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Health care proposals concern doctors

Monday 26 October 2009

StethoscopeThe Age has published an article about health care proposals by the Australian Government that have health care professionals concerned:

GP plan 'will hurt patients'


October 25, 2009

PATIENTS will lose the right to choose their GP, and the most sick and vulnerable Australians will find it harder to get medical care if sweeping changes are adopted, doctors and patient groups have warned.

Proposals being considered by Health Minister Nicola Roxon would see families with young children, indigenous patients and those with chronic conditions, disabilities or mental health problems locked into enrolling with one doctor's practice.

Almost a third of the population would be covered by the plan - a key recommendation in the recently released National Health and Hospitals Reform Commission report.

By centralising a patient's care with one medical practice, the scheme would reduce errors, costs and confusion caused by visits to multiple doctors. Currently, patients are free to see any GP they wish with no requirement to enrol.

The scheme would be voluntary, but critics believe that if adopted it would inevitably become compulsory for all Australians, and rather than improve continuity of care for the sick and elderly it would restrict choice and could lead to chronically ill patients falling through the gaps.

Under the $682 million-a-year plan, doctors would receive an extra $100 from the Federal Government for every patient they enrolled - about $32,500 for the average GP, or $146,000 per practice.

A further $800 million would provide doctors with bonus payments for treating patients on time and improving their health, with the money designed to pay for practice nurses or other support staff.

The proposal fits in with Ms Roxon's push to end ''six-minute medicine'' by rewarding doctors who take time to treat complex patients.

However, critics say the system would fail because payments do not come close to covering the cost of treating chronic conditions such as diabetes, heart disease and depression.

With doctors set to receive the same funds for enrolling a healthy child as a morbidly obese diabetic, for instance, it has raised concerns that practices would cherry pick.

''One hundred dollars won't go very far in caring for chronically ill patients,'' AMA Victoria president Harry Hemley said. ''It may even work as a perverse incentive for GPs to sign up relatively healthy patients.''

''Ultimately it will be up to the Australian community to decide whether they want their choice of doctor curtailed.''

Dr Hemley said increasing the Medicare rebate, which now covers just 53 per cent of doctors' fees, would be a better way to fund treatment for the chronically ill.

Carol Bennet, executive director of Consumers Health Forum Australia, said patients predominantly disliked enrolment schemes because they restricted their ability to change doctors.

''People with chronic conditions are not efficient for GPs to manage, so there's a real potential for doctors to choose the less complex cases. Indigenous people are often fairly transient … [with] highly complex needs, so we have to be careful that we don't disenfranchise these groups from the system.''

A spokeswoman for Ms Roxon would not confirm if patient registration would be adopted but said it would be discussed at a Council of Australian Governments meeting by the end of the year, with a view to formalising plans early in 2010.

The registration proposal has divided doctors. Some say general practice must be reformed to tackle Australia's increasing burden of chronic disease, caused by an ageing population and rising obesity, while others have vowed to fight the scheme.

At a fiery Melbourne meeting on Monday night, more than 60 GPs debated the proposal, with some claiming general practice was under siege and patient enrolment a Government attempt to control doctors.

There were also fears that because funding would be tied to enrolment numbers, large corporate clinics would aggressively target patients, potentially squeezing out small or solo practices.

With a severe doctor shortage forcing many practices to close their books, there are concerns that if mandatory enrolment were introduced on geographical lines, patients living in suburbs with a doctor drought would have no access to a local doctor.

However, Eaglehawk GP Tali Barrett said registration had been shown to save lives by providing continuity of care led by a patient's family doctor.

She said 55 per cent of Australians over the age of 65 suffered from five or more chronic conditions and that many received treatment from multiple health-care professionals.

''If a person attends several practices, who's taking responsibility for managing their problems? Who has the full history? Who knows what drugs are being taken or what investigations and referrals have been done?

''Who do the hospitals send letters to, who does the pharmacist ring when there's a problem? It's a dog's breakfast,'' she said.

''It's a waste of taxpayers' money, a waste of GPs' time and there are poorer outcomes associated with patients.''

The sentiment was echoed by Emil Djakic, chairman of the Australian General Practice Network, who dismissed claims that a registration scheme would throw the baby out with the bathwater.

''The baby's grown up, the bath don't fit any more and the water's gone cold,'' he said.

Who's affected

■ 32 per cent of Australians would be eligible to enrol

■ Aboriginal and Torres Strait Islanders: 517,000

■ Children 5 and under: 1.64m

■ People with chronic and complex conditions: 3.27m

■ People with disabilities: 640,000

■ People with mental health problems: 750,000

■ TOTAL 6.81 million


The article originally appeared here.

The Age has two related articles:

The Age (26/10): Canberra looks at GP bonus plan

The Age (25/10): Push for funding to keep the 'family' in family practice



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