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A bit of praise when it’s due for the diabetes announcement…but also some questions

Today’s joint announcement by Health Ministers Rudd and Roxon, aiming to improve the care of diabetes patients, has drawn a mixed reaction from the usual suspects.

The AMA and the rural doctors have come out swinging, while the Australian General Practice Network and the Consumers’ Health Forum are much more supportive. It will be interesting to see whose views capture the headlines and the soundbites tomorrow. My money is on the AMA.

Meanwhile, Professor Philip Davies, Professor of Health Systems and Policy at the University of Queensland’s School of Population Health (and a former deputy secretary at the Department of Health and Ageing) writes:

“There is much to praise in the Federal Government’s plans, announced today, to improve the care of people with diabetes by establishing a system of voluntary enrolment with general practices.

The idea of people with living with chronic conditions (including diabetes) being encouraged to enrol with, and obtain services from, a nominated primary care practice has a great deal to commend it. There are the obvious attractions of a more enduring relationship between patients and the people who deliver their health care.

The plan to offer annual ‘lump sum’ payments to cover the costs of those patients’ primary care services represents a bold, and many would argue long overdue, move away from Medicare’s historic reliance on face-to-face consultations with doctors.  It could do a great deal to foster more innovative use of non-medical staff and may even open up the door to telephone or web-based services – all of which are models of care delivery that Medicare has effectively precluded.

Today’s announcement also suggests that practices will be eligible for additional performance-related payments if they can provide better care and improve health outcomes.

For the first time Medicare will pay for achieving outcomes rather than simply incentivising activity per se.

All in all, a very positive move but – as was also said about the announcement of plans for a national health and hospitals network – the devil really is in the detail.

It’s not clear from today’s announcement whether the proposed annual payments are intended to cover all an individual’s MBS-eligible primary care services, or just those associated with their diabetes.

The former would expose practices to significant, and probably unacceptable, financial risk and seems far too fundamental a change to the basic premise of Medicare.

On the other hand, the latter creates the very real challenge of defining what is, and what is not, diabetes related. People with diabetes are more likely to suffer from a variety of other conditions (or to face more severe symptoms when affected by such conditions).

Will the lump sum be expected to cover all or some of their ‘excess’ use of services as an indirect consequence of their diabetes?  It is also possible to imagine a less than wholly scrupulous practice enrolling patients, collecting the appropriate lump sum payments and then determining that none of their subsequent visits are diabetes related and claiming additional fee-for-service Medicare benefits.

Questions of choice will also doubtless arise. If a patient has enrolled with practice A for her diabetes care then chooses to visit practice B will her visit still be MBS-eligible?  Even if it is diabetes related?  The intention is clearly that practice A should accept full responsibility for that patient’s diabetes related care but how is practice B to know that such an arrangement is in place?

And what of co-payments?  Once a lump sum payment has been made are all subsequent services (or all subsequent diabetes related services – assuming they can be identified) to be bulk-billed?  If not, receptionists could face an interesting challenge in explaining to patients why they can’t obtain  a Medicare subsidy for this week’s (diabetes related) consultation when they were able to claim for last week’s (non diabetes related) consultation.

Others will doubtless find more devilish details – and there can be nothing more frustrating to those tasked with reform than living in a world where every glass seems permanently to be half-empty.

Perhaps there is a case for greater clarity in announcements of such significance.

It will certainly be a pity if this genuinely good and innovative proposal is lost in a mire of nit-picking criticism.”

Comments 4

  1. fredex says:

    You wouldn’t know anybody is supporting it if you got your news from ABC TV news.
    They only quoted the AMA and Dutton.

  2. The 7:30 Report and Lateline often seem to cast their net wider but the 7pm bulletin and News Breakfast on ABC2 both seem to draw on a pretty limited pool of health commentators. It’s probably linked to which groups make themselves most immediately available to the media.

  3. Ros says:

    It is exhausting trying to follow the changes being introduced. I am still struggling to work out the NHH plan. Like the Governing Council’s which are to be statutory authorities. State bodies, so the states have to legislate to set them up? When don’t meet performance standards, Commonwealth will REQUIRE the states to address. States now a lower level of management within a health hierarchy?

    As a believer in federalism would much prefer a total transfer of the power and system to feds, with hospital boards and the government facilitating/financially supporting real networks across the whole spectrum of health within a locality. If the US and Mexico can manage to develop border networks for health care with the assistance of networking brokers amongst others, seems quite credible for Australia to develop. They are of course networks, not formal management bodies part of a hierarchy.

    Why the drip drip. Why the pilot only addressing diabetes. Obama’s pilot scheme addresses 10 chronic diseases, starting in 2013. Does the following tell us what is yet to be dripped. Draft National Primary Care Strategy.

    To build such a modern primary health care system, there are 5 key building blocks:
    1. Regional integration
    2. Information and technology, including eHealth
    3. Skilled workforce
    4. Infrastructure
    5. Financing and system performance
    Drawing from these are 4 priority directions for change:
    • Key Priority Area 1: Improving access and reducing inequity
    • Key Priority Area 2: Better management of chronic conditions
    • Key Priority Area 3: Increasing the focus on prevention
    • Key Priority Area 4: Improving quality, safety, performance and accountability

    Are they randomly selecting elements as they bumble along? If not why not release the thing in its entirety. The response from Brumby would suggest it is being made up as it goes along. Bligh just seems to be out to lunch. How can we have confidence that this grand reform of the health system is not another poorly thought through hierarchical response by a control freak who doesn’t seem to be able to follow through on his grand global ideas. Previous experience should tell us that it is another disaster doomed to eventually crash. Not unreasonable to suspect that they are nowhere near consolidating their policy and plans, just looking at the coming election.

    Not entirely new, my daughter had a public/private shared care bundled obstetric service for the birth of her 2nd child. So care shared between GP and Hospital and Hospital obstetrician, and included scans, dieticians etc, with the option to request further services (she wanted an additional scan for reasons relating to the health of her first child) but paid for by patient/client.

    Just read the following article. So a product of the dreadful Howard era with voluntary signing up and design of “better” care plans all that is new? But the obstetrics bundle required signing up with a GP whose practice then managed appointments etc elsewhere. Even the signing up isn’t new. And as far as I know had flexibility built in to deal with individual circumstances. What a revolutionary reform he is giving us.

  4. Barbara Mortimer says:

    First you have to develop diabetes. Isn’t the point of good public health policy to prevent the disease developing in the first place. Where is the common sense plan then?

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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
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#HSR15
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#OTCC15
Population Health Congress 2015
2016 conferences
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#ATSISPEP
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#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
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2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
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#OTCC2017
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