Some common sense thoughts on health reform

When I arrived last night for a meeting with Federal MP Mal Brough, I had to work my way through TV camera crews to get to my chair.

But contrary to what everyone thought, Brough didn’t come to challenge the prime-minister. The meeting with local hospital doctors, GPs and staff was about health reform and the Medicare rebate – and what he had to say was remarkable.

I was expecting the usual: Budget crisis, rising Medicare costs, price signals etc. But this was a different message coming from a liberal MP.

Brough first showed some figures comparing (combined commonwealth and state) hospital expenditure versus GP Medicare rebates: $39.9 billion vs $5.9 billion per year. He demonstrated that hospital costs are rapidly rising but GP Medicare rebates remain more or less static.

His 3 core messages:

1. This must be a debate on improving the health of the nation, not a debate on cost cutting or cost shifting

2. A co-payment or price point should not be the starting point of this discussion

3. There are tremendous efficiencies to be had in hospital, specialist services and aged care if Primary Health provision is enhanced and is the heart of the nation’s health system.

Health organisations are hammering this message: If you want to keep patients out of our expensive hospitals, strengthen general practice – don’t take money out of the industry.

Brough underlined this by showing AIHW data indicating that over one-third of emergency department presentations were for potentially avoidable GP-type presentations (see image). A GP co-payment will almost certainly drive more traffic to the hospital EDs.

Mal Brough’s suggestion: Scrap it.

2 thoughts on “Some common sense thoughts on health reform

  • I would like to find the exact citation for the AIHW report, in the hope that it
    (i) defines precisely what a GP-type presentation might have been, with either text or coded diagnoses please
    (ii) what time of day these presentations occurred (perhaps when most GP clinics were closed?), or
    (iii) perhaps the AIHW report relies only on the data collected for the Triage category scale (1-5) which is a measure of urgency (in terms of treatment response time by clinicians), and not necessarily patient distress, pain, what type of illness etc.

    That is, do these statistics rely on ‘proxy’ measures of why patients present to EDs, or is there real information hiding in there somewhere? (Call me sceptical, but I can find no information that indicates that the collection and reporting of presenting problems or diagnoses for ED patients are mandated in AU).

    This is not to say that I support any proposed co-payment (I don’t), and I also agree that anything we can do to support (or reform) the GP sector will have much greater benefits ( in health outcomes and in efficiencies and budget costs), and I suspect that the unintended outcome of a co-payment would indeed drive more patients to EDs.

    But these stats do little to help those arguments, and merely highlight that we need to have a properly informed debate among people who actually understand the health system and can tell the difference between lies, damned lies and statistics 🙂

    Liked by 1 person

    • The AIWH Report figures arise from a completely flawed definition of what is a GP-type presentation to an emergency department. This has been raised with them many times but they have refused to change it. Essentially the definition is applied in retrospect after the diagnosis and disposition is known and uses the triage score completely out of the context of its actual use.

      Extemely expensive and completely ineffective measures have been implemented based on these completely misleading statistics. GP Superclinics are but one example. Other examples are GPs setting up clinics immediately adjacent to ED’s only to find the numbers of patients they can actually see and deal with are so small they cannot sustain the clinic. Ironically many patients sent to ED urgently by GPs are counted as GP-type presentations to EDs.

      Notwithstanding the completely misleading statistics in the photo, the points made by Edwin Kruys I completely agree with. Without a strengthened general practice sector doing all possible to circumvent illness progression and prevention before the need for an emergency presentation occurs, our hospitals will become even more overloaded at great cost.

      Liked by 1 person

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