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Bearden T, Ratcliffe HL, Sugarman JR, Bitton A, Anaman LA, Buckle G, Cham M, Chong Woei Quan D, Ismail F, Jargalsaikhan B, Lim W, Mohammad NM, Morrison ICN, Norov B, Oh J, Riimaadai G, Sararaks S, Hirschhorn LR. Empanelment: A foundational component of primary health care. Gates Open Res 2019; 3:1654. [PMID: 32529173 PMCID: PMC7134391 DOI: 10.12688/gatesopenres.13059.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2019] [Indexed: 11/20/2022] Open
Abstract
Empanelment is a foundational strategy for building or improving primary health care systems and a critical pathway for achieving effective universal health coverage. However, there is little international guidance for defining empanelment or understanding how to implement empanelment systems in low- and middle-income countries. To fill this gap, a multi-country collaborative within the Joint Learning Network for Universal Health Coverage developed this empanelment overview, proposing a people-centered definition of empanelment that reflects the responsibility to proactively deliver primary care services to all individuals in a target population. This document, building on existing literature on empanelment and representing input from 10 countries, establishes standard concepts of empanelment and describes why and how empanelment is used. Finally, it identifies key domains that may influence effective empanelment and that must be considered in deciding how empanelment can be implemented. This document is designed to be a useful resource for health policymakers, planners and decision-makers in ministries of health, as well as front line providers of primary care service delivery who are working to ensure quality people-centered primary care to everyone everywhere.
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Affiliation(s)
| | - Hannah L Ratcliffe
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA
| | | | - Asaf Bitton
- Ariadne Labs, Brigham & Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA
| | | | | | - Momodou Cham
- Christian Health Association of Ghana, Accra, Ghana
| | | | | | | | - Wujung Lim
- National Health Insurance Service, Jeonju, South Korea
| | | | | | | | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
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Abstract
Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica's innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica's experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.
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Affiliation(s)
- Madeline Pesec
- Madeline Pesec is a medical student at the Warren Alpert Medical School at Brown University, in Providence, Rhode Island, and a primary health care intern at Ariadne Labs, a joint center of Brigham and Women's Hospital and the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Hannah L Ratcliffe
- Hannah L. Ratcliffe is a primary health care research specialist at Ariadne Labs
| | - Ami Karlage
- Ami Karlage is a research assistant at Ariadne Labs
| | - Lisa R Hirschhorn
- Lisa R. Hirschhorn is a professor of medical social sciences at the Northwestern University Feinberg School of Medicine, in Chicago, Illinois, and an affiliate member at Ariadne Labs
| | - Atul Gawande
- Atul Gawande is executive director of Ariadne Labs, a general and endocrine surgeon at Brigham and Women's Hospital, a professor in the Department of Health Policy and Management at the Harvard T. H. Chan School of Public Health, and the Samuel O. Thier Professor of Surgery at Harvard Medical School
| | - Asaf Bitton
- Asaf Bitton is director of primary health care at Ariadne Labs, an assistant professor of medicine in the Division of General Medicine at Brigham and Women's Hospital, and an assistant professor of health care policy at Harvard Medical School
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