Task Shifting and Health System Design : Report of the Expert Panel on effective ways of investing in Health (EXPH)

4 1. BACKGROUND . 6 2. TERMS OF REFERENCE. 7 3. OPINION. 8 3.1. Primary care and health system performance. 8 3.1. 1. Primary care scoping. 8 3.1. 2. Health system goals. 9 3.1. 3. Challenges for health systems in a changing world . 11 3.2. Primary care: definition . 14 3.2. 1. History . 14 3.2. 2. Core definition. 18 3.2. 3. Developments in primary care . 20 3.3. The role of referral systems in strengthening health system performance. 26 3.3.1. What is the purpose of referral? 26 3.3.2. What makes an effective referral system? 27 3.3.3. Conclusion. 30 3.3.4. Areas for future research . 31 3.4. Financing primary care . 34 3.4. 1. Ensuring an adequate level of financing for primary care . 34 3.4. 2. Ensuring equitable access to primary care . 37 3.4. 3. Paying providers to promote efficiency and quality in primary care delivery, including financial incentives to improve care coordination. 41 3.4. 4. Areas for future research . 46 3.5. Conclusions and recommendations . 49 4. PUBLIC CONSULTATION. 53 5. MINORITY OPINION. 53 6. LIST OF ABBREVIATIONS . 54 7. REFERENCES. 55 8. GLOSSARY . 62 Definition Primary Care – Final opinion v2 6 1. BACKGROUND The Health and Consumers Directorate General (DG SANCO) of the European Commission seeks to investigate how European health systems could benefit from a better integration between different levels of health care, both in terms of increased costeffectiveness, and in terms of improved quality of care and equity. This investigation should likely be organised along the following three lines of research: First, develop a common understanding of the concept of primary health care in the EU, including its goals, functions, and the players involved, and illustrate differences in implementation. Furthermore, identify the differences between community-based care and primary care and the defining factors of both concepts that can be applied across the diversity of European health systems. Second, a deeper reflection is needed on the role of effective referral systems in ensuring integration between all levels of the health system and in helping to ensure that people receive the best possible care closest to home. An up-to-date overview of referral systems in the EU is actually not available. Third, investigate how to identify and analyse existing typologies of funding mechanisms in primary health care: to individual providers (e.g. fee-for-service, capitation, salaried staff, mixed systems), and at higher organisational levels (e.g. lump-sum envelope systems and case-mix adjustments). The aim is to identify how financing mechanisms may contribute to the functioning of primary care especially in relation to the integration of care, both within primary care and in relation to other sectors. Definition Primary Care – Final opinion v2 7 2. TERMS OF REFERENCE The Expert Panel on effective ways of investing in Health (EXPH) is requested to provide its views on how to structure the investigation, its objectives and the main lines of research and methodology to be adopted on how better integration of care could contribute to cost effective and high quality health care systems. In particular, the Expert Panel should: 1. Provide SANCO with a comprehensive and operational definition of primary care which includes goals, functions, and players involved. It should also define community-based care, explain the differences with primary care, and present the defining factors of both concepts that could be applied across the diversity of European health care systems. 2. Pronounce itself on the role of effective referral systems in ensuring integration between all levels of the health system and helping ensure that people receive the best possible care closest to home. The panel should also provide advice as to whether a dedicated study on referral systems is needed. 3. Identify the main investigation lines which should be pursued in analysing the financing of primary health care and integrated care in order to guide DG SANCO's future activities on financing mechanisms in primary health care. Definition Primary Care – Final opinion v2