Dollars, debts and duties: lessons from funding Australian general practice

Area of Science:

• Health Services Research
• Health Policy
• General Practice Management

Background:

• Australian Divisions of General Practice operate under evolving funding models.
• New procedures link funding to nominated outcomes, impacting resource allocation.
• Understanding these shifts is crucial for effective health service delivery.

Purpose of the Study:

• To investigate changes in resource allocation and activities within Australian Divisions of General Practice.
• To analyze the impact of new outcome-based funding procedures on health service expenditure.
• To identify unintended consequences of accountability mechanisms in general practice.

Main Methods:

• Analysis of annual reports and strategic plans from 27 divisions.
• Semistructured telephone interviews with key personnel.
• Examination of expenditure and activity data in nominated health areas.

Main Results:

• Despite overall funding increases, expenditure decreased in National Health Priority Areas (mental health, diabetes, cardiovascular disease, injuries, cancer).
• Increased expenditure observed in immunisation (dedicated funding) and information technology/GP services.
• Activity selection became influenced by the ease of defining and measuring outcomes.

Conclusions:

• Outcome-based funding can lead to unintended resource allocation shifts.
• Areas with difficult-to-define outcomes may experience decreased investment, despite their importance.
• The accountability mechanism's design significantly influences service delivery and health improvement efforts.