June 12, 2008
As we know health is back on the reform agenda --in terms of private health insurance and primary care in the context of an ageing population, the increasing incidence of chronic disease, national workforce shortages and ageing infrastructure.
Private health insurance continues to churn away under the surface as it irritates many because it props up the private health insurance industry. Kenneth Davidson in The Age addresses the issue of private health insurance. He says that the unstated policy of the Howard government was designed to prop up private health insurance and maximise the incomes of doctors at the expense of the public health system but not, as far as he is aware, the policy of the Rudd Government. He says:
But one thing is incontrovertible. The carrots and sticks didn't take the pressure off Medicare. In the situation where there is a shortage of GPs, specialists and nurses, a shift in funding away from public to private provision of health services will lead to a similar shift in health professionals.It follows that if the imposition of the 1% Medicare levy surcharge (and the 30% health insurance rebate) didn't take the pressure off Medicare and the public hospital system, reversing the surcharge (and the 30% rebate) won't cause a mass exit from private health insurance as has been predicted by the AMA and the private health insurance industry
Charles Livingstone, senior lecturer in the Department of Health Science at Monash University, says that what private health insurance does is help people jump the queue, as Howard government advertising highlighted. It does this by paying practitioners more in the private system, and exploiting the differential created between public sector rates of remuneration and those on offer in the private sector
What Davidson misses is that hospital care is not everything. Primary care is crucial, even if it is usually overrlooked. In primary care there is a shift towards opening up Medicare to nurses allied health professionals working in a team headed by a GP.That basically means the patient does not need to see the GP for health care. This way of addressing a chronic shortage of general practitioners will be opposed by the Australian Medical Association which has long-campaigned to maintain the monopoly of GPs in delivering primary health services in the name of quality and safety.
The proposed reforms does not mean that allied health professionals are accepted as primary care practitioners in their own right, even though people do see them independently of the GP. They can be seen as a step in this direction. We have a long way to go to break the monopoly of GP's in delivering primary health care services to allow allied health professionals to deliver primary health care.
Update
Davidson also misses the way health services in rural and regional Australia are being reformed with due to the pressures resulting from ageing population, the increasing incidence of chronic disease, national workforce shortages and ageing infrastructure. There is a greater shift to the hubs (hospitals) and spokes (primary care) model, greater co-ordination, better greater integration of services and an increased focus on community need. This means that the role of hospitals will change with an emphasis on upgrading several acute care regional general hospitals with the smaller country hospitals acting as feeders. The smaller hospitals will provide palliative care, primary health care, community based mental health, overnight and day surgery, rehabilitation etc.
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Opening up Medicare to nurses and allied health professionals sounds very sensible. That and the prescriptions and referrals stuff Roxon was talking about last night seem more efficient than clogging the whole thing up with GP waiting lists.