J Korean Med Assoc.  2013 Oct;56(10):866-880. 10.5124/jkma.2013.56.10.866.

Standard model and quality appraisal framework for the organization of primary care

• Lee JH
• Ko BS
• Leem JH
• Lee SI

• KMID: 2193411
• DOI: http://doi.org/10.5124/jkma.2013.56.10.866

Abstract

During the past several decades, population aging and chronic diseases have been common burdens to nearly all the world's countries. To meet future health care needs, many countries have tried to improve the efficiency and equity of the health care system by reforming primary care. In the UK, which has already achieved a high level of strength in primary care, the Quality and Outcomes Framework (2004) was introduced and a great deal of the National Health Service (NHS) budget has been invested in primary care. In the US, a country with a low level of strength in primary care, to transform primary care practices to model practices, medical home movements such as the Patient-Centered Medical Home (PCMH) have been initiated after the development of the joint principles of the PCMH (2007) by 4 major societies of primary care. In Australia, despite having achieved high levels of health outcomes among the OECD countries, the Practice Incentives Program (PIP) has been introduced to respond to concerns about quality and coordination of care and prevention in 1998. In South Korea, a country with a very weak infrastructure in primary health care, where primary care has never been explicitly defined at the national level, the government is trying to improve quality in chronic care by using small financial incentives. The authors assert that a standard model and a quality appraisal framework for the organization of primary care are necessary to achieve the goals of primary care reform in this country.

Keyword

Primary health care; Quality; Republic of Korea

MeSH Terms

Aging
Australia
Budgets
Chronic Disease
Delivery of Health Care
Joints
Motivation
National Health Programs
Patient-Centered Care
Primary Health Care
Republic of Korea

Reference

1. World Health Organization, Regional Office for Europe. Trends in primary care: western Europe [Internet]. Copenhagen: World Health Organization, Regional Office for Europe;cited 2013 Aug 24. Available from: http://www.euro.who.int/en/what-we-do/health-topics/Health-systems/primary-health-care/facts-and-figures.

2. Organization for Economic Cooperation and Development. OECD reviews of health care quality. Korea 2012: raising standards. Paris: OECD Publishing;2012.

3. Thomson S, Osborn R, Squires D, Reed SJ. International profiles of health care systems [Internet]. New York: The Commonwealth Fund;2011. cited 2013 Aug 24. Available from: http://www.commonwealthfund.org/.

4. Starfield B. Primary care: balancing health needs, services, and technology. New York: Oxford University Press;1998.

5. Bourgueil Y, Marek A, Mousques J. Medical group practice in primary care in six European countries, and the Canadian provinces of Ontario and Quebec: what are the lessons for France? QES. 2007; 127:1–8.

6. Pedersen KM, Andersen JS, Sondergaard J. General practice and primary health care in Denmark. J Am Board Fam Med. 2012; 25:Suppl 1. S34–S38.

7. Vuorenkosky L, Mladovsky P, Mossialos E. Finland: health system review. Health Syst Transit. 2008; 10:1–168.

8. Royal New Zealand College of General Practitioners. A profile of New Zealand general practices in 2007. Wellington: Royal New Zealand College of General Practitioners;2008.

9. Primary Health Care Research and Information Service. General Practice size in Australia, 2005-06 to 2010-11 [Internet]. Adelaide: Primary Health Care Research and Information Service;cited 2013 Aug 25. Available from: http://www.phcris.org.au/fastfacts/fact.php?id=4970.

10. Tatara K, Okamoto E. Japan: health system review. Health Syst Transit. 2009; 11:1–164.

11. Physicians Foundation. A survey of America's physicians: practice patterns and perspectives [Internet]. [place unknown]: Physicians Foundation;2012. cited 2013 Aug 25. Available from: http://www.physiciansfoundation.org/uploads/default/Physicians_Foundation_2012_Biennial_Survey.pdf.

12. Ahn SH. Assessment of primary care level in Korea and comparison with the developed countries. J Korean Acad Fam Med. 2001; 22:483–497.

13. Feron JM, Cerexhe F, Pestiaux D, Roland M, Giet D, Montrieux C, Paulus D. GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study. Fam Pract. 2003; 20:167–172.

14. Baudier F, Bourgueil Y, Evrard I, Gautier A, Le Fur P, Mousques J. Group practice dynamics among private general practitioners from 1998 to 2009. QES. 2010; (157):1–6.

15. Campbell JL, Ramsay J, Green J. Practice size: impact on consultation length, workload, and patient assessment of care. Br J Gen Pract. 2001; 51:644–650.

16. Campbell SM, Hann M, Hacker J, Burns C, Oliver D, Thapar A, Mead N, Safran DG, Roland MO. Identifying predictors of high quality care in English general practice: observational study. BMJ. 2001; 323:784–787.

17. Kirchhoff SM. Physician practices: background, organization, and market consolidation [Internet]. Washington, DC: Congressional Research Service;2013. cited 2013 Aug 25. Available from: http://www.fas.org/sgp/crs/misc/R42880.pdf.

18. Grytten J, Skau I, Sorensen R. Characteristics of solo and group practices in Norwegian general practice. Tidsskr Nor Laegeforen. 2005; 125:1357–1360.

19. Lin HC, Chen CS, Liu TC, Lee HC. Differences in practice income between solo and group practice physicians. Health Policy. 2006; 79:296–305.

20. De Maeseneer J, Bogaert K, De Prins L, Groenewegen PP. A literature review. In : Brown S, editor. Physician funding and health care systems: an international perspective. London: Royal College of General Practitioners;1999. p. 18–32.

21. Organization for Economic Cooperation and Development. OECD health data 2013: frequently requested data [Internet]. Paris: Organization for Economic Cooperation and Development;2013. cited 2013 Aug 25. Available from: http://www.oecd.org/els/health-systems/oecdhealthdata2013-frequentlyrequesteddata.htm.

22. Lamarche PA, Beaulieu MD, Pineault R, Contandriopoulos AP, Denis JL, Haggerty J. Choices for change: the path for restructuring primary healthcare services in Canada, Ottawa [Internet]. Ottawa: Canadian Health Services Research Foundation;2003. cited 2013 Aug 25. Available from: http://www.cfhi-fcass.ca/migrated/pdf/researchreports/commissionedresearch/choices_for_change_e.pdf.

23. Bourgueil Y, Marek A, Mousques J. Three models of primary care organisation in Europe, Canada, Australia and New-Zealand. QES. 2009; (141):1–6.

24. Anell A. Choice and privatisation in Swedish primary care. Health Econ Policy Law. 2011; 6:549–569.

25. Sung NJ, Suh SY, Lee DW, Ahn HY, Choi YJ, Lee JH. Korean Primary Care Research Group. Patient's assessment of primary care of medical institutions in South Korea by structural type. Int J Qual Health Care. 2010; 22:493–499.

26. Lee JH. Desirable strategies to facilitate primary care in South Korea. Health Insur Policy. 2011; 10:8–23.

27. Lee JH. The dream of health cooperatives: a healthy community and a happy country. In : Lee JH, editor. The most humanistic health care. Goyang: Story Planner;2011. p. 21–32.

28. Cashin C. United Kingdom: Quality and Outcomes Framework (QOF). Washington, DC: The World Bank;2011.

29. National Health Service Employers. Quality and Outcomes Framework guidance for GMS contract 2013/14 [Internet]. Leeds: National Health Service Employers;2013. cited 2013 Aug 25. Available from: http://www.nhsemployers.org/Aboutus/Publications/Documents/qof-2013-14.pdf.

30. Cashi C, Chi YL. Australia: the Practice Incentives Program (PIP). Washington, DC: The World Bank;2011.

31. Agency for Healthcare Research and Quality. Defining the patient centered medical home (PCMH) [Internet]. Rockville: Agency for Healthcare Research and Quality;cited 2013 Aug 25. Available from: http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483.

32. National Committee for Quality Assurance. Standards and guidelines for NCQA's Patient-Centered Medical Home (PCMH) 2011 [Internet]. Washington, DC: National Committee for Quality Assurance;2011. cited 2013 Aug 25. Available from: http://www.iafp.com/pcmh/ncqa2011.pdf.

33. Accreditation Association for Ambulatory Health Care. Medical home [Internet]. Skokie: Accreditation Association for Ambulatory Health Care;cited 2013 Aug 25. Available from: http://www.aaahc.org/accreditation/primary-care-medical-home/.

34. National Institute for Health and Care Excellence. About the Quality and Outcomes Framework (QOF) [Internet]. London: National Institute for Health and Care Excellence;cited 2013 Aug 25. Available from: http://www.nice.org.uk/aboutnice/qof/.

35. Royal College of General Practitioners. Practice accreditation and quality practice award [Internet]. London: Royal College of General Practitioners;cited 2013 Aug 25. Available from: http://www.rcgp.org.uk/revalidation-and-cpd/practice-accreditation-and-quality-practice-award.aspx.

36. Royal Australian College of General Practitioners. Standards for general practices (4th edition) [Internet]. Victoria: Royal Australian College of General Practitioners;cited 2013 Aug 25. Available from: http://www.racgp.org.au/your-practice/standards/standards4thedition/.

37. National Committee for Quality Assurance. Start to finish: Patient-Centered Medical Home (PCMH) recognition [Internet]. Washington, DC: National Committee for Quality Assurance;cited 2013 Aug 25. Available from: http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx.