caa a22 4500 397577079 CHVBK 20180308164858.0 cr unu---uuuuu 161202e199603 xx s 000 0 eng 10.1093/oxfordjournals.pubmed.a024456 doi (NATIONALLICENCE)oxford-10.1093/oxfordjournals.pubmed.a024456 Scott Anthony Health Economics Research Unit, Department of Public Health, University of Aberdeen, University Medical Buildings, Foresterhill, Aberdeen AB9 2ZD Primary or secondary care? What can economics contribute to evaluation at the interface? [Elektronische Daten] [Anthony Scott] Background The substitution of primary for secondary care is progressing at a fast pace, yet there has been little evaluation of the appropriateness of such a fundamental change in health service organization. The aim of this paper is to raise some issues for discussion about the contribution of economics to future research on the substitution of primary for secondary care. Given the central role general practitioners (GPs) will play in a ‘primary care led' National Health Service, the paper concentrates on the replacement of secondary care by GP-based services. Methods The existing empirical evidence relevant to the replacement of secondary care by GP-based services is summarized. From this, issues for further research from an economic perspective are identified and discussed. Results The evidence comprises studies examining the efficiency or cost-effectiveness of substituting GP-based care for secondary care and studies examining the effects of incentives on the mixture and range of services provided. Cost-effectiveness evidence is scarce and inconclusive. The evidence on incentives suggests that new services are being provided in local areas which need them least. Several avenues of further research are suggested. As well as more economic evaluation, future research should concentrate on developing methods to elicit patients' and communities' preferences for GP-based care versus secondary care. Research into incentives should concentrate on assessing those factors, beyond practice characteristics, that influence GPs' decisions about whether to provide services and how much to provide. This would help to design more appropriate incentives for GPs. Conclusions The appropriate balance between primary and secondary care is unknown. The transfer of services from secondary care to general practice (and other primary care providers) should be based on empirical evidence on costeffectiveness, as should the incentives given to GPs. Although the research agenda is challenging, it is necessary in ensuring that a ‘primary care led' health system is the right way forward for the NHS. © Oxford University Press Articles nationallicence economic evaluation nationallicence primary-secondary care interface nationallicence primary care nationallicence general practice nationallicence Journal of Public Health Oxford University Press 18/1(1996-03), 19-26 1741-3842 18:1<19 1996 18 pubmed https://doi.org/10.1093/oxfordjournals.pubmed.a024456 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/oxfordjournals.pubmed.a024456 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Scott Anthony Health Economics Research Unit, Department of Public Health, University of Aberdeen, University Medical Buildings, Foresterhill, Aberdeen AB9 2ZD NATIONALLICENCE 773 0- Journal of Public Health Oxford University Press 18/1(1996-03), 19-26 1741-3842 18:1<19 1996 18 pubmed Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford