Medicare rebate puts preventive care to the fore

Published by The Australian

Twelve months ago we saw yet another extension of the grossly unfair and nonsensical Medicare rebate freeze — this time until at least 2020.

In the budget handed down last week, the federal government thankfully delivered a staggered but clear reversal of that appalling decision. GP bulk-billing incentives now will be re-indexed in line with wages and inflation from July. Patient rebates for specialist GPs will be re-indexed from 2018-19.

While this ongoing guarantee of the same funding each year in real terms may seem like a step back to where we were before the freeze, it’s a clear win for more than 85 per cent of Australians who receive preventive health services from their GPs each year. Extending the freeze to 2020 would have seen rebate funding reduced by about $1 billion. It’s also a win for all taxpayers as GP health services not only cost up to 10 times less than similar care in a hospital, they also help reduce expensive hospital admissions.

As the body that represents more than 90 per cent of Australia’s GPs and fights for the interests of their patients, the Royal Australian College of General Practitioners hopes the end of the freeze signals a pivot — a genuine commitment by the government to reinvest in preventive health and the most health-effective and cost-efficient part of the entire healthcare system, general practice.

Our agreement with the government to help strengthen Medicare recognises the essential role of GPs in a system that touches every Australian.

It reaffirms the government’s, and our own, commitment to preventive health initiatives including the review of the Medicare Benefits Scheme, improving the quality and reducing the cost of after-hours services, and streamlined pathways for becoming a GP.

As the holistic experts in prevention, treatment and care, GPs focus on the whole person rather than the disease.

We understand that patients want health and that’s not necessarily delivered through treatment. With the ever increasing costs of medications to treat specific conditions we can help reduce ballooning healthcare costs by helping to prevent those conditions in the first place. In last week’s budget, $500 million was allocated for a new drug treatment for heart failure. This is good news for patients, but imagine the opportunities if we had supported GPs with the same funds to prevent our patients from experiencing heart failure. We need to shift the focus from expensive treatment to cost-effective prevention.

Realistically, this can’t happen with a standard Medicare rebate of $37.05, indexed or not. If people think that is all it takes, then that perception is something we need to work on. The real value of visiting your GP to society at large — and the taxpayer — is immeasurably higher. Seeing your GP on a regular basis saves lives. Continuity of care leads to improved health outcomes. GPs want to spend more time with their patients and patients want to see their GP when they need to.

Improved access and comprehensive consultations will lead to less prescribing of expensive medication, less initiation of pathology and diagnostic imaging, and — last but not least — fewer hospital admissions.

Australia’s health system is far too hospital-centric, notwithstanding that we should be proud of the advances we’ve made in the tertiary care sector, in particular in the past century. Hospitals in Australia are of the highest standard, whether they are public or privately run institutions.

But they are extraordinarily expensive to run. The total annual recurrent health expenditure for public hospital services alone is more than $45bn. More than $18bn of that is contributed by the government. The remainder is contributed privately and by the states.

The cost of private hospitals is more than $12bn a year. Most of that is covered by private health insurance which again is subsidised by more than $6.3bn a year from the taxpayer.

Compare that with the $7bn the government spends each year on GP care in this country. All in all, it sounds like GP healthcare is a 21st-century bargain-basement special.

Hospitals do not function without multiple layers of administration and bureaucracy. Despite best efforts and increased funding through the years, hospitals are at breaking point. Waiting lists lengthen by the week. There are waiting lists to be on waiting lists. The variability of hospital care and treatment makes national headlines.

Still, hardly any politician can afford not to support public and private hospital funding. Any shortcoming in the delivery of clinical services is usually followed by a loud call for ever increasing funds.

There are multiple reasons for this. First, hospitals are very good at treating patients. Those treatments are often procedure-based and expensive.

A minute of theatre time at one hospital in Perth is budgeted at $160. So, the cost of two minutes of theatre time is more than what the government spends on Medicare for a patient seeking GP care. Not per minute — for an entire year.

We need to work towards fewer operations. We need less treatment. We need to focus on maintaining health. We need to focus on prevention. And that has to happen in local communities with GPs, not in hospitals.

Health Minister Greg Hunt was spot-on when he said “the holy grail is to transform avoidable hospital admissions into avoided hospital admissions”.

We could not agree more and that is one of the many keys to delivering Australians the finest healthcare system in the world.

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