The costs of prevention: what role primary care?

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An economic report looking at what Australia invests in preventive health has found Australia ranks poorly in the international context ranked 16th in OECD.

Preventive health: How much does Australia spend and is it enough? was co-funded by the Heart Foundation, Kidney Australia, Alzheimer’s Australia, the Australia Health Promotion Association and the Foundation for Alcohol Research and Education

The report found that Australia spends $27 billion treating chronic disease each year, yet only just over $2 billion on preventive health.

The discussion then explores the question: ‘how much should Australia be spending on preventive health?’

We know from the Prevention 1st campaign that when looking at Australia’s spend on prevention, we need to keep in mind that one third of all chronic diseases are preventable and can be traced to four lifestyle risk factors: alcohol and tobacco use, physical inactivity and poor nutrition.

Positively addressing and influencing these four lifestyle factors will significantly reduce the level of heart disease, stroke, heart failure, chronic kidney disease, lung disease and type 2 diabetes – conditions that are too common and which place great pressure on Australia’s healthcare systems

Key points from the report discuss that:

  • Australia could and should spend more on preventive health measures based on the evidence of the cost effectiveness of preventive health interventions
  • The key to determining the appropriate prevention spend is to compare the added value of an increase in spending on preventive health against the opportunity cost of doing so
  • There is clear evidence that many existing preventive health initiatives are cost-effective, which is where spending should be increased
  • The choice of funding mechanism, or how money is allocated to whom for prevention – is an important factor for the overall efficiency of health prevention expenditure

So where does preventative health fit in Australia’s healthcare system, and within public health more broadly? With public health services being provided at each three levels of government, as well as in primary care, community health and the not for profit sector, Australia may be more complicated than in the other countries.

In terms of investment, there is little accounting for preventative health activity that occurs in primary care settings. The report identifies the risk of channelling prevention funding through PHNs will likely increase the provision of individual and group-based behavioural or clinical prevention rather than tackling social determinants, since the former is more consistent with general practice.

“Any imbalance in the share of funds allocated through this funding channel rather than an alternative more conducive to supporting action upstream, would manifest in differences in actual cost-effectiveness of marginal activities.”


“If ‘too much’ is allocated through primary health, then we will see more funds allocated to clinical prevention programs that are relatively less cost-effective. If ‘too little’ is allocated through primary health care channels relative to the alternatives, then we will find clinical prevention programs that are not being funded even though they warrant support based on their cost-effectiveness.”

How then does primary health care tackle preventative health in a way that is cost-effective, evidence-based and accounted for? What role do health care homes play in contributing to the evidence base for cost-effective preventative health measures?