The Alberta government named improving access to primary care health services a priority in its health system reforms. Yet, the $644 million it announced in this year’s budget to connect every Albertan to a primary care team and improve access to front-line health services falls short of the funding necessary to achieve this goal.
While there is no substitute for a family physician, family doctors cannot continue to deliver care without a well-resourced and supported team. Refocusing the system around team-based care — where patients have timely access to family doctors, nurse practitioners and other health care professionals — is a critical long-term project.
It is imperative that the government be clear sighted about the investments needed to build a primary care system that delivers for all Albertans.
A recent analysis undertaken by the Alberta College of Family Physicians with input from experts shows that, realistically, the government needs to invest between $3.2 billion and $6.8 billion annually — or between $673 and $1,417 per Albertan — to fully fund team-based primary care.
It sounds like a hefty price tag until you compare it to how much is already being spent. Our analysis indicates that the government is already spending approximately $3 billion a year on primary care, but doing so in a fragmented way that is neither delivering optimal care nor offering financial efficiency.
Our model shows that making sufficient investments to primary care will result in a return on investment of over $3 billion from savings connected to reduced emergency room and urgent care visits and fewer unnecessary trips to specialists. This investment will also improve access for all Albertans to the right health care at the right time, decrease impacts on the acute care system and address health workforce challenges.
An aging population and patients with increasingly complex needs are increasing family doctors’ workloads and straining their ability to provide comprehensive care by themselves. The administrative burdens of running their own practice add to their challenges.
These issues are compounded by a growing population and a shortage of family physicians — due to factors such as retirement, doctors opting to work in other areas and fewer medical students choosing family medicine — that has left more than 650,000 Albertans without a primary care provider.
Of those with a family physician, only 23 per cent say it is easy or somewhat easy to get medical care in the evenings or on holidays without going to an emergency room.
Properly resourced and developed, team-based primary care will ensure that all Albertans have a medical home where they can access health care services when they need them — reducing lengthy wait times for appointments and the overcrowding and costs of avoidable emergency department care and hospital admission.
A team environment will also increase communication and collaboration among health care professionals and adding administrative support to the team will reduce administrative workloads for family physicians, nurse practitioners and other health care professionals, freeing them up to focus on patients.
Our estimated investment uses an order of magnitude model, where the full cost depends on the hours that primary care clinics operate. The lower end of the estimate applies to clinics open eight hours a day, five days a week.
Costs increase proportionally as clinic operating hours expand, reaching up to an estimated $6.8 billion annually for clinics open 12 hours a day, seven days a week.
Our estimates are based on a model where every resident of Alberta has a Patient’s Medical Home and is cared for by a team which includes family physicians, nurse practitioners, other health care professionals such as nurses and pharmacists, and administrative staff.
Besides including capital, space and administration costs, our model is based on the reality that salaries and benefits — including compensation — must be competitive to attract and retain primary care and other health providers to team-based settings.
The model also separates compensation for family doctors from clinic overhead costs — something not currently done — enabling and incentivizing them to practise alongside other team members without diminishing their take home pay.
Primary care funding must not only increase but be concentrated on team-based primary care and co-ordinated through the new Primary Care Alberta agency to ensure investments achieve the desired results.
Team-based primary care offers benefits for patients, health care providers and the health care system overall, but it needs to be properly funded to deliver results.
By making the right investments now, the government can ensure that primary care not only operates in a more cost-efficient fashion but offers optimal care for all Albertans.
Photo courtesy of Dave Cournoyer – Flickr: Danielle Smith, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=16644255
