The Economic Impact of Improvements in Primary Healthcare Performance

by Simone Dahrouge et al. | May 22, 2012
Full Report (PDF, 1 MB)


  • The performance of Canada’s primary healthcare (PHC) system lags behind that of other industrialized countries. Well-targeted investments in PHC can improve the health of individuals and populations, which can in turn have a positive impact on macro-economic indicators, such as employment rates, productivity and economic growth.
  • There are important gaps in Canadian PHC systems that require improvement. These include accessibility of PHC services, technical quality of care, quality improvement initiatives andpractice organization.  
  • Various interventions and investments have been shown to enhance the performance of PHC, improve the quality of care and produce economic savings. These include incorporating pharmacists into PHC teams, case-management strategies to enhance chronic disease management, and electronic medical records that include patient recall and provider reminders for preventive care and chronic disease management.
  • This report presents the results of four different approaches to evaluate the economic impact of enhancements to PHC: 1. A synthesis of the literature on the macro- and micro-economic effects of good health, with specific relevance to PHC performance. 2. A systematic review of the economic impact of incorporating a pharmacist into a PHC practice. 3. A simulation exercise that evaluates the economic impact of improvements to influenza immunization rates for older adults brought about by provider reminder systems in PHC. 4. A literature review of reductions in burden of illness associated with four specific enhancements to chronic disease management in PHC that produce health benefits. These include PHC improvements that result in improved blood pressure control, enhanced diabetes management, increased uptake of cancer screening and improved continuity of care.
  • Three of the four approaches used in the report suggest that improvements to the performance of PHC in Canada would yield economic benefits. Better health outcomes have a positive impacton employment, productivity and economic growth. Simulation results indicate that increasingthe influenza vaccination rate of the elderly population results in cost savings. Improved health outcomes for chronic disease management were linked to cost savings through reductions in hospitalizations, professional visits, emergency room visits and increased productivity; and higher continuity of care was associated with lower resource utilization and reduced healthcare costs. Despite literature that shows a positive health benefit of pharmacist integration in PHC, studies ofthe economic impact are inconclusive.
  • There are knowledge gaps and weaknesses in the current structure of Canadian PHC systems.The creation of a National Coordination Body, additional investment to improve Canada’s PHC performance and additional investment in PHC research and evaluation is recommended.