Health System Improvements Threatened by Government's Budget Measures
AMA Response to COAG Reform Council Healthcare Performance Report 2012-13: five years of performance
AMA President, A/Prof Brian Owler, today welcomed some notable health system improvements detailed in the COAG Reform Council Healthcare Performance Report, but warned that these hard-won advances could be reversed as a result of the Government’s latest Budget measures.
A/Prof Owler said that there is some good news in the COAG report.
“Across the population, life expectancy, and rates of child death, heart attacks, lung cancer and deaths from circulatory disease, have all improved over five years,” A/Prof Owler said.
“But the report also shows that public hospitals are already stretched to meet demand. Waiting times in emergency departments have improved (72 per cent), but have not achieved the target set by COAG (80 per cent by 2012-13).
“Elective surgery waiting times have increased nationally, from 34 to 36 days.
“Access to important surgery varies significantly by levels of disadvantage. For example, it takes 42 days longer for cataract extraction for people in disadvantaged areas.
“Our hardworking doctors and other health professionals are doing their best with limited capacity, but our public hospitals will now have to cope with the effects of the Government’s Budget measures.
“The Government is reducing public hospital funding by $1.8 billion over the next four years and reneging on the guarantee of $16.4 billion additional funding under the National Health Reform Agreement over the next five years.
“The COAG report also highlights the dangers of implementing the Government's poorly-designed model of co-payments for General Practice, pathology and imaging services, and increasing co-payments for PBS medications.
“According to the COAG report, in 2012–13, 5.8 per cent of people delayed or did not see a GP due to cost.
“Over the same period, 8.5 per cent of people given a prescription by their GP delayed or did not fill it due to cost.
“One in eight people (12.4 per cent) in the most disadvantaged areas delayed or did not fill a script due to cost (36.4 per cent for Indigenous people).
“Under the Government's proposed model, there are co-payments applied at multiple points in the health system - and these are excluded from the Medicare Safety Net.
“A patient who is sick and needs tests, repeat GP visits, and medication during an episode of illness would face an accumulated financial burden.
“Overseas experience has shown this to be a significant barrier to care for people in disadvantaged groups.
“Doctors know that medication non-compliance, including not filling prescriptions, has serious consequences for health care.
“Research shows that an increase in patient share of medication costs is significantly associated with a decrease in adherence.
“The rates for not filling scripts in the COAG report can be expected to increase significantly with increased co-payments for PBS medicines. This would have serious consequences for downstream healthcare costs.
“A similar impact will occur with co-payments for pathology and diagnostic imaging services.
“With less diagnostic information, treating doctors will be hampered in their diagnosis and treatment of their patients.
“Mandatory co-payments for GP services will also affect vaccination rates, leading to complications and preventable hospitalisations for some patients. Vaccine preventable hospitalisations have increased by 16 per cent over five years.
“The good news in the report about improved health outcomes is overshadowed by the risks of the Government's co-payment model, with the potential for even more people to delay or not access essential treatment.
“This will inevitably increase costs in other parts of the health system.
“The rest of the world is lowering barriers to primary care to improve overall health outcomes and make their health systems sustainable. But Australia is moving in the opposite direction - even though our health costs are not rising relative to the total Budget.
“The Government did not consult with the profession over the design of its co-payment model – and it shows.
“The Government must scrap the current co-payment model and seek expert health advice on a better policy direction,” A/Prof Owler said.
Key findings of the COAG Report include:
- a decrease in the adult smoking rate (down by 2.8 per cent from 2007-08 to 16.3 per cent in 2011-12, revision to previously reported data, p32);
- a decrease in adult risky drinking (down by 1.5 per cent from 2007-08 to 19.4 per cent in 2011-12, p10);
- an increase in adult overweight and obesity (up by 1.6 per cent from 2007-08 to 62.7 per cent in 2011-12, p33);
- an improvement in waiting times for GP services for urgent appointments within 4 hours (64.1 per cent in 2011-12, 61.4 per cent in 2009, p48). 24.6 per cent of people waited 24 hours or more in 2012-13.
Aged care services were largely ignored in the Federal Budget.
The COAG Report shows that larger numbers of older Australians are now waiting nine months or longer, after being assessed for services, before receiving those services. And this does not count the time they wait to be assessed for the aged care services.
AMA members are reporting long delays in obtaining aged care assessments for their patients. These older Australians are at their most vulnerable and need timely access to aged care services that meet their needs.
New data relating to diabetes covered in the 2011-12 report shows half (49.5 per cent) of people who knew they had diabetes did not effectively manage their condition.
Only about one in 10 people who knew they had diabetes maintained a healthy body weight.
The report lists six areas of concern:
- increasing obesity and the risk it poses of greater chronic disease, including type 2 diabetes;
- increasing rates of potentially preventable hospitalisation rates for vaccine-preventable conditions (increased by 16 per cent between 2007–08 and 2011–12) and acute conditions (increased by 11 per cent);
- elective surgery wait times have increased for many procedures Median wait times increased for 14 out of 15 selected surgical procedures between 2007–08 and 2012–13;
- many older Australians experience longer times between being approved for aged care services and receiving those services, and growth in the rate of age care services has stalled;
- one in five Australians have trouble with the cost of dental care; and
- a long-term increase in the rate of lung cancer among women.
11 June 2014
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
Odette Visser 02 6270 5464 / 0427 209 753
Follow the AMA Media on Twitter: http://twitter.com/ama_media
Follow the AMA President on Twitter: http://twitter.com/amapresident
Follow Australian Medicine on Twitter: https://twitter.com/amaausmed
Like the AMA on Facebook https://www.facebook.com/AustralianMedicalAssociation
Published: 12 Jun 2014