Let’s have a look at some of the big health projects of the past years: Super clinics, Medicare locals and the PCEHR.
Interestingly, there are a few common themes – the absence of a ‘need’ or business case being one of them. But it wasn’t all bad: One of the positive achievements was plain packaging of tobacco products.
It all started with the super clinics idea. We didn’t really need super clinics. We needed doctors, clinical staff, funding for general practice programs and support for patients. There was no business case for super clinics, but… we got super clinics. We all knew they were going to fail, they failed – and caused a major hole in the health budget.
Give it some time, said the advocates of the program… Now, six years later another audit has come to the conclusion that the program is not financially viable. Australian Doctor Magazine reported:
The $25 million Modbury clinic near Adelaide — one of the biggest super clinics built — has still only managed to recruit 2.2 FTE GPs and one FTE nurse. The $25 million Noarlunga Clinic, also near Adelaide, has 2.5 FTE GPs and one FTE nurse on staff. All the doctors were sourced from a large GP practice located nearby.
Fifty percent of the super clinics are still not financially viable, and another report last year stated that super clinics could not survive on bulk billing alone. The AMA has called again on the government to cancel the super clinics program. The AMA in a recent press release:
The Auditor-General found that only three of the 36 clinics promised in 2007 were completed on time, with seven still not operational, while just one of the 28 announced in 2010 is fully functional. (…) It is time to put a stop to the waste and direct the funds that can be salvaged to where they will do the most good.
Then we got Medicare Locals. GP Networks and Divisions of General Practice were not good enough, and although we didn’t need Medicare Locals, we got them. We all knew this extra layer of bureaucracy was going to blow a hole in the health budget.
Another survey was needed to show what we already suspected: about fifty percent of Medicare Local staff is busy writing reports for the government instead of providing services to patients or clinicians. Imagine all the staff required at the department of health to read their reports…
Medical Observer reported:
The survey of all 61 MLs, conducted by the Australian Medicare Local Alliance, also found staff had to prepare almost 2000 separate reports – almost one per week for each ML – to explain their progress to the department. The workload saw ML staff dedicating over three months of the year solely to meeting reporting requirements for the department.
Give it some time, said the advocates of the program… But it will only be a matter of time before the next report tells us that Medicare Locals will need to work more efficiently to deliver their programs.
Next came the PCEHR. Although we need eHealth solutions, we did not need a national personally controlled eHealth record managed and owned by the Government. There was no business case for this version of shared eHealth records, and clinicians warned the government on many occasions about the risks.
So we got a PCEHR – sort of. It is behind schedule, very expensive and a nightmare for clinicians and practice managers. We all knew it is probably going to fail and it has blown yet another hole in the health budget. Give it some time, say the advocates of the program….
Simon James, editor of Pulse+IT Magazine, wrote in his May 2013 Editorial:
It seems inevitable that only a small number of Australians will have a PCEHR containing any clinician-generated content by the start of July, leading one to wonder whether clinicians – and not contractors with clipboards – may have been the most appropriate people for the government to engage to drive consumer adoption.
Wise words. Engagement of clinicians is required for any health care project. A government that side-tracks important stakeholders sets itself up for failure.
Is it getting better?
After many promises of a budget surplus we’re now in the red. Instead of scrapping wasteful projects, the government keeps spending money on these projects. The National e-Health Transition Authority (NEHTA) recently received $47.2 million and a $10 million federal advertising campaign to promote the PCEHR was launched only last week.
At the same time the government is cutting back on basic health care, including the safety net, self-education of health professionals and Medicare rebates, creating more hip pocket pain for patients.