Economic evaluation and the shifting balance towards primary care: definitions, evidence and methodological issues

Current UK government policy places considerable emphasis on shifting the balance of health care provision from secondary towards primary care. Despite this emphasis, however, there has been very little economic evaluation of initiatives designed to achieve this shift. In view of this deficiency, our article has three main aims. First, it offers a working definition of shifts in the balance of care at the primary-secondary care interface. Second, it systematically reviews the existing literature on the cost-effectiveness of initiatives designed to shift the balance of care. Third, it identifies a range of methodological issues that need to be addressed if future economic evaluations in this area are to be carried out satisfactorily.