An opportunity for the Government to develop a real health policy

“Health policy has proved, over the years, to be a bugbear for the Liberal Party. The Fraser Government had made numerous changes to its health policy, which had been both unsettling and politically damaging” ~ John Howard in Lazarus Rising

As they say, those who cannot remember the past are doomed to repeat it. Governments often make two mistakes when it comes to health policies:

  1. It is driven by dollars instead of health outcomes
  2. Advice from patients and health professionals is ignored

The current ‘health’ debate has, in reality, been a debate about the level of out-of-pocket expenses. The elephant in the room – more efficient funding – has been carefully avoided. We know there is too much waste and bureaucracy in the system – and many have argued the fee-for-service model is not ideal to manage chronic health problems.

If the Abbott Government is serious about tackling some of these issues, but wants to avoid the mistakes of the past, they should embrace the RACGP’s draft Vision for a sustainable health system. It is an opportunity to start a real healthcare debate.

The new model

As the draft document reiterates, health systems focusing on primary healthcare have lower use of hospitals and better health outcomes when compared to systems that focus on specialist care. It makes sense to fund a comprehensive range of services in primary care, based on local community needs.

The new vision proposes voluntary patient enrolment with a preferred practice to improve chronic care delivery and funding. It also recommends that current incentive payments are replaced by a payment system that facilitates the following five key activities:

  1. Better integration of care
  2. Supporting quality, safety and research
  3. Team-based nursing care
  4. Using IT and e-health to improve efficiency
  5. Teaching students

Acute care and fee-for-service are still part of the package, but practices and GPs delivering ongoing comprehensive and complex care will be better rewarded in the new model. It will also assist practices and doctors looking after disadvantaged patient populations.

Much needed leadership

Earlier this year the RACGP invited members to comment on a first draft. Yesterday RACGP president Frank Jones presented the current version to Federal Health Minister Sussan Ley. It’s good to see the RACGP welcomes further feedback. Personally I am particularly interested in the response from patients and consumer organisations.

It seems the blended payment model reflects the increasing focus on chronic disease management, while still rewarding acute care. As always, the devil will be in the detail. But to be fair, this is a draft (and if you ask me, a good one).

By starting the discussion the RACGP is showing leadership. Let’s hope the Federal Health Minister is appreciative and brave enough to take on the challenge.

Revised payment model
Revised payment model as suggested by the RACGP: The model blends fee-for-service with practitioner support and practice support payments. Source: RACGP

4 thoughts on “An opportunity for the Government to develop a real health policy

  • Yes, let’s start a model here in Australia based on the Dutch healthcare system which has the best outcome of all countries in Europe.
    Indeed, the RACGP is going in that direction.
    Now it may be the time for us, as former Dutch GP’s to advise the RACGP and government!


    • Hi Felix, thanks for your comment. There are indeed some similarities e.g. the medical home (although voluntary) and blended payments, but I don’t think the vision is based on the Dutch system?


  • It is encouraging that the College is (a) taking this wider view that recognises the changes that are taking place in our health environment, and (b) is inviting the general public to a conversation on its proposals. It is still doctor-centric asking what financial arrangements can be made for doctors to deal with the new health environment.
    But, in my view, it must extend that vision. Demographic change is certainly leading to more aged-related chronic conditions, but this change in age distribution is only part of the problem caused by our current societal changes. Other conditions are a result of increases in inequality in Australia – inequality in incomes, employment opportunities, education, language, access, etc. And to deal with the health impacts of disadvantages like these, it is important that the medical profession takes the social model of health much more seriously so that we can address problems such as obesity, drug and alcohol, mental illnesses like depression, etc. These are the chronic diseases that are, in my view, of higher priority because, if treated successfully, they offer very significant returns. The College of Family Physicians in Canada have taken this perspective (and professional responsibility) seriously and have recently issued a paper encouraging doctors to incorporate consideration of the social determinants of health in their treatment procedures. The College suggests that, in addition to taking into account these factors at the individual patient level, medical providers are also part of the community and have a civic interest in developing a health environment. (I know that one of the commentors on this blog is likely to respond with a question of where the funds would come for such wider involvement…..)
    In Victoria, local municipalities have a statutory responsibility to prepare a Health and Wellbeing Plan for their community. The plans deal with maternal and childrens health, ensuring that medical services are available and accessible, facilities for exeecise for all ages, mental health programs, etc. – a very broad scope aimed at improving the health of the whole community. The plans are usually conducted in a process of consultation and drafts are released for public comment before they are adopted. It is an exercise where local medical people could give input and community leadership but it is difficult to identify one municipality of the 77 in Victoria where such leadership or professional contribution has been made.


    • Well said John and thanks for the examples. A comprehensive health policy should include a plan to deal with the social determinants of health. I’m a big fan of more cooperation between health professionals and consumers to achieve the desired change. See for example this post: The untapped power of the patient-doctor alliance, featuring patient advocate Jen Morris. In the end, we share most of our goals.


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