Health charge included in new primary care plan

Tuesday 19 January 2016

The introduction of a health charge has moved a step closer with its inclusion in the States’ new strategy for primary health care.

The strategy says that the proposed charge is likely to be introduced in a phased way but will raise £35m a year by 2019.

Bailiwick Express has previously reported that the charge will probably be introduced in 2017, be based on earnings and levied through the contributions system. The charge will help to plug a £125m gap between States income and spending expected by 2019.

The charge is seen as integral to the success of the strategy, which addresses the fundamental health-related problems facing Jersey: an ageing population; the ‘perverse incentives’ of the current system; the fact that ‘co-payments’ (whereby the cost of going to the doctor is shared between the patient and the States) do not extend to other primary care providers such as dentists and optometrists; and the difficulty of recruiting GPs and other healthcare professionals.

One proposal in the strategy is to move from an activity-based payment system – where GPs are paid per patient visit – to a system where payments are more linked to outcomes. This could be a ‘capitation’ system, where a primary health care ‘lead provider’, such as a GPs’ surgery, would receive a single payment from the States (based on a lump sum per patient) to provide a specific range of care to a specific number of people.

Each provider would be encouraged through a contract with Health to provide joined-up care by establishing their own networks of care providers. If the provider was able to keep costs down, for instance by investing more in prevention, they could make more money - providing that the quality of care didn't fall below standards agreed in the contract.

The co-payment model will, however, continue whatever system is chosen so it will still cost money to see the doctor.

The strategy also proposes making registration with a GP compulsory, which it says would lead to a better understanding of overall health needs.

The strategy will be implemented between now and 2020.