How modelling could contribute to reforming primary care-tweaking "the ecology of medical care" in Australia

Background: The Australian Ecology of Medical Care indicates that 255/1,000 Australians consult a GP 1.8 times/month (466 consultations/month) resulting in 42 specialist, 1.4 ED and 1.9 hospital referrals, 478 prescriptions, 220 pathology and 48 radiology tests, costing the Government $ 72,009 (2012–13). Government believes this to be unsustainable and controllable by setting price signals. Objectives: To investigate the impact of ‘small changes’ to health service utilisation and/or resource use. Method: Modelling the impact of increases and decreases to healthcare utilisation/resource use over a 5-year period. Results: Strategies targeting only one variable had a small and linear impact on healthcare expenditure (± 0.6–7.2%); combining changes had an exponential effect, achieving an up to 15% reduction or an over 20% rise in expenditure. Discussion: Change invariably results in trade-offs; modelling is a tool that can provide a basis to engage in shared discussions about the ‘yes, but/yes, and’ considerations of reform propositions