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health reform: looking good « Previous | |Next »
September 22, 2008

As is becoming increasingly clear the Rudd Government's health reform aims to reduce health inequality and increase access to good health care. Inequality means poor health and poor health means inequality. The commitment to reform clashes with the interests of doctors as it seeks to remake the role of general practitioners and how health funding is delivered to the states.

What the reforms seek to do around primary care is for nurses, psychologists, physiotherapists and dieticians to take on more work traditionally performed by doctors. This directly attacks the way that the health system has been organized around doctors and the way that health care is funded by Medicare.

In a recent speech entitled 'The Light on the Hill: History Repeating', given as an address to the Annual Ben Chifley Memorial Light of the Hill Dinner in Bathurst, Nicola Roxon, the Minister of Health and Ageing, argues that prevention a key weapon in the arsenal of health. Investing just in hospitals can play only a very limited role in addressing disadvantage. It can do a great deal of good, but the chance at early intervention, and a better life, has been lost. It is the notorious ambulance at the bottom of the cliff – not the fence at the top that stops the fall in the first place.

Roxon goes on to say that our health system, including funding for health services, is organised almost entirely around doctors, despite the fact that many services are now safely and ably provided by other health professionals – nurses, psychologists, physiotherapists, dieticians and others:

Doctors must and will remain central to our health system. But to date, professional resistance and government funding have prevented the development of a health sector in which services are delivered not only by doctors, but by other health professionals who are safe, potentially cheaper and, most importantly, available....Doctors will need to be prepared to let go of some work that others can safely do. To ensure this transition, there needs to be an incentive for doctors to eschew less complex work, and focus on the work that does require their high-level skills and expertise. Or if doctors do not want to let go of it, to accept being paid less for devoting their highly skilled and heavily trained selves to less complex tasks then they might.

So the reform thrust is to addresse the historical bias towards medical intervention and acute care by shifting the focus of the health system to prevention and to explore the ways in which nurses and allied health professionals can take on some of the work of GP's.

| Posted by Gary Sauer-Thompson at 9:03 AM | | Comments (5)


The president of the Australian Medical Association, Rosanna Capolingua is opposed to the reforms. She says:

Overseas experience shows that putting in other layers of primary providers does not improve access to care, and in fact increases the cost because patients are being channelled to other providers first and then need to see a doctor anyway.

Capolingua says that Roxon is threatening Australian patients with a reduction in their rebate for when they want and need to see a doctor.

Overseas experience also shows that doctors very quickly change their practice patterns to adapt to remuneration schedules. Nothing wrong with that. Governments should harness this fact and use it as a tool to encourage doctors to provide the services that are most needed. One musn't forget that the AMA is essentially a lobby group, even a union (nothing wrong with that either) and will do anything to ensure they maintain as much power and influence as possible.

The other part to this debate extends beyond the mere technical aspect of treating and preventing disease. The most powerful illness preventor is a fair society, where the socio-economic spectrum is as narrow as possible and where access to education is equal. this is emerging as an undisputed fact in public health and health economics literature. I read somewhere that 'all policy is health policy'.

Health policy should thus operate within a more holistic and interconnected framework that includes tax, welfare and education instead of in isolation. Unfortunately this is not what the doctors want to hear as it undermines their power. It is a costly misconception that only clinical care or medically-driven health prevention promotes health.

The other half of the story is getting patients to change their habits when they do need services. Would it be right to say that people from higher socioeconomic groups are more likely to seek alternatives to the local GP?

Lyn, that's a good question. I'm not aware of any evidencce onthis but I feel that the answer may surprise. One of thereasons why is that higher SE individuals are time poor, thus less likely to wait to see a GP. Also, based on my own experience as an allied health clinician, it is usually the lower SE groups that think they need a GP referral for everything. But yes, education will defijnitely be needed along with price signals (inc wait times).

Based on my own experience as someone who's moved around a lot, you don't find an awful lot of allied health professionals setting up shop in lower SE areas. Assuming that that's because there's lower demand for their services, it also decreases the likelihood of people learning of their existence and seeing them as an alternative.