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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.
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The president of the Australian Medical Association, Rosanna Capolingua is opposed to the reforms. She says:
Capolingua says that Roxon is threatening Australian patients with a reduction in their rebate for when they want and need to see a doctor.