Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed

HMO versus non-HMO private managed care plans: an investigation on pre-switch consumption

Managed care, Treatment effect analysis, Propensity score, Matching method,

Rationale, Principles, and Educational Approaches of Organizational Transormation

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74822/1/j.1525-1497.1999.00265.x.pd

Nuevo profesionalismo, educación médica y sistemas de salud New professionalism, medical education and healthcare systems

El propósito de este artículo es discutir de qué modo el denominado "nuevo profesionalismo" puede ayudar a que la educación de los médicos se haga teniendo en cuenta los efectos de la globalización tanto sobre la situación de salud como sobre las necesidades de profesionales sanitarios, con particular énfasis en los países de la Unión Europea los cuales están inmersos en un profundo proceso de reforma de sus enseñanzas universitarias. Para ello, en primer lugar se presentan los conceptos básicos del "nuevo profesionalismo" y de las estrategias fundamentales de la educación médica actual que trata de formar médicos capaces de afrontar los retos éticos, científicos y profesionales que se plantean a comienzos del presente siglo. A continuación, se insiste en la interdependencia de las reformas del pregrado, del posgrado y de la formación continuada. Se plantean luego los retos y dificultades que han de afrontarse a la hora de cambiar las distintas etapas de la educación médica. Y se concluye que, pese a lo reciente de las reformas de la educación médica, a su gran complejidad, y a la todavía escasa disponibilidad de evaluaciones contrastadas sobre sus resultados, existen fuertes sinergias entre los principios y valores del "nuevo profesionalismo" y los objetivos de las reformas.<br>The scope of this paper is to discuss how so-called "new professionalism" can help in how the education of physicians is conducted, by taking into account the effects of globalization both on the situation of health and on the needs of health professionals with particular emphasis on European Union countries, which are engaged in a profound process of reform in university education. To achieve this, first we present the basic concepts of "new professionalism" and the key strategies of current medical education, which is to train physicians capable of dealing with ethical, scientific and professional challenges that are arising at the beginning of this century. The interdependence of reforms in the undergraduate, graduate and ongoing training areas is then emphasized. The challenges and difficulties to be faced when switching to different stages of medical education are then outlined. It was concluded that, notwithstanding recent reforms in medical education, their great complexity and the still limited availability of contrasting assessments of their results, there are strong synergies between the principles and values of the "new professionalism" and the objectives of the reforms