News

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‘Undervalued and underfunded’: A comparison of global primary care

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Governments must rethink how they fund primary care in Australia and around the world, as health systems become more reliant on GPs to meet rising complex health needs, research suggests.
 
It’s not just about the dollar value, but how that money is distributed to bolster sustainable primary care, according to the authors.
 
The Australian study presented case studies from six wealthy nations – Australia, New Zealand, the United Kingdom, the Netherlands, Canada and the United States.
 
Despite many countries leaning on general practice to solve rising health challenges, ‘primary care is undervalued and underfunded’, the study said.
 
Higher-income countries were described as having lower birth rates and longer life expectancy, resulting in ageing populations and rising rates of multimorbidity.
 
This ‘increases the volume and complexity of demands on primary care’, the authors wrote.
 
‘GPs also face a rising administrative burden from regulations and management of electronic health records, including dealing with the inbox.’
 
Yet many nations were found to be spending less than 6% of their total health budget on primary care, with the US spending 4%, New Zealand 5.4% and Australia 6%.
 
Former RACGP President Professor Claire Jackson from the University of Queensland, who is one of the study’s authors, said taking a ‘same old, same old’ approach is unsustainable.
 
‘The remuneration model at the moment and the way the new bulk-billing initiatives are running is rewarding the 6–10-minute consultation much better than the 19-minute consultation,’ she said.

‘This doesn’t support the type of comprehensive care required to manage complex chronic conditions.’
 
The solution presented in the study was for governments to make a ‘a robust investment in primary care’ that is sustainable across political cycles, and with focus on areas including:

• appropriate resourcing
• a coordinated, whole-of-system approach to primary care funding
• support for GP-centred, team-based care
• a sustainable and engaged workforce
• technology that enhances rather than fragments care.

‘This ensures that primary care is strengthened as the foundation of the health system, with strategic allocation of resources, leading to better access, equity, and cost control,’ the authors recommend.
 
Professor Jackson said there is now ‘an explosion of complex chronic conditions’ putting increased pressure on the GP workforce.
 
‘The US estimates that about 50% of healthcare expense is around unhealthy life choices, so obesity, excessive alcohol consumption and cigarette smoking.
 
‘Mental health is also about prevention, getting in early around postnatal depression, and looking at adolescent mental health issues.’
 
The next step in Australia is to ‘incentivise and recognise preventive healthcare going on for all Australians’ as ‘we don’t have anything within our Medicare schedule’ that currently does this, Professor Jackson said.
 
‘What we, as the authors of this paper, would like to see is a much greater focus on general practice prevention that we know is happening ad hoc, but making it much more systematic, and having a system where we can measure that,’ she said.
 
‘We can measure mental health plans, we can measure standard consultations, but we can’t measure what’s happening in preventive health.
 
‘To manage preventive health properly – to manage complex chronic conditions, mental health issues, immunisation in children, and all of those things – there really needs to be focus on all of those issues raised in the RACGP Red Book, and incentivising those in general practice.’
 
Professor Jackson added ‘this would help prevent as much as possible the ill health that’s rolling into the hospital system and is frankly unsustainable’.
 
RACGP President Dr Michael Wright said the research further backs up the RACGP’s advocacy for an urgent bolstering of funding for general practice.
 
‘This research confirms what we’ve been saying – it’s not just different funding models that are required, it’s actually more funding that’s needed,’ he told newsGP.
 
‘We need that additional funding to allow general practice to provide the high-quality team-based care that we know we’re going to have to adapt to because of our workforce shortages.’
 
‘We can see from the UK, which had an underfunded capitation model, how both that underfunding and that model have led to a system under dire stress.’
 
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