When is a GP home-visit program financially viable?
Ian McRae A B and Mai Pham AA Research School of Population Health, Building 63, Corner Mills Road and Eggleston Street, The Australian National University, ACT 0200, Australia.
B Corresponding author. Email: ian.s.mcrae@anu.edu.au
Australian Journal of Primary Health 22(6) 554-558 https://doi.org/10.1071/PY15074
Submitted: 21 January 2015 Accepted: 18 December 2015 Published: 6 July 2016
Abstract
Despite a decline in GP home visits in Australia, these services remain an important aspect of healthcare access and delivery for the aged population. Home visits can both provide better care and decrease use of ambulance and emergency department (ED) services. The net costs of providing GP visits are complex, depending on the relative costs of home visits and ED attendances, the number of ED attendances saved by GP visits, and the number of services provided per day by a visiting GP. The Australian Capital Territory government created the General Practice Aged Day Service (GPADS) program in March 2011. Using data and information from this program as a basis, we examine the financial aspects of a daytime home-visit program in the Australian context. Whether or not a program is financially viable depends on a range of parameters; if all factors are aligned a program can generate net savings. While there is no information available on the net health benefits of home visits relative to ED attendance, these differences need not be large for the program to be cost-effective.
Additional Keywords: benefits, costs, general practice, home visit, residential aged care.
References
ACT Ambulance Service (2014) Fees and charges. Available at http://esa.act.gov.au/actas/fees-and-charges/ [Verified 23 September 2014]Australian Medical Association (AMA) (2008) AMA survey of GP visits to residential aged care facilities October 2008. Cited in Saunders C (2010) GP NSW Submission – Productivity Commission public enquiry – Caring for Older Australians. Available at http://www.pc.gov.au/inquiries/completed/aged-care/submissions/sub085.pdf [Verified 21 January 2016]
Australian Medical Association (AMA) (2014) Joining the dots in general practice – AMA Victoria, New South Wales and Queensland, general practice salary survey 2014. Available at http://www.australiandoctor.com.au/getmedia/1e2548a3-5106-4232-bbc7-e4c556af6909/Salary_Survey_AMA.aspx [Verified 19 January 2016]
Bouman A, van Rossum E, Evers S, Ambergen T, Kempen G, Knipschild P (2008) Effects on health care use and associated cost of a homevisiting program for older people with poor health status: a randomized clinical trial in the Netherlands. The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences 63, 291–297.
| Effects on health care use and associated cost of a homevisiting program for older people with poor health status: a randomized clinical trial in the Netherlands.Crossref | GoogleScholarGoogle Scholar | 18375878PubMed |
Brown L, Abello A, Thurecht L (2011). Length of hospital stay by older Australians: bed-blocking or not? National Centre for Social and Economic Modelling (NATSEM) Working Paper 11, Canberra.
George B, Harris A, Mitchell A (2001) Cost-effectiveness analysis and the consistency of decision making: evidence from the Pharmaceutical Reimbursement in Australia (1991 to 1996). PharmacoEconomics 19, 1103–1109.
| Cost-effectiveness analysis and the consistency of decision making: evidence from the Pharmaceutical Reimbursement in Australia (1991 to 1996).Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3Mnpt1yitQ%3D%3D&md5=454db754fe60a13518f93baca3386031CAS | 11735677PubMed |
Independent Hospital Pricing Authority (2011) National hospital cost data collection – Australian public hospitals cost report 2010–2011, Round 15. Available at http://www.health.gov.au/internet/ihpa/publishing.nsf/Content/CA25794400122452CA257BB800827319/$File/RD15-NHCDC- Cost-Report-2010-11.pdf [Verified 19 January 2016]
Joyce C, Piterman L (2008) Trends in GP home visits. Australian Family Physician 37, 1039–1042.
Kronborg C, Vass M, Lauridsen J, Avlund K (2006) Cost effectiveness of preventive home visits to the elderly: economic evaluation alongside randomized controlled study. The European Journal of Health Economics 7, 238–246.
| Cost effectiveness of preventive home visits to the elderly: economic evaluation alongside randomized controlled study.Crossref | GoogleScholarGoogle Scholar | 16763802PubMed |
Philbrick JT, Connelly JE, Corbett EC (1992) Home visits in a rural office practice: clinical spectrum and effect on utilization of health care services. Journal of General Internal Medicine 7, 522–527.
| Home visits in a rural office practice: clinical spectrum and effect on utilization of health care services.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s%2FhvFKltA%3D%3D&md5=d5aa9e8b8b9cd2e3a879b797463e1b9aCAS | 1403209PubMed |
Pitalia S (2013) How our acute visiting service reduced emergency admissions by 30 per cent. Available at http://www.pulsetoday.co.uk/home/practical-commissioning/how-our-acute-visiting-service-reduced-emergency-admissions-by-30-per-cent/20002277.article [Verified 28 May 2014]
Robinson S (2013) Is it time for a GP care home service? Available at http://www.gponline.com/time-gp-care-home-service/article/1193274 [Verified 28 May 2014]
Saliba D, Kington R, Buchanan J, Bell R, Wang M, Lee M, Herbst M, Lee D, Sur D, Rubenstein L (2000) Appropriateness of the decision to transfer nursing facility residents to the hospital. Journal of the American Geriatrics Society 48, 154–163.
| Appropriateness of the decision to transfer nursing facility residents to the hospital.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ksFWnuw%3D%3D&md5=08d97dafeab813ab23f27735672ae31dCAS | 10682944PubMed |
Samji N (2012) Physician house calls – a solution for the elderly? Royal College of Surgeons in Ireland Student Medical Journal 5, 81–82.
Saunders C (2010) Productivity Commission inquiry – Caring for older Australians. Australian Government Productivity Commission, Canberra.
Taylor M, Edvardsson D, Horey D, Fetherstonhaugh D, Nay R, Swerissen H (2012) General practitioner service provision in residential aged care facilities: 1998–2011. Australasian Journal on Ageing 32, 55–59.
| General practitioner service provision in residential aged care facilities: 1998–2011.Crossref | GoogleScholarGoogle Scholar |
van den Berg MJ, Cardol M, Bongers FJ, De Bakker DH (2006) Changing patterns of home visiting in general practice: an analysis of electronic medical records. BMC Family Practice 7, 58
| Changing patterns of home visiting in general practice: an analysis of electronic medical records.Crossref | GoogleScholarGoogle Scholar | 17044914PubMed |
