Published by The Australian
“The only way to organise and pay for health services well is to change the system every second year so nobody feels comfortable in it.”
That is the response of Brian Abel-Smith, a professor from the London School of Economics, when asked whether there were any new and significant ideas in healthcare policy.
The question was asked a few decades ago, but successive Australian health ministers have followed this advice to the letter.
In a rather bipartisan approach, GPs and their patients have been shaken, stirred, turned inside-out and put in the freezer. The reason? Nothing in particular, other than politics.
Funding GP visits accounts for about 7 per cent of the Australian government’s total health expenditure. Substantial yes, but it pales in comparison with the figures for the cost of pharmaceuticals and the cost of specialist hospital care. GPs are clearly not the cost drivers of Australia’s healthcare system. That is self-evident.
But GPs are an easy target for political decisionmakers, and that does affect our patients. If visits to the GP are not funded appropriately, patients delay those consultations.
Unfortunately, those patients belatedly end up in the overcrowded hospital system. This is unnecessary. It is distressing for our patients and comes with a hefty bill for the already burdened taxpayer.
It’s time for a rethink. It’s time to take reactive politics out of healthcare and to commit to evidence-based health policies. After all, isn’t it our aspiration to advance Australia fair and keep our nation healthy?
If we look at the substantial international evidence, health systems focusing on general practice have lower use of hospitals and better health outcomes compared with health systems that focus on specialist care. If medical conditions are managed by GPs, the costs to patients and the taxpayer are significantly lower than the costs of a hospital specialist.
Access to a preferred GP is strongly associated with lower emergency department presentations and hospital use across a wide range of acute and chronic medical conditions.
And if patients have to be admitted to hospital, the risk of readmission after discharge is significantly less if they have ready access to their GP.
This is not rocket science. It’s logical, evidence-based and intellectually sound. It just needs to be implemented. But it looks like politics has been getting in the way of sound health policies for far too long.
So, let’s go back to the numbers. Federal governments fund GP visits for $7.2 billion a year. That figure equals $29.50 per person per month.
If we focused just on avoiding unnecessary hospital admissions and presentations to the emergency department by enabling better access for patients to see their GP, taxpayers would save $4bn — every year. Imagine the opportunities if we then redirected those savings back to general practice: GPs could actually spend time with their patients.
Patients want health, not necessarily treatment, and GPs always want to do the right thing by their patients. Fostering that relationship will improve health outcomes, but it will also reduce the prescribing of expensive drugs and cut the number of costly blood tests and scans. GPs would be given the opportunity to invest in personalised medicine aided by data analytics, so their patients receive the individualised care they need.
We all know that a one-size-fits-all approach does not work when it comes to one’s own health.
So, let’s enable GPs to practise quality healthcare, enable GPs to extend their scope of practice to meet the need and expectations of their patients, and allow GPs to use appropriate and safe technology to interact with their patients. Technology designed solely for enhanced and meaningful use by GPs and their patients. Technology that is legally protected from being accessed and used for other, secondary purposes that are clinically irrelevant.
Let’s enable GPs to demonstrate how they continually improve as professionals, rather than asking the profession to manage costs by funding less and demanding more.
Australia’s GPs are treating 61 million more medical conditions now than a decade ago. We just cannot do more with less.
Our patients understand that, the public understands that — and political decisionmakers are asked to take action.
We may now have the right leader for Australia’s most challenging and important portfolio.
Following several positive and meaningful conversations with the new federal Health Minister, Greg Hunt, I am optimistic that he understands anything other than committing to investing in general practice would be shortsighted, and would not reflect our ambition to be the clever country with the finest healthcare system.
Lifting the Medicare rebate freeze for consultations with GPs would be a start, but imagine the opportunities if we fully commit to strengthening general practice: Australia would have the finest healthcare system in the world. Now, that would be very clever indeed.