Although written in the US context, an interesting piece on pressures for change on healthcare, driven by aging populations, more chronic disease and cost pressures. Particularly relevant is his discussion of family doctors (primary care providers), and the potential greater role they can play in prevention. Quote:
Another approach gaining rapid popularity is to switch to retainer based practices, sometimes called concierge or boutique practices. The basic concept is to limit one’s practice to 500 patients rather than the typical 1500-2000 or more. This means more time per patient. So in return for a fixed fee of about $1500-2000 per year the PCP agrees to be available by cell phone 24/7 and by email. He or she will see you in the office within 24 hours of a call. You get as much time as needed for the problem at hand. And the PCP will visit you in the hospital, the ER or the nursing home – maybe even do a house call.
The result is better quality. But there is more. Since the doctor now has the time – the patient now gets much more preventive care attention. And if a patient has a chronic illness, the PCP will take the very real time needed to coordinate that care. This will mean much better care from the specialists and will avoid unnecessary tests, scans and procedures. Better care at less expense. – One more very disruptive and I would say transformational changes occurring in medical care delivery.
While this particular approach is unlikely to work in public systems, the underlying philosophy of tweaking payment approaches to focus more on prevention are needed, as that is where the biggest potential savings are.