Proposals for changes in primary health care - position of OZPSP

1. organization of night and Christmas health care

The OZPSP postulates that the organization of the NICU should be transferred from the competence of hospitals to primary care clinics. This is because it is a service closely related to primary health care and should be provided by family physicians. One solution could be a rotating system in which individual outpatient clinics would take turns being responsible for S&H.

However, if a decision is not made to change the locations of the SCAs, the CPSP proposes to create a mechanism to oblige PCPs to work as SCAs in the area of operation of their clinics. In addition, it is postulated:

• Elimination of the requirement to conduct laboratory tests under the SCA.
• Increase the lump sum for the operation of S&H, bringing it in line with actual costs, including staff salaries.

2. improve the functioning of the PCP and reduce unwarranted referrals to the ED

There are frequent cases of PCPs referring patients to hospital emergency departments or emergency rooms without clear medical indications. Sometimes patients are also referred to NICUs despite reporting during clinic hours. OZPSP is calling for the implementation of financial mechanisms that:

• They will encourage PCPs to treat patients comprehensively in primary care.
• Introducing quality indicators in the evaluation of POZ.
• Modification of the financing system for POZ, taking into account both the standby fee and the services actually provided.

3. control of working time of PCPs

Another major problem is the failure of some PCP clinics to observe mandatory working hours. OZPSP proposes that in cases of non-compliance, clinics should be obliged to contract with neighboring facilities or hospitals, covering the cost of replacement.

4. increase diagnostic budgets in POZ

Many patients go to outpatient specialty care without basic diagnostic tests. The lack of adequate diagnostics at the PCP stage delays the treatment process and reduces the availability of specialized care for other patients. OZPSP postulates:

• Set aside a separate budget for laboratory and imaging diagnostics in the POZ.
• Expanding the basket of tests that a family doctor can order.

5. integration of diagnostic databases of POZ and hospitals

In order to streamline the diagnostic and therapeutic process, OZPSP recommends requiring PCPs to use the diagnostic base of the nearest county hospital. This would allow doctors to more quickly access a patient's current test results, which:

• It would speed up medical decision-making.
• It would improve the financial efficiency of the health care system.
• It would increase patient safety.

6 Strengthening preventive health care in the PCP

The increase in the incidence of cancer and lifestyle diseases, such as diabetes and cardiovascular disease, calls for intensified prevention efforts. OZPSP advocates:

• Strengthening the role of PCPs in conducting preventive examinations.
• Creating systemic tools to help PCPs detect and monitor diseases early.

Source: OZPSP