Devolved budgetary responsibility in primary care. A cross-country assessment of the impact on efficiency

General Practitioners and primary care physicians have a pivotal role in the allocation of health care resources in most countries. With increasing costs of care, they have therefore become a significant focus for healthcare reform in the pursuit of increased efficiency. For example, the United Kingdom (UK), United States of America (USA), New Zealand (NZ), Germany and The Netherlands, have all pursued reforms introducing explicit budgetary responsibilities for primary care. While there is a common set of objectives underlying such budgetary responsibilities, different versions have been introduced to reflect specific health environments. As most of these reforms were introduced in the early to middle 1990s, it is timely to examine their impact on efficiency. This paper therefore provides an econometric assessment of the effect of budgetary arrangements in the UK, USA, NZ, Germany and The Netherlands on the growth of primary care expenditure and flow-on costs (as proxied by pharmaceutical expenditure), as proxy indicators for efficiency. The results suggest that for all countries there is some support for efficiency improvements through the implementation of budgets for primary care.