At the National Press Club yesterday, Health Minister Peter Dutton spoke of the importance of evidence in formulating health policy.
I wonder if his advisors are reading The Medical Journal of Australia, which this week has published a study from the NT concluding that:
“Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.”
The authors report below that creating barriers to access to primary care through a co-payment will have adverse consequences for the health of Indigenous Australians in remote NT communities. (And, as we’ve already heard at Croakey, these concerns are not limited to the NT).
Improving access to primary care is a win-win
Dr Susan Thomas, Dr Yuejen Zhao, Dr Steven Guthridge and Professor John Wakerman write:
A new study published in the Medical Journal of Australia provides solid evidence that better access to primary care in remote Northern Territory communities saves money by preventing costly hospitalisations and improves health for Indigenous patients with diabetes.
This has to make sense to budget conscious politicians.
The Northern Territory has a large proportion of Indigenous residents, many of whom live in remote communities. They experience high rates of diabetes, often with serious complications, disability and death.
Indigenous people were hospitalised for potentially avoidable causes at four times the rate of non-Indigenous people between 1998-99 and 2005-06.
This was largely due to the complications of diabetes. Diabetes and related chronic diseases account for a large proportion of hospital resources as well as having broader social costs through loss of productivity and the impact on community and family life.
Primary care is an effective and efficient way of providing basic health services that promotes health and prevents illness. There is considerable international evidence that primary care is cost effective, meaning that it delivers value for money with better health outcomes at less cost to the health system.
We looked at how often more than 14,000 Indigenous remote residents with diabetes used primary care over a ten year period, and measured resulting health outcomes and hospitalisations.
We found that patients who visited primary care services 2-11 times a year (medium utilisation) had far fewer hospitalisations, lower death rates and fewer years of life lost ( a measure of premature mortality) than patients who visited less than twice a year (low utilisation).
Overall, compared to patients with low utilisation of primary care, those with medium utilisation had lower rates of hospitalisation per person (1.1 vs 5.0), fewer avoidable hospitalisations per person (0.64 vs 2.69), a lower death rate per 100 population (0.99 vs 3.23) and fewer years of life lost per person (0.24 vs 1.0). This trend was most evident for patients with more complicated diabetes.
The study also calculated the savings to health systems when primary care was used by Indigenous patients 2-11 times a year.
We found that investing $1 in this level of primary care use saved $12.90 in hospital costs. Expressed another way, the cost of preventing one hospitalisation for diabetes was $248 for those patients that used primary care 2-11 times a year. That is much less than the average cost of one hospitalisation at $2915.
The NT is a unique place with a small population spread over vast remote areas. There are few doctors, limited health infrastructure and higher costs associated with transport, housing and salaries. This poses challenges for providing primary care and contributes to higher costs compared to urban areas.
Despite these higher costs, this study found primary care was still cost effective. The study has a number of significant policy implications.
In the Northern Territory where needs are high, encouraging access to primary care services will result in better health outcomes and fewer costly hospitalisations for Indigenous patients with diabetes.
Failure to capitalise on the cost saving benefits of primary care or creating additional access barriers through a co-payment, will mean a continuation of poor health outcomes for Indigenous Australians in remote Northern Territory communities.
The results are also of interest for other high need populations including those in other states and territories.
For these groups, programs that improve access to primary care may also deliver better outcomes and overall health system savings.
This study adds to the international evidence that improved access to primary care in a variety of settings makes sense both financially and in terms of health outcomes.
• Dr Susan L Thomas, Senior Research Fellow (1,3)
• Dr Yuejen Zhao, Principal Health Economist (2) and Adjunct Senior Research Fellow (1,3)
• Dr Steven L Guthridge, Director (2) and Adjunct Associate Professor (1,3)
• Professor John Wakerman, Director (1) and Chief Investigator (3)
1. Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT
2. Health Gains Planning Branch, Department of Health, Darwin, NT
3. Centre of Research Excellence in Rural and Remote Primary Health Care, Bendigo, Vic.