Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Australia.
Center for Quantitative Economics, Jilin University, No. 2699 Qianjin Avenue, Gaoxin District, Changchun 130012, China.
Health Policy. 2021 Jun;125(6):717-724. doi: 10.1016/j.healthpol.2021.03.004. Epub 2021 Mar 24.
This study examines the association between primary care investment and performance, in 34 OECD countries for 2005-15. Specifically, we explore whether an increasing investment in primary care is associated with improved performance, and whether particular characteristics of organisation and delivery are associated with a better return on primary care investment. We take advantage of new data sources that provide rich information on health and health systems as well as economic and distributional characteristics. Multilevel modelling was utilised to analyse cross-country variation. The results show that greater investment in primary care does not improve health system performance for complex targets (i.e., no reduction in preventable hospital admissions) though there is modest improvement in breast and cervical cancer screening rates. We also found that those countries in which GPs are more aware of health promotion/preventive activities achieve higher screening rates with the same amount of investment. The findings imply that primary care investment strategies need to look beyond high-level expenditure and characteristics of primary care strength, to institutional and funding arrangements and how these link to policy goals. Despite broad enthusiasm for strengthening primary care in general, we conclude that primary care policy needs to be appropriately targeted to improve health system performance.
本研究考察了 2005 年至 2015 年间 34 个经合组织国家初级保健投资与绩效之间的关系。具体而言，我们探讨了增加初级保健投资是否与绩效提高有关，以及组织和提供的特定特征是否与初级保健投资的更好回报有关。我们利用新的数据源，这些数据源提供了有关健康和卫生系统以及经济和分布特征的丰富信息。采用多水平模型分析了国家间的差异。结果表明，尽管乳腺癌和宫颈癌筛查率略有提高，但增加初级保健投资并不能改善复杂目标（即，没有减少可预防的住院治疗）的卫生系统绩效。我们还发现，那些对促进健康/预防活动意识更强的国家，在投入相同的情况下，能够实现更高的筛查率。这些发现意味着初级保健投资策略需要超越高支出和初级保健实力的特征，关注机构和资金安排以及这些因素与政策目标的联系。尽管人们普遍热衷于加强初级保健，但我们的结论是，初级保健政策需要有针对性地进行调整，以提高卫生系统的绩效。
