Outpatient care falls between multiple cracks in our health system: hospital/GP, public/private and federal/state. Perhaps for these reasons, this sector has been neglected by governments and policy makers and is in desperate need of reform.
Professor Stephen Duckett outlines why outpatient clinics are a ‘policy renovator’s opportunity’, highlighting the importance of linking GP and specialist care and identifying a promising model for the use of telehealth to deliver outpatient services.
Stephen Duckett writes:
Public hospital outpatient clinics are an oft-neglected but essential component of the health system, providing patients with specialist care without out-of-pocket payments.
By contrast, the private specialist medical services in the community often come with high out-of-pocket costs for patients. But the trade-off for the ‘free’ care in the public system is long waiting times.
Outpatient clinics are a policy renovator’s opportunity. They are often poorly organised; too often, people with an appointment have to wait hours to be seen.
The long waits – to get an appointment and then to be seen – force many people to instead see specialists privately –and pay the high out-of-pocket costs. But more people will be unemployed in post-pandemic Australia, and so more Australians may not be able to afford private specialist care.
A big shake-up needed
Outpatient services need a big shake-up. There needs to be more services, so more people can to be seen without incurring out-of-pocket payments. But the expansion needs to be done in the most efficient way possible.
Outpatient clinics provide three major services:
- A consultative service involving specialist assessment and referral back to a general practitioner;
- Ongoing specialist treatment; and
- Assessment before surgery and then necessary care after surgery.
Anecdotal evidence suggests clinics often tend to hang on to patients when the patient could quite appropriately be referred back to a general practitioner. Such a referral strengthens the primary care system and is often more convenient for the patients.
A related issue is whether the patient should have been referred for a face-to-face appointment at all. As part of Australia’s post-pandemic health system, there should be more secondary consultations – between a specialist and a GP about a patient, whether or not the patient is present.
Public hospitals should make it easier for outpatient consultations, especially follow-up consultations, to be provided via telehealth. Phone of video follow-up after surgery has proven to be safe and effective. It’s acceptable to patients and doctors, and it’s cheaper for patients and health care systems.
Public hospitals – and state health authorities – should establish norms of what proportion of follow-up consultations should be provided by telehealth, and they should ensure clinics have the right equipment and training to hit the targets.
A telehealth model
The Western Australian Sustainable Health Review provided a model. It recommended that 65 per cent of outpatient services for country patients be by telehealth by July 2022, and that ‘telehealth becomes the regular mode of outpatient service delivery for most appointments in both country and metropolitan areas across all disciplines by July 2029’.
A further issue for policy makers is where outpatient services are provided. It is certainly efficient for multidisciplinary clinics to be provided within the hospital, but hospitals might also consider whether some specialty clinics should be provided in general practices or in community health centres.
This would improve patients’ access and build better relationships between primary care services.
Public hospitals should establish outpatient taskforces to review their services and take advantage of the disruption caused by COVID-19. The aim should be to enhance the patient experience and ensure more Australians can get specialist care without out-of-pocket payments.
Stephen Duckett is director of the health program at Grattan Institute