Primary care purchasing. Are integrated primary care provider/purchasers the way forward?

Integrated primary care provider/purchaser organisations are currently being developed in the UK and other countries. In common with many other European countries and New Zealand, there has been a swing away from market-orientated models of healthcare organisation towards models which blend centralised planning and quasi market approaches. Primary care groups in the UK and independent practice organisations in New Zealand provide new opportunities to combine micromanagement techniques in the delivery of patient care and approaches to improving population health. These new organisations are building on the experience of health maintenance organisations (HMOs) in the US and physician-led purchasing in the UK and other countries. However, there are distinct differences between countries due to differences in health and social care systems and the degree of emphasis on primary physician involvement. Moreover, the continuing emphasis on a physician-led medical model may be at odds with developing a public health approach which emphasises participative and collaboration with local populations and other primary care providers--an area where physicians have little experience.