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Time for serious health policy

15 Apr 2014

Time for serious health policy

There has been an epidemic of crazy health policy proposals floated in the media and political circles in the first few months of 2014.

There has been speculation ahead of the Budget about GP co-payments, freezing Medicare rebates, means testing, and a charge for patients who go to emergency departments with minor ailments.

Many of these thought bubbles have been raised by so-called health experts. They get discussed and dissected in the media, and they attract supporters and detractors. The AMA hopes they never see the light of day, let alone make it into Government policy.

The big problem is that these bad policy proposals are not going away. They linger. The Government should be killing them off, dismissing them outright. But, for some reason, the various Health portfolio Ministers are letting these ideas emerge again and again in Budget conjecture.

We urgently need the Government to engage in meaningful consultation with the medical profession about health policy. There are significant challenges ahead for our health system. We need solutions, and soon.

It is not possible to develop significant health policy that works without first consulting with the people who work in the front line of the health system every day.

Making policy on the run is no way to equip the health system to meet future needs.

First, we must remove the policies that we know won’t work from discussions. The AMA has been in the media explaining why these things won’t work.

The reports of a possible charge for ‘low acuity’ patients treated in emergency departments suggest that policymakers have been more focused on budget savings than patient care.

Category 4 and Category 5 emergency department patients are not necessarily GP patients – they are the patients who can safely wait for care.

They are not clogging up the emergency departments, so the proposal is trying to solve a problem that does not exist.

The problem in emergency departments is lack of capacity in the hospital to move sick people out of the emergency department into inpatient beds.

The Government must also clarify its position on primary care, especially general practice.

The GP co-payments idea could actually lead to increased costs to the health system, and should be ruled out immediately.

Freezing Medicare rebates would have a compounding effect on patient out-of-pocket costs, creating another disincentive for people to see their doctor.

Targeting GP services for savings is a false economy that would lead to greater costs down the track.

General practice is a very efficient part of the health system, helping minimise the number of people who end up needing far more expensive hospital or chronic care.

There is not a significant problem with supposed unnecessary use of GP services. This is a furphy. The greater concern is putting barriers in the way of people seeking relatively inexpensive GP treatment for health complaints.

Forcing people to avoid seeing the doctor for minor ailments is a dangerous and expensive policy direction. Minor ailments become major ailments if not treated early.

The international evidence shows that the key to a sustainable health system that delivers high quality outcomes for patients is to ensure the barriers to accessing primary care are low.

Rather than looking to make savings in general practice, the Government should be investing more in primary care and prevention.

We need to keep people out of hospital, where care is much more expensive. We do not need to keep them away from their GPs by adding new price barriers.

Fee-for-service should remain as the cornerstone funding source for general practice.

But we need to reshape current systems to meet the challenge being thrown up by the major cost drivers of an ageing population with chronic and complex health needs, and the sheer volume of services capable of being delivered to those suffering the impacts of non-communicable diseases.

The solution is in how we can provide longitudinal, continuous and coordinated care, not necessarily in changing the way we get paid.

Wellness maintenance, chronic disease management, and appropriate end-of-life care are the key.

More comprehensive care could be better encouraged if GPs were better supported to spend more time with their patients, and to make better use of the clinical teams that are beginning to build around them.

The imbalance in existing patient rebates for GP services rewards high throughput and discourages longer consultations and team-based care.

This is the serious policy discussion the Government should be having with the medical profession.

Published: 15 Apr 2014