Organization and financing of British primary care groups and trusts: observations through the prism of US managed care.
There are many parallels between the UK's new primary care commissioning organizations and the managed care organizations and integrated delivery systems that have evolved in the USA over the last three decades. Those building primary care groups and trusts (PCG/Ts) can learn from the American experience with health maintenance organizations and other similar entities. These lessons should also be relevant to those in other countries interested in establishing innovative primary care led organizations within the broader structure of a socialized health care system. Following an overview of US managed care and an update of the progress of the UK's PCG/Ts, we go on to suggest how new consortia of PCG/Ts might be developed and how budgets and provider incentives could be structured. This international comparison suggests that the resources needed to support the development of effective PCG/Ts will be considerable, as will the need to maintain organizational flexibility. If primary care organizations are to thrive, it will be essential to develop truly integrated budgets for primary and secondary care.
Weiner
Jonathan
J
Johns Hopkins School of Hygiene and Public Health, Johns Hopkins University, 624 North Broadway, Room 605, Baltimore, MD 21205, USA.
Gillam
Steve
S
Lewis
Richard
R
D002017:Budgets; D003266:Continuity of Patient Care; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D017146:Models, Organizational; D009936:Organizational Innovation; D011320:Primary Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive; D013222:State Medicine / Q000458:organization & administration*; D006113:United Kingdom; D014481:United States