Letter from ECPCP to the Austrian authorities about the health care reform
The European Confederation of Primary Care Paediatricians (ECPCP) is a union of over 25.000 child- and adolescent doctors from 18 European countries working in the field of primary care.
The ECPCP was set up for the interests of children and adolescents and supports the complete implementation of the UN convention on the rights of the child. This includes amongst other things, the provision of the best possible medical care for all children in their respective countries.
Medical knowledge, especially with respect to childhood illness has increased tremendously over the last century and has led to a dramatic reduction in mortality and morbidity in premature infants, babies and children. As a consequence, ever more children and adolescents also with rare chronic illnesses may lead a good life. This development is essentially due to the field of paediatrics. The implementation of this knowledge in primary care as well as in organ-specific paediatric sub-specialities requires broad paediatric training. This understandably cannot take place in the generalized training of general practitioners’ (GP's). Primary health care of children and adolescents in Austria is at present maintained at a high level by the combined efforts of paediatricians and GP's. Patients have the right to select the doctor of their choice.
This so called mixed paediatric health care system has been successful in many European countries and one must come up with very good reasons for throwing a valued system overboard. In countries, for example, in Poland and the Baltic States, where a system change took place and primary care was placed in the hands of the GP's, the quality of health care for children suffered so badly that these countries have now returned to paediatric primary care. In those countries where traditionally primary health care was always in the hands of the GP (for example Great Britain) the referral rate and especially preventable and expensive hospital admissions are very much higher than in countries where paediatricians work in primary health care.
Trained specialists in child- and adolescent medicine can solve a significant part of the problems of children and adolescents in an ambulatory setting und thus spare them an unnecessary hospital stay. Several years ago in Germany a similar plan for a primary health care system handled by GP’s was overridden after massive protests by parents and doctors. This resulted in the legislature expressly providing a role for the paediatrician in primary health care.
In the meantime there exists a good scientific data base showing that ambulatory primary health care for children run by paediatricians under qualitative and economic aspects is better than exclusive primary health care performed by GP's. In this regard, a work was published in an internationally renowned professional journal showing that the recognition of kidney tumors in infants occurs at a much earlier stage in Germany than in Great Britain.
The colleagues of the Austrian Society for Child- and Adolescent Medicine and the group "Political Child Medicine" have already collected the data (ÖGKJ PKM 2015 Model for the primary care of children and adolescents in Austria).
The ECPCP advocates that in a primary health care system in Europe, paediatricians should always be the first contact person for families with their children. We support a team- oriented health care system. The paediatrician should be the coordinator and have control in the provision of health care for children and adolescents.
In the event, as we have been informed, that in the Austrian concept only GP's will be given a central role in primary health care, we find this to be a dangerous step backwards. We warn of the consequences. A drop in quality of the current standards will surely impact on the morbidity and mortality of children and will result in increased dissatisfaction by patients and parents.
In order not to endanger the quality of health care we advocate to preserve and strengthen the central role that the paediatrician has in the primary health care of children and adolescents in Austria. Certainly the Austrian paediatric community will support all political efforts to reform and improve the multi-professional and interdisciplinary primary health care of the population.
Dr. Gottfried Huss
Dr. Elke Jäger- Roman
On behalf of the Executive Board and Executive Committee of ECPCP