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Strong primary care and patients' survival
Michel Wensing1, Joachim Szecsenyi2, Petra Kaufmann-Kolle3
1Full professor at Heidelberg University Hospital, Department of General Practice and Health Services Research and Implementation Science, Im Neuenheimer Feld, 130.3, 69129, Heidelberg, Germany. michel.wensing@med.uni-heidelberg.de.
Scientific Reports
|July 28, 2019
Summary
Germany's primary care reform, implemented in 2008, showed improved patient survival rates. Participation in chronic disease management programs significantly boosted survival, demonstrating the benefits of strong primary healthcare.
Area of Science:
- Health Services Research
- Public Health Policy
- Epidemiology
Background:
- Primary healthcare is fundamental to effective healthcare systems.
- Germany initiated a significant health system reform in 2008 to bolster primary care services.
- Key reform elements included voluntary enrollment, chronic disease management, specialist care coordination, quality improvement, and capitation-based payments.
Purpose of the Study:
- To evaluate the impact of Germany's primary care reform on patient survival.
- To compare survival rates between patients enrolled in the reform and a control group.
Main Methods:
- A comparative cohort study was conducted in Baden-Wuerttemberg, Germany, with a 5-year follow-up period starting in 2012.
- The study included 1,003,336 enrolled patients and 725,310 control patients.
- Survival analysis utilized a Cox proportional hazards regression model, adjusting for patient and physician characteristics.
Main Results:
- Enrolled patients exhibited lower mortality rates compared to control patients (Hazard Ratio: 0.978; 95% CI: 0.968–0.989).
- Enrollment in chronic disease management programs demonstrated an independent positive impact on survival (Hazard Ratio: 0.744; 95% CI: 0.734–0.753).
Conclusions:
- The findings suggest that strengthening primary care through such reforms is safe and potentially enhances patient survival.
- Intensive management of chronic diseases within primary care settings appears to be a key driver of improved survival outcomes.