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Good reform must proceed

Last year was a tumultuous year for governments and, as a result, a tumultuous year for health reform. The health reform agenda in January 2011 is far removed from that of last year.  So too is the approach the Government will need to take to get any of its major reforms implemented.  Already we have seen a change, and a significant one at that.  The Government’s decision to revisit its policy on care for people with diabetes shows that consultation and negotiation with the profession before announcing policies may be the way of the future.

23 Dec 2010

By AMA President Dr Andrew Pesce

Last year was a tumultuous year for governments and, as a result, a tumultuous year for health reform.

The health reform agenda in January 2011 is far removed from that of last year.  So too is the approach the Government will need to take to get any of its major reforms implemented.  Already we have seen a change, and a significant one at that.  The Government’s decision to revisit its policy on care for people with diabetes shows that consultation and negotiation with the profession before announcing policies may be the way of the future.

It was a smart move by the Government.  Now everybody has a chance to benefit from a new approach to providing care for people with diabetes – the Government, the medical profession, other health professionals and, above all, the patients.

This approach should now be used by the Government to smooth over a few more bumps in the road.

It is important that the GP Super Clinics process be re-calibrated.  There should be much more emphasis (and funding) in providing infrastructure support for existing general practices.  The new GP Super Clinics should only proceed in areas where there is evidence of genuine need and where there is no unfair competition with existing general practices.  This would not only preserve established services that have served communities for a long time, but it would also ensure that the Government is getting better returns on its Super Clinic investment.  It would also mean that new health care services will be made available where they are most needed.  Again, winners all round.

There are changes also needed in two areas where there was well-intentioned reform with unintended consequences – practice nurse funding and after-hours GP care.  There was little or no consultation with the AMA and the medical profession on these new arrangements – and it shows.

In both cases, GPs are finding themselves worse off than before the changes.

As a result of the after-hours changes, there will be no significant take-up of the new arrangements, but there will be a huge impact on the services that currently operate.  In short, general practices will be penalised and there will be little incentive for new services to commence.  Patients will lose out.  This policy must be fixed.

Similarly, many general practices will lose any incentive to employ more practice nurses under the new arrangements.  The removal of incentives again produces a net negative effect.

Meaningful consultation with the medical profession will produce reform – good reform.

But the biggest impact on the Government’s health reform agenda will come from the changing complexion of Australian politics.

Minority Government at the Federal level has brought about a more inclusive and consultative process, which so far seems to be working.

however, the bigger change is at the State level.  The new Coalition Government in Victoria should be joined in a few months by a new Coalition Government in New South Wales.

This will bring a big change in attitude in the nation’s two biggest States.  It will no doubt put pressure on the COAG Agreement and all the complex health funding arrangements contained therein.

While work on Local Hospital Networks and Medicare Locals has begun, their future shape and function face further pressures – mainly because of funding disputes.

The AMA wants to see good reforms carried through.  Our public hospitals need it.  General practice needs greater support.

Our hope is that the national need for health reform takes precedence over the inevitable squabbles about how to pay for it.

Perhaps there is a silver lining out there after all.  We may end up with a single funder for our public hospitals.  Now that’s a New Year resolution worth pursuing.


Published: 23 Dec 2010