Failing to get frontline healthcare right comes at a huge cost - Prabani Wood

Research found every dollar invested in primary care saves approximately $13 of expenses.

THREE KEY FACTS

• Health Minister Simeon Brown’s primary care package addresses GP shortages with overseas doctor placements and digital healthcare.
• Investing in primary care can save significant costs, with early treatment preventing expensive hospital interventions.
• Continuity of care with the same GP improves health outcomes and reduces emergency department visits.

The primary care package recently announced by Health Minister Simeon Brown tackles our GP shortage with overseas doctor placements, more GP trainees and digital healthcare. These welcome initiatives recognise the critical challenges facing general practitioners nationwide.

The GP workforce faces immense strain from underfunding, unrealistic job-sizing, hospital care failings, and fragmentation as more GPs move to telehealth and urgent care.

At The New Zealand Initiative, I have just released my new report, “The Heart of Healthcare”, examining the challenges facing our primary care system.

The clinical case for strengthening primary care is compelling. There is also a strong economic argument. Healthcare debates often overlook this, but it deserves attention, especially with growing fiscal pressures.

Think of your local GP practice as the frontline of our healthcare economy. When working optimally, it serves as an efficient filter, resolving most health issues before they require expensive specialist interventions.

Overseas research demonstrates that every dollar invested in primary care saves approximately $13 of expenditure on post-primary healthcare.

Treating a condition early is almost always less expensive than addressing it later when it has progressed. A minor infection treated promptly by a GP costs the system a fraction of what the same infection would cost if it developed into sepsis requiring hospitalisation.

The ripple effects extend throughout our healthcare system. Lack of GP access forces patients to emergency departments, overwhelming them. An emergency department visit costs the system around $650, compared to $50 for a GP consultation. This misalignment of resources represents a significant hidden cost to our healthcare system and economy.

Hospital admissions tell a similar story. Research shows that for each additional 10 GPs per 100,000 population, we see 40 fewer hospitalisations annually. In business terms, this represents significant cost avoidance through early intervention. It could translate to millions in annual savings.

The full economic value of primary care is realised through the concept of “continuity of care” – seeing the same doctor consistently. This might seem like a luxury in today’s healthcare environment, but it is a vital efficiency mechanism.

Think of it like a longstanding business relationship. You do not need to start from scratch each time because there is established trust and shared knowledge.

Doctors avoid unnecessary test duplication when patients see them repeatedly. Knowledge of a patient’s history allows for quicker diagnoses. Adherence to treatment plans improves. A large US study showed that patients with good levels of continuity of care with their GP were 16% less likely to visit the emergency department. All of this translates to better health outcomes and lower system costs.

Former Prime Minister Bill English pioneered the “Social Investment Approach” during his time as Finance Minister. While he applied it primarily to social services, the same principles work perfectly for healthcare. Using data and targeting early interventions leads to better social and fiscal outcomes.

New Zealand sits on a potential goldmine of health data that could transform how we deliver care. Yet, we lack local research demonstrating the economic returns of primary care investment. International evidence is compelling, but more New Zealand-specific studies would provide a stronger case for policy change. As a nation that prides itself on innovation, this is a significant missed opportunity.

Technology certainly has a role to play in modernising primary care. The Minister’s announcement of a 24/7 digital service acknowledges this potential. Telehealth and artificial intelligence tools offer exciting possibilities for extending care to under-served populations, but it is important to recognise that they are only useful adjuncts to in-person care.

There is irony in discussing cutting-edge technology when many GP practices still use fax machines to transfer patient records. Our primary care infrastructure requires fundamental upgrades before fully embracing digital innovation. We must first build a sustainable specialist GP workforce.

Perhaps the most frustrating technological challenge is the fragmentation of our health information systems. Hospitals, GP practices, specialist clinics and pharmacies often use incompatible platforms that do not communicate effectively with each other.

This fragmentation is not just an administrative headache. It has real economic costs. Critical test results get delayed. Doctors duplicate treatments. Preventable errors occur. A single, patient-centred information system would yield substantial efficiency gains.

The Government’s focus on primary care is heading in the right direction. Yet the announcements represent just the beginning of what needs to be a comprehensive overhaul. The economic case for such reform is clear: strengthening primary care is not just good medicine – it is good business. The full benefit of primary care cannot be achieved without building continuity of care and long-term therapeutic relationships with patients.

For anyone wishing to understand the importance of GPs and the challenges they face, my report, “The Heart of Healthcare”, offers insights directly from the frontlines. The health of our nation – and our healthcare budget – depends on getting this right.