The two patient enrolment systems are worlds apart when it comes to the types of incentives on offer and how patients move within the system.
Voluntary patient enrolment schemes don’t come in one size and shape – and Australian doctors can rest assured that MyMedicare has relatively little in common with the UK’s much-maligned capitation system.
According to a new paper from researchers at the University of New South Wales’s International Centre for Future Health Systems, primary care enrolment systems can be broadly categorised along two lines: whether patients were free to attend other practices and whether there were different financial or non-financial incentives to attend their chosen practice.
Under MyMedicare, Australian patients are still technically free to visit a GP practice other than their registered one for any reason.
The only real restriction is that, once signed up, patients can only access certain items – the new chronic condition management plans, for example – from their registered practice.
MyMedicare-enrolled patients can also access both financial incentives like additional bulk billing incentives and non-financial incentives like longer MBS-funded telephone items.
In comparison, British patients are required to register with a GP practice in order to access the NHS and cannot attend another practice while enrolled.
The researchers identified the fact that primary care referral is required to access NHS-funded secondary and tertiary care as a non-financial incentive for patients to enrol.
Of the 12 high-income countries with patient enrolment systems that the researchers looked at for the Lancet Primary Care article, Australia was the only one where patients had unrestricted access to other practices and were offered both financial and non-financial incentives.
Canada, Italy and Norway all ran enrolment systems where patients had restricted access to other practices while enrolled, but patients weren’t offered any particular benefit for signing on.
“Canada’s a really interesting context for several reasons,” lead author and UNSW future health systems researcher Dr Shona Bates told The Medical Republic.
“You’ve got different provinces with different schemes in place, but in some of the provinces that we looked at, you’ve got an enrolment scheme which gives you access to regular continuity of care through a GP and a very formal arrangement between the general practitioner and the patient, but it’s also backed up with other primary care options.
“[These include] walk-in clinics, which don’t offer that continuity of care but provide an alternative option to access primary care.
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“But there are massive waiting lists for those clinics where you do enrol, so they’ve had to create systems to triage those waiting lists to make sure that priority patients are enrolled with practices.
“I guess the incentive to enrol is that continuity of care and [the idea] that someone is looking out for you and that takes responsibility for your care.”
The only other country to offer both financial and non-financial incentives to enrol was France, which differed from Australia in that it does not allow enrolled patients to visit other practices.
According to the researchers, which included current RACGP president Dr Michael Wright, the countries where the strongest comparisons can be made are Denmark and New Zealand, where patients are not restricted to their enrolled practice but receive financial incentives if they do.
“The key difference, when you’re looking at somewhere like New Zealand, is that you can attend any practice you want, but they’ve got some really strong financial mechanisms to encourage people to see the same practice,” Dr Bates said.
“If you want high enrolment rates, then you might want to look at other countries who have unrestricted access to see how they are encouraging higher levels of enrolment.”
Sweden alone ran a system where patients were not restricted to their enrolled practice and – as far as the Australian researchers could discern – were offered no incentives for enrolling.
