Monday, June 4, 2012

[EQ] The Economic Impact of Improvements in Primary Healthcare Performance

The Economic Impact of Improvements in Primary Healthcare Performance PHC

Simone Dahrouge, Rose Anne Devlin, Bill Hogg, Grant Russell, Doug Coyle, Dean Fergusson
Canadian Health Services Research Foundation – CHSRF – 2012

Available online PDF [89p.] at:

This report presents the results of four different approaches to evaluate the economic impact of enhancements to PHC:

1. A synthesis of the literature on the macro- and micro-economic effects of good health, with specific relevance to PHC performance.

2. A systematic review of the economic impact of incorporating a pharmacist into a Primary Healthcare Performance PHC practice.

3. A simulation exercise that evaluates the economic impact of improvements to influenza immunization rates for older adults
    brought about by provider reminder systems in PHC.

4. A literature review of reductions in burden of illness associated with four specific enhancements to chronic disease management in
    PHC that produce health benefits. These include PHC improvements that result in improved blood pressure control,
    enhanced diabetes management, increased uptake of cancer screening and improved continuity of care….”

“….Three of the four approaches used in the report suggest that improvements to the performance of PHC in Canada would yield economic benefits.
Better health outcomes have a positive impact on employment, productivity and economic growth.
Simulation results indicate that increasing the influenza vaccination rate of the elderly population results in cost savings.
Improved health outcomes for chronic disease management were linked to cost savings through reductions in hospitalizations, professional visits, emergency room visits and increased productivity; and higher continuity of care was associated with lower resource utilization and reduced healthcare costs.

Despite literature that shows a positive health benefit of pharmacist integration in PHC, studies of the economic impact are inconclusive…..”


The gaps in Canada’s PHC performance level

Technical quality of care (Figure 1)

Accessibility (Figure 2)

Quality improvement initiatives (Figure 3)

Practice organization (Figure 4)

Interventions to improve quality in primary healthcare

Quality improvement initiatives

Information technology

Human resources

Economic impact of improvements in PHC

The link between PHC services and economics: A review of the literature

The link between PHC and health (Arrow 1)

Macroeconomic factors and health (Arrow 2)

Microeconomic factors and health (Arrow 3)


The economic impact of adding a pharmacist in a PHC practice:

A systematic review

A simulation of the impact of improvements in influenza vaccination rates

Model based simulator

Scenarios – Data – Results - Sensitivity analysis


Economic impact of improvements in selected indicators






Recommendations and expert commentaries


National coordination body

Investments in primary healthcare

Investing in high quality PHC research/evaluation




Appendix: A: Result-based logic model for PHC

Appendix: B: OECD framework

Appendix: C: Synthesis of review literature – study protocol

Appendix: D: Description of studies included in the section on interventions to improve PHC performance

Appendix: E: Systematic review – study protocol

Appendix: F: Quality assessment checklist and quality assessment results

Appendix: G: Flow diagram summarizing the flow of information through the different phases of the systematic review

Appendix: H: Included studies

Appendix: I: Elderly population projections from 2010 to 2036

Appendix: J: Population vaccination rates for elderly population in 2007

Appendix: K: Simulation results by province
Appendix: L: References



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