New modelling makes billion-dollar argument for increased primary care funding

Matt Woodley

10/12/2020 3:36:29 PM

PwC Australia has revealed the billions in potential savings that could be realised through healthcare reform, but RACGP President Dr Karen Price says it will require ‘conviction and courage’.

Stethoscope and calculator
Greater investment in primary care would save billions and increase quality of life, according to the PwC report.

The ‘conservative’ assessment has shown fully implementing the RACGP’s Vision for general practice and a sustainable healthcare system (the Vision) would save the healthcare system at least $1 billion in 2021, and upwards of $5.6 billion over the next five years.
According to the PwC Australia report, commissioned by the RACGP, these benefits would be realised by reducing the need for more expensive secondary care and improving the nation’s productivity through a healthier workforce.
It would also generate indirect benefits to Australian society by supporting health equity for parts of the community that disproportionately rely on secondary care, such as treatment in hospitals.
Responding to the PwC Australia report, RACGP President Dr Karen Price said the modelling is 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,’ she said.
‘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.
‘When you consider that $79 billion was spent on Australian hospitals in 2018–19, 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.’ 
Specific findings from the PwC modelling include:

  • estimated benefits of at least $1 billion in 2021, comprising
    • $773 million in savings in preventable hospitalisations, hospital readmissions and emergency department presentations
    • $250 million in workforce productivity savings and at least (these saving would be projected to reach $5.6 billion over the next five years)
  • longer-term projections indicate savings 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.
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.
Given the long-term health consequences of the COVID-19 pandemic are likely to be severe, Dr Price believes enhanced investment in primary care could not come at a more important time.
‘[Long-term health impacts include] 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,’ she said.
‘These patients will need access to a strong primary care system. However, our current system disproportionately focuses on acute care in a hospital setting.’

RACGP President Dr Karen Price said the modelling is further evidence of the cost-effectiveness of investing in primary care.

Dr Price said additional funding for primary care would likely be offset through reduced future capital costs for hospitals, with the demand for care instead being met by the primary care sector.
‘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,’ she said.
‘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.’
Australia’s ageing population and rising rates of chronic disease also indicate a need for greater primary care investment, Dr Price said, as long-term prevention activities, including early identification and ongoing disease management are required.
‘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,’ she said.
‘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 preventive 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.’
With the Federal Government in the process of developing its long-term plan for the healthcare system – a priority of which is strengthening primary care – Dr Price said now is the opportunity direct funding to where it can ‘make the most difference’.
‘Many aspects of healthcare policy are complicated, but in this instance the perfect solution is right in front of our eyes,’ she said.
‘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 nationwide. 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.’
According to PwC, its estimates are ‘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.
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Dr Dhara Prathmesh Contractor   11/12/2020 7:57:17 AM

Fantastic insight and approach to this new model of care. Target 🎯 to generate healthier communities and stronger workforce. Better economies.

Dr Janice Faye Sheringham   11/12/2020 12:37:57 PM

If governments ignore the economic implications of reports like these, and there are many both herd AND overseas we WILL go down the destructive path seen in either UK or worse, USA! None of us want either of those endpoints, so heap on the pressure Karen, and strike while all the possibilities are in ours AND the entire populations’ favour!

S   15/12/2020 11:07:52 PM

Disease prevention is not best done one on one from GP to patient. GP front line workers are not a workforce that can educate our entire population one by one as this is not the best method and should not be the focus of governments. Disease prevention is largely driven by health policy and education such as health promotion by government bodies - thats where the money should be going. Eating healthy, exercise etc makes our disease burden much lower and mental health/illness “prevention” as a chronic disease is complex. Conversely the disease burden worsening with an ageing population is inevitable and again is not best dealt with by further enhancing front line GP funding rather by further increasing the capacity of quality “round the clock” care in nursing homes and in the home plus funding medical research. I would rather see government money be spread across the smartest, most-effective initiatives in terms of health policy, education and specialised, targeted health services.

Rural GP   29/12/2020 5:49:03 PM

PwC AUSTRLIA? :sorry cant find who this title is, in the article. I may have missed it, but please when first using the initials please print full name .
Thanks for the article though