Author’s reply to Pereira Gray and colleagues

I thank Pereira Gray and colleagues for debating my provocative contention that neither prevention nor improved primary care, though valuable and even essential, saves money.12 Pereira Gray and colleagues emphasise the importance of continuity of care, providing four references with evidence—mostly in studies of cohort design but also a review of the literature—that there is an association between better continuity and better healthcare, including reduced costs. This makes sense, and although we might quibble about study design, causality, and cost effectiveness, the conclusion is likely to be correct.I endorse their view. Undoubtedly, there will be other aspects of primary care that can be improved and will reduce healthcare and societal costs. It is possible that diseases such as diabetes and hypertension could be managed largely, but never wholly, in primary care, but this will still generate upstream costs, as patients with these diseases live longer and eventually need costly secondary…
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