Health funding should follow the evidence

7 minute read

Preparing the federal health budget is quite similar to making a cake

Preparing the federal health budget is quite similar to making a cake

It’s got to be very tasty, it should look good and one has to be mindful that everybody wants a rather large slice. But essentially, as the leading patisserie chefs would tell you, it’s all about substantial ingredients and some nice flavour.

I appreciate that the flavours of the 2016 health budget are very political indeed. Some like it – others don’t. But the substantial ingredients of this budget should be evidence-based. And they are clearly not.

Why else would the foundation of our health system, general practice, be defunded until at least 2020?

It looks like the 2016 budget is all about political flavour and not about the evidence, because the evidence that investing in general practice leads to greater savings of the health system at large is overwhelming1-29. (See below)

Essentially, health systems focusing on general practice have lower use of hospitals and better health outcomes compared with health systems that focus on specialist care. If medical conditions are managed by GPs, the costs to patients and the taxpayer are significantly lower than the costs of a hospital specialist. Access to a preferred GP is strongly associated with lower emergency department presentations and hospital use across a wide range of acute and chronic medical conditions. And if patients have to be admitted to hospital, the risk of readmission after discharge is significantly less with ready access to their GP.

Do those examples matter? Of course! They reflect the substantial evidence base that general practice not only improves health outcomes but also improves the budget bottom line.

The savings, if we invested in general practice, would be $4 billion per year. Compare that with how much the federal government allocates for general practice per year in the first place: a comparatively measly $6 billion, roughly $250 per person per year. Pretty much the same amount it spends on the private health insurance subsidy, which in the 2016 budget is indexed again at an average 4% per year until 2020.

Those measures are not evidence-based by any stretch of imagination. They stink. Take a bite of that budget cake, and you’ll get sick.

Prof Bastian Seidel is a GP and RACGP Councillor

1.         Kringos DS, Boerma WG, Hutchinson A, van der Zee J, Groenewegen PP. The breadth of primary care: a systematic literature review of its core dimensions. BMC Health Services Research,. 2010;10(1):65.

2.         Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gaceta Sanitaria. 2012;26:20-6.

3.         Deraas TS, Berntsen GR, Hasvold T, Forde OH. Does long-term care use within primary health care reduce hospital use among older people in Norway? A national five-year population-based observational study. BMC Health Services Research,. 2011;11:287.

4.         Engström S, Foldevi M, Borgquist L. Is general practice effective? A systematic literature review. Scandinavian journal of primary health care. 2001;19(2):131-44.

5.         Gravelle H, Morris S, Sutton M. Are Family Physicians Good for You? Endogenous Doctor Supply and Individual Health. Health Services Research. 2008;43(4):1128-44.

6.         Gunther S, Taub N, Rogers S, Baker R. What aspects of primary care predict emergency admission rates? A cross sectional study. BMC Health Services Research,. 2013;13:11.

7.         Macinko J, Starfield B, Shi L. The contribution of primary care systems to health outcomes within Organization for Economic Cooperation and Development (OECD) countries, 1970-1998. Health Services Research,. 2003;38(3):831-65.

8.         Shi L. The impact of primary care: a focused review. Scientifica. 2012;2012.

9.         Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Affairs. 2010;29(5):766-72.

10.       Baker A, Leak P, Ritchie LD, Lee AJ, Fielding S. Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation. British Journal of General Practice. 2012;62(595):e113-e20.

11.       Cowling TE, Cecil EV, Soljak MA, Lee JT, Millett C, Majeed A, et al. Access to primary care and visits to emergency departments in England: a cross-sectional, population-based study. PloS one. 2013;8(6):e66699.

12.       De Leon SF, Pauls L, Shih SC, Cannell T, Wang JJ. Early assessment of health care utilization among a workforce population with access to primary care practices with electronic health records. Journal of Ambulatory Care Management. 2013;36(3):260-8.

13.       Doran KM, Colucci AC, Hessler RA, Ngai CK, Williams ND, Wallach AB, et al. An intervention connecting low-acuity emergency department patients with primary care: effect on future primary care linkage. Annals of emergency medicine. 2013;61(3):312-21. e7.

14.       Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does better disease management in primary care reduce hospital costs? Evidence from English primary care. Journal of Health Economics,. 2011;30(5):919-32.

15.       Einarsdóttir K, Preen DB, Emery JD, Kelman C, Holman CAJ. Regular primary care lowers hospitalisation risk and mortality in seniors with chronic respiratory diseases. Journal of general internal medicine. 2010;25(8):766-73.

16.       Fan VS, Gaziano JM, Lew R, Bourbeau J, Adams SG, Leatherman S, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: a randomized, controlled trial. Annals of internal medicine. 2012;156(10):673-83.

17.       Gibson OR, Segal L, McDermott RA. A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing. BMC health services research. 2013;13(1):336.

18.       Gulliford MC. Availabilty of primary care doctors and population health in England: is there an association? Journal of Public Health Medicine. 2002;24(4):252-4.

19.       Hippisley-Cox J, Coupland C. Development and validation of risk prediction algorithms to estimate future risk of common cancers in men and women: prospective cohort study. BMJ open. 2015;5(3).

20.       Huntley A, Lasserson D, Wye L, Morris R, Checkland K, England H, et al. Which features of primary care affect unscheduled secondary care use? A systematic review. BMJ open. 2014;4(5):e004746.

21.       Karapinar-Carkit F, Borgsteede SD, Zoer J, Siegert C, van Tulder M, Egberts ACG, et al. The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients. BMC Health Services Research,. 2010;10:39-.

22.       Leendertse AJ, de Koning FH, Goudswaard AN, Jonkhoff AR, van den Bogert SC, de Gier HJ, et al. Preventing hospital admissions by reviewing medication (PHARM) in primary care: design of the cluster randomised, controlled, multi-centre PHARM-study. BMC health services research. 2011;11(1):4.

23.       Macinko J, Starfield B, Shi L. Quantifying the health benefits of primary care physician supply in the United States. International journal of health services. 2007;37(1):111-26.

24.       Martín-Lesende I, Orruño E, Bilbao A, Vergara I, Cairo MC, Bayón JC, et al. Impact of telemonitoring home care patients with heart failure or chronic lung disease from primary care on healthcare resource use (the TELBIL study randomised controlled trial). BMC Health Services Research,. 2013;13(1):118.

25.       O’Malley AS. After-hours access to primary care practices linked with lower emergency department use and less unmet medical need. Health Affairs (Millwood),. 2013;32(1):175-83.

26.       Ricketts TC, Holmes GM. Mortality and Physician Supply: Does Region Hold the Key to the Paradox? Health Services Research. 2007;42(6 Pt 1):2233-51.

27.       Royal S, Smeaton L, Avery A, Hurwitz B, Sheikh A. Interventions in primary care to reduce medication related adverse events and hospital admissions: systematic review and meta-analysis. Quality and Safety in Health Care. 2006;15(1):23-31.

28.       Worrall G, Knight J. Continuity of care is good for elderly people with diabetes Retrospective cohort study of mortality and hospitalization. Canadian Family Physician. 2011;57(1):e16-e20.

29.       Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. Journal of hospital medicine. 2010;5(7):392-7.

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