Dollars, debts and duties: Lessons from funding Australian general practice

This study investigated changes in resource allocation and activities of Australian Divisions of General Practice associated with new funding procedures which link monies to nominated outcomes. The study involved analysis of annual reports and strategic plans, and semistructured telephone interviews with key personnel from 27 divisions of general practice. The main outcome measures were: number of activities in various nominated health areas; total and median expenditure per activity in each area; and methods of resource allocation. Despite a modest increase in funding to the total general practice divisions program over the two year period, expenditure decreased in the National Health Priority Areas of mental health, diabetes, cardiovascular disease, injuries and cancer. There was increased expenditure in the priority area of immunisation, which received dedicated funding. There was greatly increased expenditure in the areas of information technology and services to GPs (including continuing medical education, professional development and workforce issues). The ease of defining and measuring outcomes influenced the choice of activities. In 1996, activities were linked to formal needs analyses in approximately 20 per cent of cases. The most frequent driving force for projects was enthusiastic GPs. In 1998, resource allocation decisions were more explicitly linked to formal needs analyses; however, the standard of the needs analyses varied widely between divisions. Changes in funding procedures which use nominated outcomes as the major accountability mechanism may produce unexpected, and unintended results, including significantly decreased expenditure in areas with outcomes which are hard to define and measure but which are important for health improvement.