Introduction by Croakey: The Prime Minister was a no-show for the traditional National Press Club election address today, but Opposition leader Anthony Albanese was there, and flagged his intention to step up action on COVID.
COVID was not mentioned in any significant detail in his prepared presentation but was raised after a question from a journalist.
Albanese responded that as Prime Minister he would seek a comprehensive briefing next week on how to reduce the impacts of COVID, including by encouraging higher uptake of booster vaccinations.
“We do need to step up the national strategy…” he said. “We need to continue to be vigilant and recognise that this pandemic is still having a real human impact.”
His comments stand in contrast to the Prime Minister’s ongoing insistence that the pandemic is over.
However, Albanese’s presentation did not include a strong focus on health policy or the urgent need for health reform.
Yet many health groups and leaders have been advocating tirelessly for systemic reform to address widespread inequities and inefficiencies. Among them is cohealth, a not-for-profit community health organisation in Victoria, whose election statement calls for wide-ranging reforms.
In the Q and A below with Croakey, Kim Webber, Executive – Strategy, Impact and Development at cohealth, puts the case for the next Federal Government to prioritise primary healthcare reform and action on the social determinants of health.
Q: Our current fee-for-service model for funding primary healthcare means people with the greatest needs for comprehensive, quality care often miss out. cohealth has called for a move towards blended funding models, with a loading for client complexity and outcome-based payments rather than so much reliance on fee-for-service. Have any political parties or candidates in this federal election told cohealth that they support this approach? What is your assessment of the likelihood of the next Government doing this? (Eg 50 percent chance?)
Kim Webber: It is right that that the current funding model means those with greatest need miss out. But it also means organisations like cohealth who employ GPs so our clients can access medical services are making significant financial losses due to the time that clients need not being valued in a purely fee for service model. cohealth loses a significant amount of funding every year in our GP clinics so we need an urgent change.
We’ve yet to receive a response from either major party on our proposal for blended payments.
We were pleased to see the Opposition’s commitment to investing in Medicare and general practice, to enable GP services to operate more sustainably however we are disappointed that there is no commitment to structural reform. Without it we cannot have sustainable primary care that support complex clients.
Q: Given the immense resistance that often occurs within the health sector to structural reforms like this, what is cohealth’s assessment of the factors that might help support such reforms, and what are the likely barriers and your strategies for overcoming these barriers? Who are your greatest allies in this campaign?
Kim Webber: Almost all health peak bodies, professional health associations and health think tanks agree that structural reform is long overdue.
In the past there has been resistance to changes to the fee-for-service model, however as rebates fail to keep up with medical costs, organisations like the AMA have thrown their full weight behind the reform efforts.
The community health sector have a deep understanding of the need for reform, and are galvanising their efforts to achieve systemic change.
Recently the national rural health alliance proposed the establishment of Rural Area Community Controlled Health Organisations (RACCHOs), which also provide an opportunity for system level reform
Q: You mention in your Federal Election Statement that “within cohealth general practice services are loss making, a position that is not sustainable”. Can you please explain what you mean by this? Is it that cohealth does not raise enough funds from Medicare funding for GP services to pay for the costs of those services?
Kim Webber: cohealth’s general practice services are not financially viable – it costs much more to provide GP services than we are able to recoup from Medicare rebates.
The Medicare framework is suited to short, transactional consultations that enable GPs to see high volumes of patients. But many clients need much longer appointments times that do not attract a commensurately higher rebate, so GPs spend more time delivering care but don’t receive greater payment from Medicare. cohealth absorbs the shortfall but this impacts the resources we can commit to other areas of our organisation.
cohealth’s GPs are generally salaried but the salary is much lower than GPs would receive in private practice so we rely on the passion and commitment of our GP to providing care to our high need clients.
The solution is more than just increased rebates – we need a system that recognises that people who present with much more complex health issues require more time and intensive treatment. And that GP care is an investment in care that can keep people well and working and away from expensive acute care.
Examples of the types of complexity that cohealth GPs see (these are not isolated examples… these case studies are reflective of cohealth’s patient cohort):
- A person with an opioid dependence who has been seeing one of our GPs for pharmacotherapy treatment. As well as issues around addiction and a history of trauma related to homelessness, the patient is a paraplegic as a result of a spinal infection. He sees the doctor regularly to manage his medications, and also is receiving treatment for incontinence and to reduce his risk of diabetes. This patient requires regular and lengthy appointments to support his best health.
- A long-term patient with severe mental health issues which she is managing through medication and other treatment requiring regular GP visits. At her last appointment the patient disclosed that she has recently fled family violence and currently staying in crisis accommodation. Her mental health has declined, and she has started self-harming. Our GP is working closely with her case worker and housing support officer to ensure that she has the wrap around supports that she needs.
Q: Can you quantify the size of the loss?
Kim Webber: The financial loss to cohealth is significant.
Q: Given you say this is not sustainable, what are the possible scenarios that cohealth is facing and over what timeframe? Will you be able to continue offering GP services or are you considering the possibility of stopping these services? If this is the case, what would that mean in practical terms? (for example, how many GP services does cohealth provide a year?)
Kim Webber: Despite making a loss, we are committed to ensuring our clients have access to GP services because we recognise their vital role in healthcare and patient outcomes. cohealth has no intention of stopping these services – our GPs are a vital part of the healthcare team.
Another implication of the broken funding model is that it is harder to attract and retain GPs to community health. cohealth GPs are salaried because we recognise that the lower volume of patients means a fee-for-service model would be unviable for GPs. Despite the fixed income, the salary is not competitive with that received by GPs in private practice so we rely on the passion and commitment of our GPs to community healthcare.
One of our GP positions – the Street Doctor – has been vacant for nearly a year. Without committed doctors choosing to work in community health, vulnerable people are at risk of missing out on the kind of integrated care that they need.
The lower pay is a factor in the difficulty recruiting to community health, though our GPs tell us that this is balanced by the opportunity to undertake meaningful work that supports some of the most vulnerable people in the community. By giving access to high-quality primary healthcare, and working in a multidisciplinary environment, our GPs are able to see significant improvements in patients’ quality of life often over short periods of time. They are an incredible group of clinicians and the skill level and complexity of care that they provide needs recognition.
Q: Regarding your election request for funding for innovative programs to provide integrated primary healthcare and social determinants of health supports such as housing and pathways into education and employment, can you give any concrete examples of such programs, whether in Australia or overseas? Does cohealth have such a proposal on the books, or a pilot for which you are seeking funding? If so, can you please give an overview.
Kim Webber: We have recently had Victorian Government funding for the Family Recovery Program which supported very large migrant families impacted by COVID. It has been fantastic to not only case manage a family’s healthcare needs of long COVID but to also support them to do short courses in sewing or cooking and seeing them move into small business and employment. Also being able to support family relationship improvements and education outcomes for the children so that the family as a unit has improved health and wellbeing. A true demonstration of investing in the social determinants of health.
Another program is the health concierge (guide) workforce model where we employed more than 100 people from Melbourne’s high rise public housing towers to provide public health messaging during the pandemic. Not only did this program support health outcomes in the community but also gave people their first jobs in Australia providing them with training and experience. Many of these employees have been snapped up into our roles providing experience, skills, economic and social benefits to individuals, their families and the community. The program is due to finish at the end of June but we are keen to continue this model.
We also have an amazing program that has been running for more than 10 years in Melbourne supporting people with mental health issues and experiencing homelessness. The goals of the clients are often based around family relationships or learning and education. To support someone to reunite with family members and then see the impact on their health and wellbeing is inspirational.
Finally, we have long had a vision for an Integrated Community Health and Social Housing Hub. This innovative model would co-locate healthcare, state-of-the-art community spaces, and social housing under one roof, creating a community hub centred on the whole person. This model will help those living in the social housing to access the health services they need to stay well and also to connect in with the community. Through our mental health residential services we can see the importance of community connection in improving client’s wellbeing and recovery.
With Government support we have the opportunity to extend the existing integrated primary healthcare, mental health and social support services to encompass secure, affordable on-site housing for people with complex health and social circumstances.
Q: What is your assessment of how primary healthcare services and policy has fared under the LNP Government since 2013? What have been the impacts for the community’s health?
Kim Webber: The failure to adequately fund Medicare does not rest solely on the shoulders of any one party; the underlying structural problems in primary care have been ignored by successive governments. Primary care is an investment and pays dividends in reducing hospitalisations and supporting a healthy population. But it is a long term investment ill-suited to election cycles.
Health Care Homes (HCHs) were a trial of a new primary care to manage and coordinate care for patients with complex and chronic conditions. The trial was completed but we haven’t seen any systemic changes from that trial.
Australia’s healthcare system remains unfortunately focused on the acute sector, with no meaningful efforts or funding increases to boost early intervention and primary prevention programs and services.
The healthcare system has become even more inaccessible for people facing disadvantage and there are increasing numbers of people delaying or avoiding accessing healthcare because of cost.
This includes seeing a GP, getting allied healthcare, filling prescriptions, seeing a dentist.
We’re seeing the results of a perfect storm of providers having to pass on more costs to consumers while simultaneously we see increased costs of living, stagnating income support payment, and low wage growth.
Primary care needs investment and attention and it needs it urgently.
Q: What is the first major health announcement you would like the next Federal Health Minister and/or Prime Minister to make?
Kim Webber: Above all else, we want to see a renewed focus on reducing health inequalities and a focus on meeting the needs of people experiencing disadvantage, which could be achieved through the significant structural reform of the primary care sector.
This could include patient registration to a coordinated care model and blended payments which are based on outcomes, adjusted for patient cohort complexity.
Importantly, consumers, health professionals and the community health sector must have a place at the table to help inform decisions. cohealth are looking forward to working with the incoming Federal Government to ensure that everyone has access to high-quality healthcare and the best possible health.
cohealth has been providing care to disadvantaged clients for more than 130 years. cohealth has 50,000 patients to whom we provide care. We have a lot of lessons and learnings we can share with government and we want to help build a sustainable primary care system that delivers what clients need.
Q: What specific actions would you like the next Federal Health Minister to take on climate action?
Kim Webber: The incoming Federal Government must take urgent, ambitious action against climate change, through committing to net zero carbon emissions by 2035, supported by policies for a fair and inclusive transition.
There is a reason that cohealth and other health organisations commit our voice, time and resources to this issue – climate change is a threat to health. Climate change is already having impacts on people’s physical and mental health. The biggest impacts are born by those people who are already disadvantaged. Without urgent action these impacts will continue to worsen.
We would like the Federal Health Minister to commit to a national climate and health strategy like that outlined in the CAHA Healthy Regenerative and Just Framework.
Among the specific actions cohealth will be calling for from the incoming Federal Health Minister are to:
- advocate for Cabinet to outline a plan for Australia’s transition away from coal and gas to renewable technologies
- establish a taskforce to introduce measures to reduce emissions within the health sector (as a sector we must do more); and
- ensure that we have appropriate surveillance and monitoring systems to respond to extreme weather events and their consequences.
Q: What is cohealth’s overall assessment of health in the federal election campaign to date?
Kim Webber: Health has been given surprisingly limited attention, with only relatively small announcements for specific measures, with the exception of Labor’s $970 million Medicare announcement.
The reality is that structural reform needs are still unaddressed, and require long-term, big picture thinking.
For many years we’ve been calling for greater investment in public dental services, so that everyone can achieve good oral health. Sadly our major parties continue to neglect this vital aspect of healthcare, and too many Australians are waiting years for the dental care they need.
Action to address the social determinants of health are almost entirely absent from the policy platforms of the major parties.
In particular we have seen no substantial investment in social housing nor any increase to income support payments, which are leaving people living in poverty.
The current rate of Jobseeker forces people to choose between paying their rent, putting food on the table or getting the medical services they need.
Giving people a liveable income would have immediate and significant benefits to their health.
We need a federal government that takes responsibility for building a more equitable society which will not only prevent ill health but ensure better access to healthcare so we can keep people well and out of hospital.
See Croakey’s archive of stories on primary healthcare