Reform of healthcare towards a more market-driven system could have a negative impact on patients, Irish GPs have been warned.
Health outcomes, such as childhood immunisation rates, disimproved following the restructuring of the health service in New Zealand, a meeting of the Irish College of General Practitioners was told. Dr Helen Rodenburg, president of the Royal New Zealand College of General Practitioners, said a series of changes to the health sector - which were largely driven by a market philosophy - resulted in a 10 per cent fall in childhood immunisations between 1996 and 1998.
The number of women requiring readmission after childbirth increased from 6 per cent to 10 per cent between 1996 and 1999, and the overall rate of hospital admissions also rose significantly over a 10-year period.
"Some of the possible reasons for these poorer outcomes were changed incentives for general practitioners to refer and to admit patients to hospital, and other barriers to primary care," she said.
New Zealand was one of the principal models used by the Department of Health here when it drew up the 2001 strategy, "Primary Care - a New Direction". However, as a result of poor outcomes - which Dr Rodenburg blamed on a lack of national co-ordination and restricted funding - the New Zealand Ministry of Health itself published a further primary healthcare strategy in 2001, which has been generally welcomed.
It proposes that all services, including general practice, be provided by primary health organisations (PHOs). All funding would be channelled through these organisations. The PHOs were specifically asked to "work with groups in their populations which have poor health or are missing out on services", Dr Rodenburg said. They must also provide a minimum set of essential community-based services and will be held accountable for the quality and effectiveness of the services they provide.
Dr Michael Boland, director of the ICGP Postgraduate Resource Centre said that "with smaller lists (of patients) and better access to diagnostic tests, GPs could do more and refer less often".
He warned against investing more funds in hospitals, specialists and equipment, as "this rarely resolves problems of overcrowding and long waiting times".
On maintaining standards in new and emerging models of general practice, Dr Boland said patients preferred to relate to an individual who integrated and co-ordinated their healthcare, rather than receiving "care by committee". For teamwork to be effective in a primary care setting, members would have to share a common vision, have good clinical records and work in close proximity to each other. "Each and every patient must have one care-leader," he said.
While emphasising that teamwork "is the way to go", Dr Boland said he was concerned that the new primary care teams could, if not structured properly, provide "fragmented care".