Delivery of primary health care to persons who are socio-economically disadvantaged: does the organizational delivery model matter?

Kalau saya yang baca artikel ini, take home message-nya adalah sebagai berikut. Cara organisasi membayar dokter mereka bervariasi. Model kapitasi tidak mendorong dokter semangat melayani penduduk miskin. Jadi jika diterapkan pada puskesmas, manajer kira-kira harus memikirkan lagi model insentif yang membuat tenaga kesehatan adil dalam memperlakukan pasien miskin. Jadi manajer harus mempelajari bagaimana organisasi lain membuat dokter happy, dan berusaha berkompetisi. Hal ini harus kita cari... Mub


Evaluated the delivery of primary health services for different socioeconomic groups and assessed the performance of different organizational models in terms of equality of health care delivery in Ontario, Canada. We assessed self-reported health status of patients, visit duration, number of visits per year, quality of health service delivery, and quality of health promotion. The used multi-level regressions to study service delivery across socio-economic groups and within each delivery model. Identified disparities were further analysed using a t-test to determine the impact of service delivery model on equity.

Result :

• Low income individuals were more likely to be women, unemployed, recent immigrants, and in poorer health. These individuals were overrepresented in the Salaried model, reported more visits/year across all models,and tended to report longer visits in the Salaried model. Measures of primary care services generally did not differ significantly between low and higher income/education individuals; when they did, the difference favoured better service delivery for at-risk groups.
•  At-risk patients in the Salaried model were somewhat more likely to report health promotion activities than patients from Capitation and Fee-For-Service models. At-risk patients from Capitation models reported a smaller increase in the number of additional clinic visits/year than Fee-For-Service and Salaried models. At-risk patients reported better first contact accessibility than their non-at-risk counterparts in the Fee For Service model only.

Primary care service measures did not differ significantly across socio-economic status or primary care delivery models. In Ontario, capitation-based remuneration is age and sex adjusted only. Patients of low socio-economic status had fewer additional visits compared to those with high socio-economic status under the Capitation model. This raises the concern that Capitation may not support the provision of additional care for more vulnerable groups. Regions undertaking primary care model reforms need to consider the potential impact of the changes on the more vulnerable populations.

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Refference :

Dahrouge S, Hogg W, Ward N, et al. Delivery of primary health care persons who are socio-economically disadvantaged: does the organizational delivery model matter? BMC Health Serv Res. 2013;13(1):517. doi:10.1186/1472-6963-13-517. 

Defi Monicha , KMPK 2014