Primary care, cost-effectiveness, and playing at being bad cop

At the International Forum on Quality and Safety in Healthcare which had 3500 delegates last week in London, Martin Marshall (Professor of Healthcare Improvement at UCL’s DAHR) and myself debated whether primary care really saves money and improves health outcomes. Marshall played ‘good cop’ and trotted out the well-known Starfield data which shows that countries with primary care systems provide cheap and effective health care, along with data from the Commonwealth Fund surveys which generally show the UK in a good light. But ‘bad cop’ Roland was not so sure and suggested there was often a big gap between the rhetoric of what primary care promised and what it actually delivered. Most of the audience (largely from primary care) were comfortable with the ‘good cop’ story, but no-one was prepared to explain why the lady from Taiwan had a system with no GPs, direct access to specialists, and good outcomes at 3.5% of GDP. So does primary care need to do more to demonstrate its cost-effectiveness? And how much of a good thing is too much of a good thing?

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