How to save general practice – the billion dollar question

The billion dollar question

Our efforts to protect patients backfired last week. At first glance it looked like the co-payment plan was off the table. The press took the bait and announced that the $7 Medicare co-payment measure introduced in the 2014-15 budget was cancelled. GPs got what they wanted: Vulnerable patient groups were no longer expected to pay.

Then the penny dropped.

The government has strategically placed an even bigger time bomb under general practice, set to detonate in January 2015 when many doctors are on holiday. The new plan will take billions of dollars out of general practice over the next four years, and shift costs to patients, GPs and public hospitals.

A good summary of the catastrophic proposal by the Abbott government can be found here.

Being efficient isn’t good enough

GPs find it hard to understand why general practice is under fire. RACGP President Dr Frank Jones: “It remains unclear why the Government would seek to target general practice in isolation in its attempt to set a price signal, particularly when we know it is the most cost efficient pillar of the Australian healthcare system.”

It is tempting to explain our strengths over and over to ministers and senators, but it’s probably a waste of time. They know. Health Minister Peter Dutton said in 2011 (when he was in opposition):

“As the most common health system interaction for patients, providing nearly 120 million services each year, general practice is ideally placed to address the future burden facing our health system from demographic changes and chronic disease. (…) “We all know that we need to do more successive interventions before patients reach hospitals if we are to have any chance of alleviating the growing burden on our health system.

The piper calls the tune

He who pays the piper calls the tune. GPs are largely paid by commonwealth funding and bulkbilling rates are at record height – so don’t expect any sympathy from the feds.

Should we continue to argue that healthcare costs are not spiraling out of control? It looks like the government has made up its mind, so let’s leave that argument for what it is.

The government knows that GPs are a soft target as we are represented by too many organisations.

But the pollies don’t seem to know how to make healthcare more efficient.

The good news is: We do.

A wise GP posted this on Facebook:

“There’s a possibility the government doesn’t want to destroy general practice, doesn’t want to dissuade the next generation of doctors from being GPs, because it’s genuinely not in their interest. It’s possible they are still actually inviting our help to avoid both. It’s our call and responsibility to do just that, knowing we will never please everyone.

The billion dollar question

The billion dollar question is: How do we convince Tony Abbott and Peter Dutton there are better ways to save health dollars?

We all know there are inefficiencies in healthcare. It makes more sense to tackle these, than to kill a sector of our healthcare system that keeps people well and out of expensive hospitals.

Some have suggested we could save on:

  • Overdiagnosis and overtreatment
  • Inappropriate screening procedures
  • Profit driven healthcare models.

Other suggestions that have been made:

  • Targeted co-payments for selected tests or procedures
  • Applying more evidence-based solutions
  • Mixed funding models replacing fee-for-service
  • Looking for savings across the whole healthcare system.

The answer may be around the corner. GPs like Dr Evan Ackermann have great ideas – see the slideshow below.

3 thoughts on “How to save general practice – the billion dollar question

  1. Great post. I agree that GPs need to become more accountable for what we politely call variations in the quality of care.

    I note in Evan Ackermann’s excellent slides the call for every person to be supported by government funding to belong to only one general practice at a time. It is amazing to realise that the current system pays Medicare benefits for people to visit many different general practices, even on the same day.


  2. Love the ideas.
    Can’t help it but to think I’d also like to hold the federal government (as a whole, all parties) accountable for the billions of dollars they wasted on a useless PCEHR and a change from divisions to MLs to Primary Health Care networks!


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