A person’s first level of contact, with regards to the health system is known as Primary Health Care (French, S., Old, A., & Healy, J. (2001)). It is necessary, usually community based, health care aimed to be reachable to all everywhere and delivering health care nearer to people’s homes and workplaces (Gillies A. (2003). The primary providers of this type of health care are general practitioners (GP’s); however the number of nurses and midwives that are providing primary health care is rising (French et.al (2001)). Types of primary health care include the treatment of everyday problems such as sore throats, diabetes, etc. but also preventive care such as vaccinations and screening (Bodenheimer, T. S., and Brumbach, K. (2009)). Primary health care also requires continuity which allows a GP to track and ensure the health of a patient over time (Schoen, C., Osborn, R., Doty, M. M., Bishop, M., Peugh, J., Murukutla, N. (2007)).
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The next level up from primary health care is Secondary and Tertiary Health Care. Secondary requires the use of more specialised skill and equipment to fix the problems (Bodenheimer, T. S., and Brumbach, K. (2009)). Such services will usually be found in hospitals, inpatient services and outpatient clinics, as well as the occasional private clinics (French et al (2001)). This type of care is reserved for specialist doctors in such fields as neurology, gynaecology, general surgery amongst others and can only act as consultants through referrals from the person’s GP (Bodenheimer, T. S., and Brumbach, K. (2009)). Tertiary health care is for the more complex and expensive procedures with only a select few hospitals fully equipped to handle them, such as open heart surgery or organ transplants (Bodenheimer, T. S., and Brumbach, K. (2009)).
Nowadays the distinction between secondary and tertiary is blurred as technological advances have made previously complex procedures relatively uncomplicated, such as non-invasive surgery (French et.al (2001)).
Which primary health care services enhance individual health? Which ones enhance population health?
Due to the signing of the 1978 Alma Ata Declaration, a strong focus was put on primary health services, both to enhance individual health. Services that are designed to enhance the overall health of an individual include immunisation against many harmful infectious diseases such as measles and polio. These vaccines are usually administered by your general practitioner or nurse practitioner in your community. Another individual enhancer includes screening programs that allow us to identify any dangerous and/or deadly diseases or conditions present in a person, for such things as tumours (Gillies A. (2003)). Services that enhance population health are in most cases very large preventive, educational and recuperative services aimed at tackling the main health concerns of communities. Examples include the education of proper nutrition so people can eat more healthily, improved and satisfactory quality of water supplied to the population, better elementary public hygiene. When a threat of an endemic in the region/area occurs, the management of it to prevent further contamination of others is a large scale, and preventive, type of population health services. An important population health enhancer is the provision of services for soon to be or planning to be mothers and for those already with children, known as family planning. In some cases, for the health of people to be fully achieved, having access to very necessary drugs and medication is a service that enhances population health (Gillies A. (2003)).
What is ‘gatekeeping’? Describe the consequences of gatekeeping for patients and for the overall health system.
Gatekeeping is a concept wherein the availability of receiving a consultation from a secondary health care provider, such as brain or orthopaedic specialist, is limited to the patient without acquiring a written referral from their primary care provider (PCP), their general practitioner. This leads to the PCP acting as a ‘gatekeeper’ (or a general health co-ordinator) and is done to limit the number of referrals to specialist, diagnostic tests amongst other services with the promise of incentives for doing so due to certain financial agreements with these specialists (Bodenheimer, T. S., and Brumbach, K. (2009)). An exception to this is in the case of accident and emergency services (French, S., Old, A., & Healy, J. (2001)).
The consequences of this system for patients are that some will become annoyed with any limiting of availability to specialists. This is due to many patients insisting that they must have access to both adequate primary and specialty care, when they feel the need for more specialized care they have a problem with the constricting of access to them (Bodenheimer, T. S., and Brumbach, K. (2009)). Another consequence is that patients are ensured of receiving the correct treatment at the proper time in the right place (Bodenheimer, T. S., and Brumbach, K. (2009)). Also due to the PCP’s being able to deliver continuing and thorough care for patients, there are higher chances of improved health outcomes (reference required – WHO health network?)
PCP’s having more access to their patients and the gatekeeping role they perform have led to lower hospitalisation, usage of specialist and emergency centers and the odds of unnecessary health interventions and is considered to be more cost effective than going directly to a specialist (reference required – WHO health network?). The presence of such a system also appears to have a beneficial effect of lowering the need for costly and specialist-led hospital care (reference required – WHO health network?).
In New Zealand we have a health care system in which most primary care requires payment from recipients of care, yet almost all higher level care is free.
What problems are likely to arise from this ‘dual system’?
Unnecessary use of hospitals and ambulances, less access for poorer people, Robin Hood effect, inverse care law, funding, cost, define,
What, if any, are some positive features of this system?
Security felt by people who otherwise couldn’t afford,
Identify some (4-5) indicators that provide evidence of the extent of problems.
GP’s per capita in certain areas, unnecessary hospitalisation, wrongful budget spending (over and under), quality of care by GP’s who believe patients are fine,
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