Primary care systems are facing increasing patient complexity, workforce shortages, and growing needs for prevention and care coordination. In France, the predominantly fee-for-service payment model insufficiently values non–face-to-face clinical work, preventive care, and team-based practice. The experimental “Médecin Traitant Renforcé” (MTR) programme, implemented in four primary care centers in Paris, introduced a voluntary hybrid payment model combining a monthly per-patient capitation fee with fee-for-service payments, centered on the general practitioner and structured multidisciplinary teams.To assess the impact of the MTR programme on preventive care practices, healthcare utilization, and health expenditures, compared with conventional fee-for-service primary care.An observational medico-economic case–control study was conducted by an independent evaluator using linked data from the French National Health Data System (SNDS) from 2020 to 2023. A total of 13,156 patients enrolled in the MTR programme were matched to 39,548 control patients based on age, sex, socioeconomic indicators, clinical complexity, and prior healthcare expenditures. A difference-in-differences approach was used to compare outcomes one year before and one year after programme entry.Patients enrolled in the MTR programme showed higher preventive care uptake, with increased screening rates for breast cancer (+4.3 percentage points), cervical cancer (+17.2), and colorectal cancer (+14.7), as well as higher influenza vaccination coverage (+9.8), compared with controls. The model was associated with organizational changes, including three times fewer changes of designated general practitioner, a higher annual number of general practice consultations (5.6 vs 3.8), and a significant reduction in full hospital admissions (7.2% vs 9.2%). Despite higher primary care expenditures, total reimbursed healthcare costs were 9% lower per patient (−€249), mainly driven by a 29% reduction in costs related to full hospitalizations.These findings suggest that a hybrid payment model may strengthen prevention, continuity of care, and reduce full hospital admissions, while lowering overall per-patient expenditures. However, results should be interpreted cautiously given the limited follow-up period and the specific experimental context.The “Médecin Traitant Renforcé” programme appears to be a credible option for transforming primary care delivery, combining quality and efficiency, provided that capitation levels are appropriately calibrated and teams have sufficient organizational maturity.

In Germany, general practitioners (GP) are often the first point of contact for patients of all age groups and with different health problems. To date, there are only a few epidemiological overview studies that describe GP consultations on the basis of the reasons for and results of consultations as opposed to billing data. The 6th Saxon Epidemiological Study in General Practice (SESAM-6) systematically recorded the everyday work of GPs in consultations over the course of a year.The aim of SESAM-6 is to investigate the frequency of consultations, the prevalence of known long-term diagnoses and diagnostic and therapeutic decisions in GP practices.The data collection of the cross-sectional study was conducted from October 2023 to September 2024 in GP practices in the state of Saxony, Germany. The participating doctors were randomly assigned one week per quarter (over a survey period of 12 months). Every fifth doctor-patient contact was recorded anonymously by the GPs by means of a questionnaire for half a day (morning or afternoon). Following data collection, the consultation occasions were coded according to the ICPC-2 classification system, while the permanent and new diagnoses were coded using ICD-10.N=109 GPs (59.8% women, mean age 47.2 years, 78.5% office-based) participated in the study, of which 21.5% worked in a rural area, 25.2% in a small town, 19.6% in a medium-sized town and 33.6% in a large city. N=7746 patients (53.7% women, average age 53.5 years) were documented, of which N=5340 (68.9%) had at least one chronic disease. The average consultation duration was 10.8 minutes (SD=6.8). The ten most common reasons for consultations were common cold (9.9%), medication/prescription (5.6%), cough (4.0%). The ten most common known long-term diagnoses were Hypertension (41.7%), dyslipidemia (19.5%), diabetes mellitus type 2 (17.1%). The ten most common new diagnoses were upper respiratory tract infection (10.0%), back pain (4.3%), infectious gastroenteritis (2.3%).The data obtained can be used to develop evidence-based strategies for improving GP care. They will also be incorporated into the training and further education of GPs.Based on the data, it is necessary to discuss which activities should be delegated to other occupational groups.

It has been previously shown that the patients in different primary care physician payment models vary by level of morbidity. There are two different approaches for measuring morbidity or case-mix that are in common use in XXX: YYY and ZZZ. The YYY have been used extensively in research applications in XXX, while the ZZZ has been used more commonly for administrative and governmental applications including adjustment of capitation payments. Little is known about how the measures from these two methodologies compare with one another.To evaluate the morbidity, characteristics, and service utilization of patients who are enrolled in different primary care payment models, and to compare the two approaches for classifying patient case-mix.In this cross-sectional study the morbidity, resource use, and health conditions of patients in each of the primary care payment models are compared using both approaches. The study includes all residents of XXX on March 31, 2023, classified as those who were formally or virtually enrolled in a primary care enrolment model (capitation, enhanced FFS, or other), virtually enrolled to a FFS physician, or not having a regular source of care. Patient characteristics include age, sex, income quintile, and geographic location.According to morbidity measures from the YYY, patients enrolled to physicians in enhanced FFS models had the highest level of morbidity while the ZZZ indicated that patients who were virtually enrolled to a FFS physician had the highest. Both approaches showed patients who did not have a regular provider had the lowest level of morbidity.Some of the observed differences in morbidity may be related to the specific data sources used by each approach or their underlying algorithms. Further analysis of these factors will be carried out along with an assessment of their ability to explain actual service utilization.The increasing use of the ZZZ in XXX necessitates a more integrated use of this approach in primary care research and evaluation. This study provides guidance on which aspects of the ZZZ are best suited to be reported on and used on a routine basis.

Universal Health Care is about accessing quality health care at the time of need without financial hardship but access to health facilities and services remain a big challenge especially in the rural communities where transportation is limited. Konsulta is a program for health in the Philippines by Philhealth, a local health insurance provider, giving free outpatient services like medical consultations, essential laboratories and medicines to its members and dependents thru capitation payment to its accredited health facilities. The World Health Organization (WHO) health systems strengthening (HSS) framework analyzes health systems in terms of six core components or building blocks (service delivery, health workforce, health information systems, medical products, vaccines and technologies, health financing and leadership and governance).Reaching To Care for UHC was established in Municipal Health Office of Motiong in 2023 utilizing WHO HSS Framework to assess the problems and to provide interventions to the identified gaps.With the use of WHO HSS Framework, Motiong was able to localize implementation of UHC by generating income thru capitation from Philhealth and utilizing this to provide more health services in communities closer to where people were residing.More defined problems lead to better suited plans and more focused results. By using the WHO HSS Framework in understanding problems and crafting solutions, led to more appropriate interventions and eventually better health outcomes.Use of WHO Six Major Building Blocks as a health system strengthening tool and maximizing partnership with Philhealth through the use of validated Electronic Medical Record and enabling support to health workers, helped a small town in the Philippines to deliver more health services to people living in the grassroots.

The shortage of physicians in rural areas is a persistent problem. Policymakers and educators continue to seek effective strategies to increase and retain rural physicians. However, evidence on the long-term impact of rural medical education program remains limited.We aimed to assess the long-term outcomes of Jichi Medical University (JMU) in Japan, which provides tuition-free medical education in return for a 9-year rural service obligation and whose mission is to train and deploy physicians to rural communities.This is a cross-sectional study of JMU graduates from 1978 to 2021. Follow-up rate was 97.0%. We excluded graduates who had died. The primary outcome was the retention rate of home-region. Secondary outcomes were the proportions practicing in medically underserved area and in primary care specialties. Medically underserved areas were defined as municipalities in physician-shortage areas/spots officially designated in 2021 under national criteria. Primary care specialties were defined as internal medicine, surgery, pediatrics, community/rural/general medicine based on self-declared specialties according to the previous study. Outcomes were reported separately for during-obligation and post-obligation periods; for secondary outcomes, the during-obligation period was defined excluding residency.Of 4610 JMU graduates, we analyzed 4534 for analysis; 19.0% were female. The retention rate of home-region during obligation was 98.0% over up to 9 years after graduation. After obligation, the retention rate of home-region was 71.0% up to 35 years. The proportions of JMU graduates practiced in medically underserved area were 24.8% during obligation and 12.1% after obligation. The proportions of primary care specialties were 78.5% during obligation and 62.0% after obligation. In medically underserved areas, 79.8% during obligation and 75.6% after obligation worked as primary care specialties.This study demonstrated JMU graduates maintained a high rate of rural practice even after completing their obligation. This was comparable to the 40–70% short-term regional retention reported in European rural programs. A limitation of this study was that we did not investigate determinants of retention.Over approximately 45 years, JMU achieved sustained retention of home-region. Additionally, JMU graduates deployed to medically underserved area and to primary care specialties. These long-term results may serve as a reference for similar initiatives in Europe.

Establishment of a community-based emergency medical system is important in a rural private hospital to address the aging rural population and decreasing human medical resources. Here I introduce my efforts to establish a functional medical care system under collaboration with other healthcare professionals, such as paramedics, pharmacists, dietitians, and medical social workers.In my hospital, I simplified emergency medicine into 4 categories; trauma, hemorrhage, infection, failure of major organs. My hospital acted as a first responder for critical patients. I built a roof heliport, as capital investment, for air transportation. I contracted medical cooperation with Okayama University Hospital in order to transfer the patients with time-sensitive severe diseases. Once transferred patients recovered from most critical phases, they were readmitted to my hospital to have rehabilitation for going home. I shared the progress of patients with neighboring GPs and MSWs. Multi-disciplinary interactive meetings were regularly held in my hospital. As education for my employees, I invited special practitioners from Okayama University Hospital as lecturers about non-communicable diseases 3 times a year.The number of emergency patients accepted in my hospital was 441 cases in 2011 and increased 1653 cases in 2016. The emergency acceptance number has changed with around 1,600 afterwards until 2025. Priority of providable medical services, continued education of employees, and capital investments should be properly conducted for the future.My approach has improved the medical efficiency in rural health care settings. Under my instruction, neighboring GPs and healthcare professionals have taken unified action at disaster prevention trainings. Satisfaction and trust of rural residents to my hospital have increased and hospital management has been successfully maintained.The establishment of multidisciplinary teamwork and interprofessional partnerships is indeed pivotal for addressing the complex, multifaceted medical needs of the aging population in rural healthcare settings.