Work Package 6

Economic and Skill Set Evaluation and analysis of models: led by Professor Heather Gage

In this work package, we will consider the economic implications of alternative models of child health across European Member States, Norway and Iceland. Specifically, we will:

  • map and compare the workforce configuration and costs of delivering the alternative models of primary child health care in use in Europe;
  • model the efficiency and effectiveness of alternative models of primary child health care across Europe; and
  • investigate the impact of reimbursement, payment and incentive systems on the performance of primary child health care systems across Europe.

Different models of primary child health care involve different mixes of staff, such as medical, nursing, social work and allied health professionals; and take place in differing environments and institutional settings. As staffing is the largest variable cost in delivering health care globally, understanding the optimum staffing levels and skill mix is vital to delivering high quality, cost-effective care.

Furthermore, many European governments aim to move care away from secondary care settings into primary and community care services, yet this has had limited impact in a number of countries (e.g. UK) where in reality there has been an increase in the amount of acute paediatric care occurring in a hospital setting.
At the same time there has been a general policy shift away from primary care paediatric services towards general family practice; and a steady change in skill mix, with role substitution occurring across medical specialities in Europe. For instance, the greater use of unregistered nurses and allied health professionals, and the growing number of nurse practitioners or consultants combined with the introduction of non-medical prescribing.

Different models of payment and co-payment exist in Europe, as well as incentivisation through pay per performance schemes (additional to population targeted incentives). Whilst these are well studied in both general adult primary and secondary care, there is a dearth of studies within the context of paediatric services. We will map these changes and their variations across Europe and then examine the evidence on the costs and effectiveness on child health outcomes.