The Royal Australian College of General Practitioners (RACGP) is urging the Federal Government to boost primary care investment to significantly improve health outcomes for Australian patients and to reduce total healthcare costs.
New modelling by PricewaterhouseCoopers Consulting (PWC) describes the multi-billion dollar economic benefits of implementing the RACGP’s Vision for general practice and a sustainable healthcare system (The Vision).
The Vision sets out a roadmap for a sustainable and high-quality healthcare system built on the foundation of strong primary healthcare.
PWC found that implementing The Vision creates substantial economic benefits by reducing the need for more expensive secondary care and improving the nation’s productivity through a healthier workforce. There are also the indirect benefits to Australian society in supporting health equity for parts of the community who disproportionately rely on secondary care, such as treatment in hospitals.
The modelling revealed:
estimated benefits of a billion dollars, at a minimum, in 2021 (that includes $773 million in savings in preventable hospitalisations, hospital readmissions and emergency department presentations as well as $250 million in workforce productivity savings) and at least $5.6 billion over the next five years
this would rise to at least $6.9 billion in the five years from 2026 to 2030 and $8.7 billion in the five years from 2031 to 2035
98,000 quality adjusted life years (QALYs) gained in 2021 and 520,000 QALYs gained over the next five years representing billions of additional dollars in economic value beyond the direct savings. This is unsurprising since enhanced general practice has been shown to increase breast cancer screening between three and 21%, cervical cancer screening between four and 30%, and colorectal cancer screening between four and 30%.
In addition to the measured economic benefits, the non-monetary benefits that would accrue from greater investment in primary care include increased local research guiding how to best care for the community, improved patient and health provider satisfaction as well as economic growth due to a healthier population.
RACGP President Dr Karen Price said that the modelling was further evidence of the cost-effectiveness of investing in primary care.
“We urge courage and conviction to do what is so plainly in the interest of the health of Australians and the Australian economy. An additional investment of $1 billion in primary care would result in a much greater suite of combined benefits because we would be spending much less on secondary care,” she said.
“When you consider that $79 billion was spent on Australian hospitals in 2018-2019, an allocation of $1 billion to general practice is relatively modest.
“It’s not just the PWC modelling that shows this. A September 2020 report on the rates of return on health investments from Victoria University reinforced the economic and social benefits we stand to gain by prioritising prevention for our most common health issues including cardiovascular disease, diabetes, anxiety and depression.”
Dr Price said that enhanced investment in primary care could not come at a more important time.
“The long-term health consequences of the COVID-19 pandemic are likely to be severe,” she said.
“That includes the effects of people delaying or avoiding seeking care as well as the impacts of the COVID-19 virus itself on the long-term physical and mental wellbeing of patients. We will also see an increase in mental health concerns.
“These patients will need access to a strong primary care system. However, our current system disproportionately focusses on acute care in a hospital setting.
“Additional funding for primary care would likely be realised through reduced future capital costs for hospitals as the demand for care is met by the primary care sector. So if we want to improve the health of our nation and save on healthcare costs, boosting primary care and keeping patients well and out of the hospital system is the most logical choice.
“Rather than short-term treatment of severe injury and illness in a hospital, many conditions require more than a single intervention.
“General practice involves the holistic care of a patient before and after hospital care for the lifetime of the patient. I believe that if primary care is adequately funded we can revitalise general practice and make it an even more rewarding career path.
“Like many countries, Australia is experiencing rising rates of chronic disease and an ageing population so long-term prevention activities are required including early identification and ongoing disease management. GPs are the major diagnosticians of the healthcare system.
“This is where primary care comes in – a GP provides the long-term care needed to improve the health trajectory of patients, keeping them well and out of hospital.
“In 2017-18 we had almost three quarters of a million ambulatory care sensitive conditions – that is hospital admissions that could have been prevented if a patient had received preventative health interventions and early disease management.
“In 2018-19, there were more than eight million emergency department presentations and almost half of them were classified as semi or non-urgent. These are the presentations that well-coordinated GP-led care could manage. These visits are also growing due to the rising incidence of chronic illness and decreased availability of GPs, it is a recipe for disaster.”
Dr Price said that boosting primary care funding would improve the entire nation’s health system and benefit the demographic groups with the poorest health outcomes.
“The Federal Government is developing its long-term plan for our health system with a key priority being the strengthening of the primary care sector. This is the opportunity to refocus funding to where it can make the most difference,” she said.
“Many aspects of healthcare policy are complicated, but in this instance the perfect solution is right in front of our eyes.
“If we boost funding for primary care we could help more patients access care from their trusted GP. We will see better health outcomes for patients as well as reduced expenditure on healthcare in Australia.
“Implementing The Vision will promote health equity for Aboriginal and Torres Strait Islander people, people living in rural and remote areas and those living in low socioeconomic areas – the groups who currently use disproportionately more secondary care.
“We know that Aboriginal and Torres Strait Islander people are three times as likely to have a preventable hospitalisation, people living in remote or very remote areas are 8% more likely to have a hospital readmission and people in low socioeconomic groups are 1.4 times as likely to use an emergency department.
“This is the human cost of health inequities that exist nation-wide. General practice is distributed more evenly than specialist care, which is used disproportionately by more affluent households, so boosting primary care is the obvious answer.”
PWC’s estimates are highly conservative and may be as high as $4.5 billion in 2021 and $24.8 billion over the next five years – not including consideration of QALYs and indirect benefits. They also do not include other outcomes of high-quality general practice such as reducing duplication of services and avoiding use of unnecessary medical or pharmaceutical services.