Do patient enrolment systems lead to better care?

Australian researchers have reviewed international evidence and found that patient enrolment systems, such as Australia’s MyMedicare, can improve planning and multidisciplinary treatment, but may have a limited influence on continuity of care.
 
Those findings were published this month in The Medical Journal of Australia (MJA), with the study’s four authors including RACGP President Dr Michael Wright and recently appointed Chief Medical Officer Professor Michael Kidd.
 
Before MyMedicare was introduced in October 2023, Australia was one of the few OECD countries without a system to link patients formally to their general practice.
 
In this context, the authors sifted through international articles looking for clues on its likely impact on Australian healthcare.
 
‘The reported advantages of enrolment were related to clinical service delivery,’ they concluded.  
 
‘Enrolment allowed better planning, the use of multidisciplinary teams, and greater efficiency and more income for practices.’
 
However, the evidence shows little impact on continuity of care.

This is because the majority of patients were already seeking care from a preferred or usual GP prior to the introduction of most enrolment schemes.
 
It found that because most patients naturally choose to seek care from a usual GP, and because this is more common for people with higher health needs, the introduction of enrolment made little difference to the levels of continuity of care in most countries.
 
The research looked at peer-reviewed journal articles published from 1 January 2014 to 12 July 2024, considering the impact of primary care enrolment models.
 
Of 508 articles deemed potentially relevant, 24 met the criteria to be included in the study. There were 11 Canada-based studies, four carried out in Australia, two in the United Kingdom and New Zealand, as well as one each in Ireland, the United States, and France.
 
One of these studies compared schemes in 12 countries, while another was a rapid review. The four articles published in Australia covered trials of enrolment prior to Medicare.
 
The MJA paper highlights that in some cases, enrolment could reduce continuity of care, with one article noting potential difficulty in getting an appointment with a preferred GP, care shifting to other medical practitioners, and practices possibly focusing on people with less complex needs.
 
One limitation noted by the authors was that the introduction of the enrolment was typically part of broader reform, making it difficult to attribute any changes specifically to enrolment.
 
The authors note if funding is inadequate or unclear or the reforms are complex, enrolment could lead to ‘poorer outcomes for patients, general practitioners, and practices’.
 
‘People are more likely to enrol with a general practitioner or practice when they perceive that it benefits them, regardless of the service funding model,’ they concluded.  
 
The analysis also found that older people, women, people in higher socio-economic areas and those with multiple conditions or chronic disease are more likely to take part in voluntary registration schemes, and also more likely to have regular GPs.
 
Men and marginalised groups including recent migrants and First Nations people were less likely to register.
 
‘The multifaceted nature of primary care models made it unclear which enablers of and barriers to enrolment had the greatest impact,’ the authors wrote.
 
They also highlight potential factors limiting practices carrying out registrations.
 
‘Practices were discouraged from registering people if the model was complex or the capacity of the practice had been reached,’ the authors wrote.
 
‘Further, funding models needed to adequately support practices to register people with complex health needs to ensure that the patients receive appropriate care.’
 
The article concludes that enrolment schemes such as MyMedicare need to be evaluated on an ongoing basis ‘to assess levels of engagement by patients and general practices, drawing on the experiences of other countries in which similar schemes operate’.
 
Moving forward, the authors said it may be important to identify who is not enrolling in these schemes to understand how they are accessing care.
 
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