The Commision of Audit continues to draw response from the broader health community. Many thanks to Australian Medicare Locals Alliance Chair, Dr Arn Sprogis for this review.
Dr Sprogis writes:
A surprising weakness in the Commission of Audit report was its section relating to the health sector with what appears to be a complete misunderstanding of health care financing and the impact of changes to the various levers in the system.
There would not be another developed country which in its attempts to contain rapid growth in outlays would reduce the role of primary health care, in particular general practice, and yet this is precisely what it has recommended with the addition of GP co-payments and increases to the PBS.
The international trend is to increase the role of localised systems of primary health care in order to contain the rapid growth of hospital and other high cost care in the face of the challenges posed by for example, avoidable hospital admissions and ED care, chronic and complex disease, aged care, mental health amongst many others.
It was disappointing that there was no mention of the productivity and efficiency gains which an increased focus on primary care systems would readily achieve within the short term and again which other countries take for granted.
The reductions in health outlays which can be achieved by enhancing local primary health care systems are of a scale multiple times larger than the small savings to government being proposed by the Commission. In an efficient and productive health system health care should be undertaken as closely as possible to where people and their families live and by providers who are most skilled at care within the community as the first step.
To achieve the productivity, efficiency and quality gains in the health sector requires universal access at the primary health care end and the recommendation relating to GP co-payments in the absence of any alternative reductions in barriers to care will increase overall health outlays and at the same lead to no care or more inappropriate care.
Examples of what is possible, just in the hospital arena for example, are outlined in the recently the Productivity Commission estimate that in 2012-2013 there were over two million potentially avoidable GP-type presentations to emergency departments. Issues around hospital funding have also been highlighted in the latest report by the Grattan Institute, which claimed that more than $1 billion per year was being wasted in public hospitals. If avoidable hospital admissions were reduced by a more appropriate system of care at the primary health care level then we could reduce cost growth $2.5 billion a year vastly dwarfing the GP co-payment measures being proposed.
Primary health care focuses on health promotion, disease prevention and early intervention. People need community-based care to help them self-manage and to minimise the chances of chronic conditions getting worse. Its equitable and multi-disciplinary approach particularly assists disadvantaged groups and those with chronic and complex conditions.
Over the lifetime of the 2008 Australian adult population, the opportunity cost savings of disease prevention programs were conservatively estimated to be $2.3 billion, including the “sum of health sector offsets and the combined workforce, household and leisure production effects”.
What was also missing from the Commission’s report was any mention that a local primary health care system already exists, Medicare Locals, and that it is the best option for achieving the large cost growth savings required by the government and at the same time improving quality of care. Medicare Locals evolved from the international evidence on the value of a strong primary health care system and have been developing rapidly to improve the coordination of and access to General Practice, Mental Health, Aboriginal Health, Chronic Disease services and Aged Care services, as well as delivering local services to improve health in areas of need.
There are many examples of areas where Medicare Locals are delivering better health outcomes in targeted areas, and better value for money through their programs – with most of this work focussed on keeping people well and out of hospital. Across the country, Medicare Locals have started to implement health pathways and resources led by GPs, to improve clinical outcomes, improve coordination of care, reduce duplication, and improve efficiencies in the system. They’re connecting with Local Hospital Networks and other local service providers that contribute to de-escalating the growth of health expenditure.
What is a positive from the report is the Commission’s recommendation for the Health Minister Peter Dutton to report back to the Prime Minister Tony Abbott within the next 12 months, about the potential productivity and efficiency gains in the health system. This will give Medicare Locals valuable time to continue the dialogue and realise the opportunity for major productivity, efficiency and quality care gains through organised primary health care.