No more health reviews, it's time for reform
We don't need a Medicare review to tell us the we are spending too little on primary care to keep people out of expensive hospitals, writes John Dwyer.
Published on the 05 May 2015 by John Dwyer
Image: iStock
OPINION: It's often claimed that Australia has one of the best healthcare systems in the world. However, this status is rapidly slipping away from us as we fail to adapt healthcare to meet contemporary realities and needs.
Developed countries are facing major epidemics of lifestyle-related diseases that too often evolve into chronic and complex conditions which consume most of our healthcare dollars and the time of our clinicians. Patients with these conditions require frequent admissions to hospital and despite Australia having more hospital beds per capita than most countries, we need more. The $50 billion we spend on hospital care dwarfs the $19 billion dollars we spend on Medicare. The states fund public hospital care and find it increasingly difficult to do so. They are frustrated that they control no levers they can pull to decrease the demand for hospital services.
The federal government funds Medicare that pays for the majority of our primary care services which are not resourced to stop the tsunami of Australians developing chronic diseases. We need to urgently reconstruct our primary care services, providing them the infrastructure that would enable them to improve the health of Australians, extract far more health from available dollars and reduce expensive hospital admissions.
Strong evidence
In so doing we would not be innovative pioneers. There is a strong evidence base to guide us provided by the experience of many countries which, over the last 10 years or so, have swung their health systems around to emphasise prevention, early diagnosis and treatment of potentially chronic diseases and care in the community for many we send to hospital. For us to embrace these changes will require political leadership and vision, unavailable to date, to take us on a health reform journey that will take a decade to complete.
So are we close to starting our reform journey? It's hard to be optimistic. The Abbott government plans to cut millions of dollars of promised federal support for state hospitals without committing to primary care strategies that might reduce the demand for hospital services. Our new health minister Sussan Ley, while appropriately consultative unlike her predecessor, is a prisoner of cabinet decision-making and thus must enforce the freeze on general practitioners' fee-for-service Medicare payments until 2018. While she emphasises that her government co-payment policy is "dead and buried", freezing fee adjustments will leave many doctors who would lose $30,000 of anticipated income with no choice but to charge a co-payment. Such strategies generate more problems, not solutions.
What should we make of the government's announcement last week of major reviews of two Medicare-related issues? One review will look at the 5500 Medicare "item numbers" i.e. tasks or services that are supplied mainly by our GPs and for which they receive a specific remuneration or fee for service. The taskforce will be looking for "low value and inefficient practices as well as overpriced procedures and tests". A second review will examine ways GPs can improve their care of patients with chronic and complex diseases and mental health disorders, and foster better communication between hospitals and GPs. The taskforce is asked to look at innovative funding models that might support better care and outcomes.
Slow progress
To those of you who are not review weary, frustrated by the lack of correlation between recommendations and implementations, these initiatives may be welcomed. However, government reviews so often provide the appearance of progress but produce no tangible outcomes. I have recently participated in three government-initiated reviews of strategies to improve the supply of Australian doctors to rural communities, all of which provided similar recommendations, none of which have been implemented. The second stream of the new reviews is unnecessary. Our government, while constantly emphasising its fiscal problems, will spend millions asking questions that were so recently asked of and answered by Kevin Rudd's expensive but authoritative Health and Hospitals Reform Commission. The current review will supply the same answers. Any implementation will not occur before 2016.
We know which changes we need to make to our health system. What we need now is not more reviews but a Healthcare Reform Commission to take us on the reform journey. When we reach our destination we will be spending more on Medicare but much less on hospital care. Savings will easily fund the needed primary care infrastructure that will help Australians enrolled in a medical home avoid lifestyle-related disease. (Google "medical home" for a description of the model). Reform will require a great deal of state and federal co-operation rather than the blame game that so often characterises health politics. However, there is a hunger for healthcare reform, a consensus regarding the changes needed and no reason to wait any longer to implement reforms that will provide us with more cost-effective, equitable healthcare with better health outcomes for Australians.
John Dwyer is Emeritus Professor at UNSW and founder of the Australian Healthcare Reform Alliance.
This opinion piece was first published in the AFR.