Acute hospital admissions are increasing well above the population growth rate despite increased use of general practice (GP) services, says Lyndon Keene, Director of Policy and Research for the Association of Salaried Medical Specialists (ASMS).

This is one of the findings of an ASMS Research Brief looking at whether access to primary care, with a greater focus on health promotion and illness prevention, reduces pressure on hospitals.

“Evidence from New Zealand and overseas shows this approach has frequently not achieved what its advocates and governments hope and expect,” says Mr Keene.

He says primary care plays a vital role preventing illness and death, but it generally falls short of expectations in respect of keeping people out of hospitals. Reasons for this include a lack of clear evidence to determine the most effective approaches, lack of clinical time, lack of patient compliance, practitioner attitudes, and financial disincentives.

In New Zealand, barriers to accessing primary health care means the patients most likely to derive benefit often miss out on timely interventions, so recent moves to reduce cost barriers to accessing it are welcome. But it must be recognised this will identify previously unmet needs, which in turn will lead to more pressure on hospital services.

“With continuing tight funding, attempts to strengthen primary care at the expense of hospital care will lead to a greater bottle-neck to accessing hospital services which in turn will increase pressures on primary care.”

Mr Keene says reducing pressure on hospitals requires strong integration between hospitals, GPs, and social services and a cross-party political commitment to a long-term strategy. This not only requires a well-functioning and accessible primary health care system but also a well-functioning, accessible hospital system.

He says the evidence shows integration succeeds when it’s approached from the “bottom up”, and health practitioners are given adequate time to develop innovative practices. This cannot happen while hospitals, as well as primary care services, are struggling to cope from one day to the next.

Mr Keene argues the most effective measures for keeping people out of hospital lie outside the health system, in the form of taxes on unhealthy food, alcohol, and tobacco.

Housing and poverty are also big factors in health.

“Without addressing the social and economic causes of poor health, it’s very difficult to improve the effectiveness of the health care system,” Mr Keene says.


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