NZ Herald: Budget crunch in a healthcare crisis

Originally published by the NZ Herald 25/04/2024

The recent issues surrounding the new Tōtara Haumaru hospital on the North Shore, which remains unopened due to staffing and budgetary issues, serve as a poignant reminder of the misplaced priorities in our healthcare spending.

While it’s tempting to invest in grand new facilities like Tōtara Haumaru, with its innovative healing garden and state-of-the-art surgical suites, these investments miss the mark if the basic healthcare needs of the community are not met first.

It is well known that primary care is the cornerstone of a functional healthcare system. It is where prevention happens, where chronic diseases are managed, and where minor issues are treated before they escalate into emergencies that require hospital care.

By strengthening primary care, we can reduce the demand for hospitalisations, and emergency department visits, thereby easing the burden on our healthcare infrastructure.

Highlighting the critical role of primary care in preventing escalating healthcare demands, a reduction in GP consultations could potentially double emergency department presentations. Moreover, the financial disparities in delivering primary care versus tertiary care are well documented; for instance, in Australia, the government spends about $595.17 on a non-admitted emergency department visit compared to just $76.95 for a GP consultation.

In Canada, improved access to primary care is linked with up to a 30 per cent reduction in hospitalisations for conditions such as diabetes and hypertension. This dramatic difference highlights the economic benefit of strengthening primary care to address health issues before they escalate into costly hospital care. Investing in primary care yields substantial returns, significantly reducing hospital stays and thereby not only saving costs but also improving health outcomes.

This investment strategy extends beyond mere financial savings, fostering a healthier population and enhancing overall quality of life, making it a pivotal and life-enhancing approach to healthcare management.

The benefits of robust primary care are even more significant for underserved communities, such as Māori, Pasifika, and those living in rural areas. These groups often face the greatest barriers to healthcare access and have higher rates of health inequities.

Strengthening primary care can not only help reduce these inequities but also supports the health system’s sustainability by preventing manageable conditions from becoming acute crises. For a government that is focused on outcome-based initiatives, primary healthcare should be an easy investment thesis. In the upcoming healthcare budget, the Government stands at a pivotal crossroads, with an opportunity to make a transformative investment in our nation’s health.

Should the proposed increase in funding be minimal, it will not adequately address the profound challenges facing our primary care system. An underwhelming allocation of resources risks leaving primary care facilities unable to maintain access or enhance services and risks having long-standing GPs exiting the profession faster than anticipated.

Consequently, this limitation could place undue strain on already overstretched hospitals and aged care services, inhibiting their ability to deliver comprehensive care.

A substantial boost in funding for primary care is not just a matter of budget allocation; it is an investment in the very fabric of our society’s health and wellbeing. Without it, we risk continuing the cycle of reactive healthcare, where more resources are consistently funnelled into emergency and acute care settings — areas that could have been less burdened had there been adequate preventative care measures in place.

In addition, once the funding has been confirmed, it’s crucial to scrutinise the funding distribution process, as too often, the intended funds do not reach primary care providers directly. This issue is especially evident with mental health and health improvement practitioners, including health coaches, who are vital in primary care settings but the primary care provider, not receiving the direct funding instead these are provided by PHO’s, without the funding reaching frontline primary care. This gap underscores the need for a more transparent and effective distribution mechanism to ensure that resources are utilised where they are most needed.

So, while new hospitals like Tōtara Haumaru are impressive, they should not come at the expense of primary care—the real frontline of health prevention.

We need a strategic shift in our health budget to prioritise primary care, ensuring it receives the support necessary to fulfil its critical role. This is how we build a healthcare system that not only saves money but also, more importantly, saves lives.

‍– Cecilia Robinson is a founder and co-CEO of primary care provider Tend Health