ Excess administrative costs due to Kaplan style
multipayer fee-per-item system: 10% €18.3 billion = €1.8 billion
Total = €7.3 billion
Who Pays?
Ireland population: 4.6 million
Non-payers, current medical card patients: 1.92 million
Next 30% “nominal payment”: 1.38 million
Balance population to pay approx. €6 billion: 1.3 million
= €4,600 per man, woman or child or €18,400 per family
17. Leadership skills
• Integrity/Fairness/Honesty
• Technical Competence/Understand program,
• True engagement with team (Arnstein’s Ladder)
• Vision/Creativity/Initiative => Proactive>Reactive
• Ability to Delegate
• Communicate: both transmitting and receiving information
• Commitment/Enthusiastic
• Open to Change
• Motivate/Team Builder/Enable members of group to grow
18. 3.1 3.4
2.5
4
3.5
3
2.5
2
1.5
1
0.5
0
K Lynch
predicted
figure
Gov. Survey
GMS 2 week
recollection
Gov. Survey
Private 2
week
recollection
UK
QRESEARCH
Audit
IMJ GMS
Audit
IMJ Private
Audit
Lifeways
2006 GMS
Under 5s
Audit
Lifeways
2006 Private
Under 5s
Audit
Under 6s attendance rate:
Minister Kathleen Lynch Figures
19. 3.1 3.4
2.5
6.5
7
6
5
4
3
2
1
0
K Lynch
predicted
figure
Gov. Survey
GMS 2 week
recollection
Gov. Survey
Private 2
week
recollection
UK
QRESEARCH
Audit Under
6s
IMJ GMS
Audit Under
6s
IMJ Private
Audit Under
6s
Lifeways
2006 GMS
Under 5s
Audit
Lifeways
2006 Private
Under 5s
Audit
Under 6s attendance rate: UK figures
20. 3.1 3.4
2.5
6.5 6.6
5.1
7
6
5
4
3
2
1
0
K Lynch
predicted
figure
Gov. Survey
GMS 2 week
recollection
Gov. Survey
Private 2
week
recollection
UK
QRESEARCH
Audit Under
6s
IMJ GMS
Audit Under
6s
IMJ Private
Audit Under
6s
Lifeways
2006 GMS
Under 5s
Audit
Lifeways
2006 Private
Under 5s
Audit
Under 6s attendance rate: NUIG figures
21. 3.1 3.4
2.5
6.5
5.8
2.7
6.6
5.1
7
6
5
4
3
2
1
0
K Lynch
predicted
figure
Gov. Survey
GMS 2 week
recollection
Gov. Survey
Private 2
week
recollection
UK
QRESEARCH
Audit Under
6s
IMJ GMS
Audit Under
6s
IMJ Private
Audit Under
6s
Lifeways
2006 GMS
Under 5s
Audit
Lifeways
2006 Private
Under 5s
Audit
Under 6s attendance rate: 2014 IMJ
What figures do you believe?
22. Individual Performance and Burnout
• Satisfying work provides autonomy, complexity, and a
connection between effort and reward - Malcolm Gladwell
• Should there be a relationship between the added value an
individual brings to an enterprise and remuneration?
Burnout
• Cognitive, emotional and physical intensity of job (Good features also)
• Patients poor access to resources/being deprived of their entitlements
• Lack of association between national policy and best evidence based
practice
• Politics/public service unions driving health care policy
• Clinical leaders having to cede all authority to administrators
• Lack of association between health care inputs and outputs
23. Burnout
• Regulatory bodies confusing bureaucratic achievements/ adherence
with hospital based protocols with good primary care
• Good work is penalised (particularly in US)
• Unnecessary administration/bureaucratic barriers to fair payment
• Hostile media
• General Practice exposed to much greater financial cuts than public
service
• Media/corporate healthcare influences on patients causing
inappropriate scaremongering.
• Patients unrealistic perceptions
• Constant weight of personal responsibility and public accountability
• Dealing with uncertainty
24. Affect of Stress or Burnout on Performance: Science; 2013
Being preoccupied with money problems affects attention
= 13 IQ points loss on formal cognitive assessment
= losing a night's sleep
= difference in IQ between a person who is a normal adult versus a
chronic alcoholic
Annals of Family Medicine; 2014
Care of the Patient Requires Care of the Provider:
The Triple Aim—enhancing patient experience, improving
population health, and reducing costs
Burnout is associated with lower patient satisfaction, reduced
health outcomes, and it may increase costs
Burnout thus imperils the Triple Aim
25. The paradox between current models of Primary Care and
evolving Evidence Based Medicine concepts
US Model
• Healthcare run by corporations
• Total health spend: 16.2% GDP
• 4% total health spend on general practice
• Fee-per-item with heavy emphasis on administration not true outcomes
• Focus on commoditising and fragmenting care
• Activity generation is promoted by hospitals buying up primary care
• Medicare / Health Maintenance Organisations policies promotes this by
paying more to GPs attached to hospitals
• Outcomes: Profit
• Most inefficient in the OECD
26. The paradox between current models of Primary Care and
evolving Evidence Based Medicine concepts
UK Model
• Universal Entitlement
• Total health spend: 8.9% GDP
• 8% public spend or 7% total health spend on general practice
• Very big GP practices – less continuity of care
• Capitation payments > Fee-per-item
• Focus political agenda primary care on consumer wants > needs
• Massive burden of clinical & social care as well as administrative
activity
• Rewarding easily measured outputs rather then true outcomes
• High death rates
27. The paradox between current models of Primary Care and
evolving Evidence Based Medicine concepts
Irish Model
• Oldest, Poorest & Sickest have Full Entitlement – Most Equitable
• Total health spend: 8.5% GDP
• 3.2% HSE spend or 2.5% total health spend is on GP
• Possible total spend including private income 3.8% (Gov. data)
• Smaller GP owned practices: more accessible, flexible,
innovative, personalised service & more continuity of care
• GMS Capitation payments > Fee-per-item/Private Fee-per-item
• General Practice is focused on consumer needs > wants
• Massive drive to corporatise, increase bureaucracy, commoditise
and fragment care, removing clinicians from policy decisions
28. The paradox between current models of Primary
Care and evolving Evidence Based Medicine
concepts – International comparisons
What Works Well
Small, motivated, well resourced GP led surgeries with good
administrative, nursing & I.T. focusing on personalised patient care >
disease care being paid on a predominantly capitation basis
What Does Not Work
Large, over-resourced, highly bureaucratic, corporate primary care
centres with good administrative and I.T. support where individual
clinicians focus on administering fragments of care rather than
whole patient outcomes being paid on a commoditised, fee-per-item
basis
William Behan
twitter@DrWilliamBehan