Making the dollars count
It would seem that funding for general practice as we know it is coming to a cross road.
There has been so much speculation about possible changes to how GP services are funded that it is becoming increasingly likely that we will get some related announcements in the upcoming Budget. The challenge for the Government will be to make sure that any changes make every dollar count.
Health Minister Peter Dutton has repeatedly said that Medicare is unsustainable, and that those who can pay for their health care should.
To this end, a plethora of funding ideas have come out of the woodwork. These include the infamous $6 co-payment, means tested Medicare, increasing the Medicare levy, tiered MBS payments with restrictions on who can be bulk billed, block funding or capitated funding for targeted groups, and a greater role for private health insurance in primary care.
At least a conversation has been started about how health care expenditure in this country could be better utilised.
With it has come, I believe, a stronger sense in the Government of the role that general practitioners, who are the foundation of quality primary health care, play in the overall picture of health expenditure.
What needs to be driven home is that general practice consumes a relatively small part of the overall health expenditure and helps to keep overall health system costs sustainable. The Australian Government spent $59.5 billion on health in 2011-12, of which only $7.4 billion (12.4 per cent) was spent on general practice. The recently released AIHW report Health expenditure Australia 2011-12: analysis by sector shows that, as a proportion of primary health care funding, medical services has declined from 22.9 per cent a decade ago to 19.1 per cent in 2011-12. More primary health care funding is now spent on pharmaceuticals than on medical services.
General practice is not part of the problem, but part of the solution.
Investing in general practice is a better way for Government to spend its health dollars if it is serious about keeping patients healthier and providing them with the medical care they need, when they need and in the most appropriate part of the health system.
Preventing illness along with avoidable hospital presentations, admissions and lengths of stay, is where the big cost savings for Government will be made.
The only problem is, these savings won’t be immediate and, as is all too often the case, immediate impacts are what the Government is looking for, particularly given the current state of the Budget.
The challenge for this Government will be look to the future, and to invest now in primary health care, where it will get better bang for its buck and better outcomes for patients.
The AMA is open to discussions about how general practice can be better resourced to take a more structured and pro-active approach to managing patients, particularly those with chronic and complex conditions. GPs need to be better supported to spend more time with such patients on a long-term basis. The AMA wants to see further investment in general practice through greater support for longer consultations where more problems can be addressed and preventive health issues attended to. More effective funding for chronic disease management is a must.
Any changes to funding arrangements, however, need to be well thought out, targeted and aimed at improving patient outcomes.
Supporting general practice in this way will help make sure every dollar counts.
Published: 01 Apr 2014