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Total purchasing in primary care: three case studies.

S Abbott1, S Harrison, N Walsh

  • 1Health and Community Care Research Unit, University of Liverpool, UK.

Journal of Management in Medicine
|June 10, 2000
PubMed
Summary
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Total Purchasing in Primary Care (TPPC) initiatives faced organizational and behavioral change challenges. While influencing some services, TPPC struggled to significantly reduce hospital admissions and lengths of stay.

Area of Science:

  • Health Services Research
  • Primary Care Management
  • Healthcare Policy

Background:

  • Total Purchasing in Primary Care (TPPC) was piloted in the mid-1990s.
  • Early evaluations of pioneer sites revealed challenges similar to later pilot sites.

Purpose of the Study:

  • To evaluate the challenges and successes of Total Purchasing in Primary Care (TPPC) implementation.
  • To assess the impact of TPPC on healthcare delivery and hospital utilization.

Main Methods:

  • Analysis of evaluations from three pioneer TPPC sites.
  • Comparison of challenges faced by pioneer and pilot TPPC sites.

Main Results:

  • TPPC sites needed to develop effective internal organizations and external relationships with other health agencies.

Related Experiment Videos

  • Difficulty was encountered in changing the behavior of local acute care providers.
  • TPPC and GP fund holding showed success in influencing elective and community service delivery patterns.

    • Conclusions:

    • Implementing TPPC requires significant organizational development and inter-agency collaboration.
    • Influencing acute care provider behavior and reducing hospital admissions/lengths of stay remain formidable challenges for TPPC initiatives.