Like what you've read?

On Line Opinion is the only Australian site where you get all sides of the story. We don't
charge, but we need your support. Here�s how you can help.

  • Advertise

    We have a monthly audience of 70,000 and advertising packages from $200 a month.

  • Volunteer

    We always need commissioning editors and sub-editors.

  • Contribute

    Got something to say? Submit an essay.


 The National Forum   Donate   Your Account   On Line Opinion   Forum   Blogs   Polling   About   
On Line Opinion logo ON LINE OPINION - Australia's e-journal of social and political debate

Subscribe!
Subscribe





On Line Opinion is a not-for-profit publication and relies on the generosity of its sponsors, editors and contributors. If you would like to help, contact us.
___________

Syndicate
RSS/XML


RSS 2.0

The great health divide

By John Dwyer - posted Friday, 10 March 2006


The recent Productivity Commission’s report on the health workforce contains several sensible suggestions none of which were acted upon at the recent COAG meeting. Disappointingly however, the report failed to recommend that Australia should become self-sufficient in terms of training the professionals it needs and did not bite the bullet on the number of additional HECS funded places we need in our universities for students of the health professions.

Remodelling primary care in Australia

Two much-needed reforms will require the remodelling of primary care. The first demands that much more emphasis be placed on preventing illness. The second necessitates the restructuring of primary health care so that doctors can care for many patients in a community setting who are currently being sent to hospitals.

In the delivery of primary health care, the Australian system is becoming increasingly less fair. In many poorer socioeconomic areas, doctors have little choice but to bulk-bill. When pressures force them to attempt to ask for co-payment, we know that a number of patients will stay away from the doctor’s surgery. The situation exists where, in some areas, doctors have to make their income through the volume of services they provide, whereas elsewhere, where the average person can readily afford a co-payment, doctors can provide a better quality service. This means that, increasingly, those Australians whose lifestyles are putting them at risk for the development of major illnesses and who need the most quality time with their doctors often receive the least.

Advertisement

Australia needs to explore alternative models of remunerating general practitioners so these difficulties can be overcome. To do so, the country must experiment with programs that see a move away from the exclusively “fee-for-service” payments that currently characterise the primary care system. This involves exploring, as other countries have done and are doing, the appropriateness in contemporary Australia of offering general practitioners up-front payments - “contracts” to care for patients with chronic and complex diseases, with such remuneration making it possible for them to look after patients at home rather than sending them to hospital. This is the ultimate solution for addressing the hospital crisis.

Doctors need to be part of primary health care teams where health care professionals, such as specialist nurses and other allied health professionals, are available to provide many of the services currently provided by doctors. This means extending Medicare payments to health professionals other than doctors (one of the sensible recommendations in the Productivity Commission’s report). The primary health care team would focus on personal needs of the patient and pay a considerable attention to individual health plans to help people prevent illness.

Only part of a general practitioner’s work needs to be remunerated in this way, with a number of standard services continuing to be available through a “fee-for-service” mechanism. In New Zealand, such a system exists and, without any coercion, 80 per cent of general practitioners have embraced such a model of care. The major stumbling block here is that the model requires federal and state governments to pool funds to allow the appropriate business plans to be developed.

Hospital reforms

Particularly in recent years, there has been insufficient political honesty about problems within the hospital system. Many consumers feel that no matter which public hospital they attend, they will find a broad range of services available, including those for the management of emergencies, and that all these services will be of similar quality. Given the workforce situation, this is certainly not true and, indeed, is never likely to be true.

Nothing is more important in Australia, in terms of improving quality and safety, than exploring with the public the reality that role delineation for individual hospitals will ensure that the services they do offer, although not the full range, are of the highest quality. Hospitals should be networked so they create, in a given region, “a string of pearls,” with each hospital offering programs of excellence where the workforce skill mix is available to do the job properly. Certainly, no matter where an Australian enters the hospital system, they should be triaged and assisted in moving to a facility that does have the capacity to care adequately for their current problem.

Even if Australia had the appropriate number of health professionals, the opening of additional public hospital beds so critically needed at the moment is not the ultimate answer. The primary care remodelling discussed above will provide the best solution for the clearly unsustainable pressure on the country’s hospitals.

Advertisement

Current data proves beyond doubt that the almost $3 billion tax dollars used each year to support private health insurance does not achieve the goal of relieving pressure on the public hospital system. Private hospitals provide a range of very different services to those that place pressure on public hospitals. What is needed is a genuine partnership between private and public hospitals, with considerably more of the private health insurance dollar going directly to hospitals rather than to third party payers. With appropriate leadership, policy makers can do far more to promote synergy and collegiality between private and public sector hospitals.

The way forward

At the Health Care Summit, delegates agreed unanimously that federal government should immediately establish an Australian Health Care Reform Commission. The Commission would be composed of leading policy bureaucrats from state and federal departments of health, experts in change management, and clinical and consumer leaders. The job of the Commission would not be to generate policies, but to work on implementation strategies. By its very nature, this would be a collaborative effort between state and federal governments, the bureaucracy, clinicians, and consumers.

Without the best brains available coming to work every day to work diligently on the reform agenda, it is hard to imagine progress being made with these urgently needed reforms. Of course, the first step involves a degree of political leadership and courage to make this happen. That courage should be boosted by consistent polling, which makes it clear that there is no domestic issue as important to the Australian community as restructuring and improving the health care system to provide Australians with the care they want, very much need, and can afford.

  1. Pages:
  2. 1
  3. Page 2
  4. All


Discuss in our Forums

See what other readers are saying about this article!

Click here to read & post comments.

13 posts so far.

Share this:
reddit this reddit thisbookmark with del.icio.us Del.icio.usdigg thisseed newsvineSeed NewsvineStumbleUpon StumbleUponsubmit to propellerkwoff it

About the Author

Professor John Dwyer is Founder of the Australian Healthcare Reform Alliance and Emeritus Professor of Medicine at the University of NSW. He is co-founder of the "Friends of Science in Medicine".

Other articles by this Author

All articles by John Dwyer

Creative Commons LicenseThis work is licensed under a Creative Commons License.

Article Tools
Comment 13 comments
Print Printable version
Subscribe Subscribe
Email Email a friend
Advertisement

About Us Search Discuss Feedback Legals Privacy