Why Primary Health Care? And Difference Between Secondary and Primary Health Care - GO HEALTH TOWN


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Monday, October 7, 2019

Why Primary Health Care? And Difference Between Secondary and Primary Health Care

Why Primary Health Care? And Difference Between Secondary and Primary Health Care

What is meant by primary health care, how to assess its impact on the health of populations and what can be read about the lack of resources allocated to them.

Brief Definition Of Primary Health Care

Primary health care refers to primary care, which is the level of the care system that is the gateway to the health care system, providing general, comprehensive, ongoing care, integrated, accessible to all, and that coordinates and integrates services needed at other levels of care (Macinko 2003).

A more complete definition of primary health care missions is proposed below.

It seems essential at this stage to agree on the words to have a common language but also to get out of wrong value judgments. The confusion of primary care / primary health care is one of those difficulties.

If we observe a health system from the supply of services, we must be able to raise levels of health care provision: at its base, the primary level, not segmented, nor by age, sex or type of problem, neither by body nor by users' financial capacity. This primary level is supposed to be able to meet 90% of the health problems of an unselected population. Then the secondary level, reference level, and finally the tertiary level, that of high-tech medicine (university hospitals). These last two levels are by definition specialized and therefore segmented.

The other angle of observation is that of the demand, of the place where the patient makes contact with the system and presents his problem. This place will be the first line. Especially in our country where access to the different levels is not staggered and therefore free, the first line can be located in many places, including in the secondary and even tertiary level: the emergency services are one of them. Example, but a Brussels menopause center too.

The role of primary health care should not be defined in isolation but in relation to other constituents of the health system. Primary and secondary care, both general and specialized, all have important roles. They are not mutually exclusive but necessary to the system. However, advances in technology, improved education and training, changing needs related to epidemiological transition, social and lifestyle changes are increasing the need for primary health care, and calling for an organization such primary care is in the majority of cases the first line.

A health system based on primary health care is more efficient, more efficient and of better quality.

The Point Of View Of International Organizations

In 1978, primary health care became one of the key policies of the World Health Organization when the Alma-Ata Declaration and the "Health for All" Strategy were adopted in the course of the year. 2000 "(WHO 1978).

1. World Health Organization

For example, the World Health Organization has stated in the Lubljana Charter on Reforming Health Care, among its fundamental principles, the need for European health systems to be oriented towards primary health care and to enable through these primary care, to promote health, improve quality of life, prevention and treatment of diseases, rehabilitation, management of pain and palliative care, patient participation in decision-making regarding their health, integration and continuity of care, taking into account the specific cultural context (WHO 1996).

In its World Health Report 2003 - Shaping the Future, the World Health Organization strongly encourages a major shift towards the model of health systems based on primary health care. This report states that, twenty-five years after the declaration of Alma-Ata, many in the world of health consider essential to privilege primary health care for a fair progression of health. The World Health Organization considers that primary health care covers key principles, including universal access to care, need-based coverage, commitment to health equity in the context of development-oriented towards social justice, community participation in the definition and implementation of health programs, the adoption of inter sectoral approaches to health.

"Experience shows that the best results are achieved in health systems with integrated and effective primary health care services, probably because they provide more comprehensive and coordinated longitudinal services."

2. OECD Economic Surveys

The OECD Economic Surveys - Belgium 2005 (OECD 2005), after analyzing the Belgian health situation, makes these recommendations: "The government should vigorously encourage patients to take the principle of consulting their GP in the first place (unless in case of emergency) ; for this reason, it should not reimburse the medical expenses of patients who have not been referred by their GP. "

For the OECD, the lack of staggering in Belgium leads to an inadequate use of medical resources by patients. Current attempts to increase incentives to go through the GP are not strong enough. Increasing the responsibility of generalists by adding the role of gate keeper, induced by staggering, must be paid. The need for an integrated health care system is made explicit, with a pivotal role for the GP. In addition to this role of gatekeeper, the role of coordinating long-term care processes and being the primary source of contact for the patient and family is also recognized. By the example of the provision of adequate guidelines, the OECD cites the need for the system to give generalists the necessary means to ensure their growing role.

As for the financing of primary health care, we will cite again this OECD report (OECD 2005), which gives a good summary of what is happening in Belgium: "In Belgium, doctors are paid on a fee-for-service basis. This mode of remuneration encourages practitioners to inflate the volume of acts by performing unnecessary services and prescriptions. A capitation system may encourage practitioners to subcontract their patients, to refer more quickly to the second line or to select people with a low risk of illness. In response to the dead ends of the two payment methods, some countries are moving towards a more complex payment system that combines a fixed part (capitation or salary) with a fee-for-service payment for certain specific interventions ".

3. EU Health Community

At the informal EU conference Shaping the EU Health Community in Den Haag on 7-9 September 2004, no fewer than 440 health care experts from the 25 Member States of the European Union come together to make recommendations together to the ministers of health of the countries Among these recommendations was the high priority of primary health care and public health in the development of health systems. There was also the need to postpone the dependency of older people as much as possible, by promoting health and maintaining as much health as possible, which we think could be the best missions in the world of the health care system, to be supported by first-level health care (Van Bennekom 2004).


Evidence in the scientific literature

If one looks in the international scientific literature, one can also find objective arguments in favor of the development of primary health care.

1. Starfield and Shi (Starfield 2002) 

Starfield and Shi (Starfield 2002) ranked thirteen industrialized countries with more than five million people according to the level of importance attached to primary health care in their health system, and compared them for indicators of health population, and the cost of health services. The authors observed that the more the system has a strong focus on primary care, the lower the costs of all health care services. The impact of a primary care orientation is also positive on a variety of population health indicators, particularly in the early years of life of the population. A positive impact is also felt for older people, but will be more sensitive to the importance of overall health system financing and first- and second-line coordination, which should enable effective referrals to specialize and more of need.

Among the fifteen characteristics used to score the countries studied, three health system characteristics and two characteristics related to primary care practices distinguish in particular the least performing countries in terms of primary health care. System-related and underperforming characteristics in poorer performing countries are: equitable distribution of resources, universal insurance coverage, and low direct personal financial participation; the characteristics of primary care practices are the provision of comprehensive primary care services and family-oriented services. According to Starfield and Shi, a health system reform that, in addition to placing greater emphasis on primary health care, would focus on these characteristics, should contribute to better overall health, and a lower level of health cost.

A similar study of ten countries in 1991 (Starfield 1991) also found a positive impact of primary care developed. It was further indicated that the outcomes of health care services are also influenced by the presence and performance of other social services, and an adequate public education system.

According to these two studies, Belgium ranks among the lowest-ranked countries for the place left to primary health care.

According to Starfield (Starfield 2005), the number of active general practitioners has a positive influence on health indicators, while once a certain threshold is exceeded, the growing number of specialists has a negative effect. Primary health care also improves the equity of health services. A health system based on sustained primary health care would, therefore, be more equitable, more effective and more efficient.

According to B. Starfield, primary health care actors allow adequate management of front-line demands, with a baseline after necessity assessment, as opposed to specialists whose job is to search for "zebras among horses ". Primary care providers can, therefore, limit unnecessary technical examinations. Primary health care also provides a holistic approach to the different co-morbidities presented by patients taking into account the social, family, psychological, cultural particularities of the person. The specialists have the function to focus on pathologies related to specific spheres of medicine and to control them well. If the two professions are complementary, patients are in great need of the function of synthesis and monitoring of generalists. Finally, primary health care is best placed to monitor the overall health of the population, and to identify the most frequent and important needs.

2. Macinko

Macinko et al. (Macinko 2003) also studied OECD data from 1980 to 1998 to study the contribution of primary health care to health indicators. Their study allows them to observe that the emphasis on primary health care is inversely associated with all-cause mortality, premature mortality for asthma, bronchitis, emphysema, pneumonia, cardiovascular disease, and heart disease. The author concludes that a strong primary care system and practice characteristics such as geographical regulation of supply, continuity, coordination, community orientation are associated with better health of the population.

The authors also note that in all these years, few countries have improved the basic essentials of their primary care system, and this is true for Belgium, which since 1980 has kept the same score, among the lowest.

There is a long list of bibliographic references, which also show a correlation between the development of primary health care, better results for health indicators (morbidity and mortality), better user satisfaction and lower costs for social security systems. At the European level, there is the summary report of the Health Evidence Network (HEN), a service of the World Health Organization Europe, published on the basis of extensive bibliographic research (more than one hundred references) or the European report. Primary care, published by the Dutch Gezondheidsraad in 2004 (Gezondheidsraad 2004), which also reports on a lengthy literature search showing the highest efficiency and effectiveness of health systems based on sustained primary care. ï¾

Patient Satisfaction

The same Health Evidence Network study (HEN 2004) reports that, except in the UK (probably for reasons of too small overall budget allocated to the health system), the level of satisfaction is higher in the countries that provide care important primary health care. For example, Denmark has the highest rate of public satisfaction with health care, which is attributed to the high availability of primary health care in that country. But patient satisfaction also depends on the type of services offered by primary health care: delivery mode of care, accessibility outside office hours, identified GP, continuity, prevention.

A survey conducted by Health Test (Health Test 2000) with a representative sample of the Belgian population, provides information that:

  • 95% of people already have a doctor, and 75% the same for more than five years. Of the 5% without a GP, more than half would be willing to limit themselves to one GP, either spontaneously or if there is a financial incentive.

  • 90% of respondents favor a centralized medical file, and among them, 92% find that it is the generalist who must be the holder of this task. 87% felt that specialists should be obliged to send the results and examination reports to the GP holding the file.

  • Staggering gets less adhesion. However, a number of patients would return to the GP for first contact if there was a financial benefit to doing so. It should be noted in the comments of this survey, the lack of knowledge of the population on both curative and preventive activities that can be advantageously performed in general practice.

This information shows that for the population too, the general practitioner, the central actor of primary health care is very important. This is not why resistance to the development of primary health care should be explained as the basis and basis for public health care.

According to the same article reporting a survey of general practitioners, they consider enrolling all patients in a doctor of their choice as a priority for the reorganization of primary care. This would mean that the opinion of many generalists does not correspond to what some voices in the profession want to imply.

But Then, Why Do Not We Develop More Primary Health Care?

This is the question posed by the Health Evidence Network (HEN 2004): despite the accumulation of evidence for primary health care, the allocation of resources, in most countries, still favors hospitals and care specialized.

Part of the reason, according to this report (HEN 2004), is the perception of what primary health care is, what it has to offer: policy makers, as well as many health professionals see it as a low-level activity, with a low effect on mortality and morbidity, and as having a triage role for access to hospitals, rather than considering their actual and positive contribution to health gain. .

This inefficiency in resource allocation, however, has implications for the fairness and efficiency of services. This could explain why increasing public spending on the health care system does not improve equity of access or outcomes proportionally, and has less impact on average health status than might be expected. It therefore seems that politicians, health professionals, and the public need to be better informed about the concept of primary care and the benefits they can bring.

In Belgium, primary care and general medicine, which is the backbone, have been in crisis for several decades. These social and health professions, which are fundamental, are the subject of a disenchantment of professionals and public authorities: training conditioning, absorption of all care by the second and third levels (hospitals and services academics) low political interest highlighted in several international studies, derisory financial allocations for missions theoretically assigned to primary care.

We note the existence in Belgium of multiple models of primary care dispensation. Without clearly defined policy orientations, individual or collective providers will pursue their own goals, logically and understandably. These models can either converge if one organizes them in this direction, or camp on irreconcilable positions.

In the absence of these choices, we fear that the general "outpatient" sector will be confined to filling the tasks abandoned by the hospital sector by default; local services will dry up and home care will be structured solely in relation to the management of hospital flows. In quantitative terms, at the financial level, we would witness the increase of the current inflator trend, and in qualitative terms, on the human level, we would mortgage the taking into account of individuals as a whole and the humanization of care structures.

The World Health Organization, in its World Health Report 2003, states that while quality of care depends to some extent on individual caregiver characteristics, levels of performance are much more dependent on the organization of the health care system where the work is done. For the World Health Organization, recognizing that the quality of health care is primarily system-related is the first step towards improving both the process and the outcomes of health care.

Primary Care Vs Secondary Care

Health care involves the diagnosis, treatment and prevention of illness, injury or mental disorder. Health care is provided by qualified professionals to improve well-being. Several countries have different health systems. Some are free and others are paid, and some countries have a mixed system. The general configuration includes the curative, preventive and administrative sectors. The exact hierarchy differs from country to country. The health sector has levels depending on the delivery of health care: primary, secondary and tertiary.

What Is The Difference Between Secondary And Primary Health Care?

  • Primary health care is for a larger group, while secondary health care is for a few people. 

  • Primary care is the first contact, while secondary care may or may not be the first contact according to the national health system. 

  • The primary care system allows patients to self-guide, while the secondary care system gets self-referral patients as well as primary care centers.

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