AUSTRALIANS, and governments, need to put a higher value on general practice services if the nation is to avoid a looming healthcare crisis, one Tamworth doctor has warned.
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Dr Ian Kamerman, president of the Rural Doctors Association of Australia, says rather than charge a co-payment for GP services, as proposed in the budget, the federal government needs to rethink the way Medicare is funded and help change patient expectations about the treatment they receive.
He says Medicare, now 40 years old, has devalued general practice to the point where patients expect it to be free, while accepting the need to pay for other medical services.
“The problem is the government has set up a model over time which has devalued general practice, so there is huge pressure on practices to bulk bill,” Dr Kamerman said.
“People have the concept that healthcare should be free – they’re happy to pay for a specialist, but not a GP.”
Dr Kamerman believes co-payments are a very small part of the future of general practice funding.
“If you want to look at the evidence, we need to actually seek payments for quality because then you might be able to convince people of the value of the general practice service,” he said.
“And (rating) the quality in general practice is easy – it’s comprehensive care, co-ordination of ... chronic disease management, it’s after-hours service, hospital avoidance.”
For those who reject the notion of dispensing with bulk-billing altogether, Dr Kamerman puts it in “you get what you pay for” terms.
“You, as a consumer can know right away, ‘yep, this is a quality practice, and I’m happy to pay X amount for this service,” he said.
“When you’re running, by and large, a bulk-billing practice – and I’m not pointing out anyone specifically here – generally you’re relying on a model that requires you to have briefer consultations, one problem only and essentially putting people through because that’s the model Medicare funds the best.”
Quality of service is not considered in the current Medicare model, Dr Kamerman says, to the detriment of patients, particularly those in rural and regional areas.
“The issue is, I think, that the government tends to look at (healthcare) as a numbers rather than a skills game, but just because you’ve got bums on seats doesn’t necessarily mean people have high-level skills,” he said.
“In rural areas, the hospital-based care is as important as office-based care; that (doctors) can do the procedural-based stuff and look after whole communities, rather than just people who come into their office.”
The programs that provide this level of quality and expertise though are under threat however, many dismantled in the budget.
“So, we actually get to that position, so what do we do now, we say, ‘oh yes, we’ve solved that problem, let’s change it all and put it under a whole lot of risk’,” he said.
“As with any major reform, this will cause chaos for the next five to 10 years if it goes through (the senate).”
