Opinion & Commentary
Health policy fails to target problem
The sound and fury accompanying Kevin Rudd's hospital reform plan means you might have missed the primary care initiative announced by the Federal Opposition last week. A Rudd Labor government will spend $220 million to establish ''GP super clinics'' in regional and outer metropolitan regions. Incentive payments are to be offered to encourage doctors and allied health professionals to bring a broad range of health services under one roof. The purpose of these one-stop shops is to provide local communities with enhanced preventive and multidisciplinary care, particularly for patients suffering chronic conditions. The goal is to improve public health outcomes, create a less expensive health system, and take the pressure off public hospitals. But Labor's policy overstates the potential benefits of investing in primary care. It also fails to target the real problems in the health system, particularly in public hospitals.
Labor says the new super clinics will provide bulk-billed services in underserviced locations with high levels of need, and that this will prevent non-urgent patients clogging up hospital emergency departments. Yet this won't solve the national shortage of doctors. Labor's plan is to get sought-after doctors to relocate to suburbs said to be unable to attract GPs, and have them provide bulk-billed and presumably out-of-hours care, in return for a measly $15,000 incentive payment. Moreover, the problems in public hospitals are not caused by lack of bulk-billing. (New figures show GP bulk-billing rates have increased to just over 78 per cent.) Research conducted for the Australasian College for Emergency Medicine in 2004 found that non-urgent patients do not significantly add to emergency department workloads and are not the cause of hospital overcrowding. The real cause of delayed admission and long waiting times is high occupancy. The unavailability of acute and elective beds is exacerbated by the number of elderly patients who remain in hospital due to the shortage of ''high-care'' places in residential nursing homes.
Hence, the best way to ease the pressure on hospitals would be to extend the accommodation bond system to ''high-care'' nursing home facilities, as recommended by the 2004 Hogan review. Accommodation bonds are already in place for ''low-care'' facilities. They are financed by the sale of the homes of residents, and are returned to their estate upon death, minus an administration charge. If recipients of ''high-care'' places were required to pay a bond, the aged-care sector would receive the capital needed to create extra places. This would also put an end to the interminable federal-state blame game over public hospitals. But with an election nearing, neither the Government nor the Opposition will commit to this eminently fair policy. The price paid for allowing some privileged members of the community to retain complete control over their inheritance is an inadequate aged- care system and an overburdened public hospital system. So, instead of the sure fix, both sides of politics are promising ''long-term solutions'' which basically involve throwing more taxpayers' money at the health system. Labor's plan to address the twin challenges of population ageing and rising incidence of lifestyle disease is to reorientate the health system away from high-cost curative care in hospital towards lower cost primary care in the community. Once diagnosed with a chronic condition such as diabetes, chances are that some patients will work with their doctors to manage their illness and avoid the real risk of acute episodes.
Good management may well prevent expensive secondary medical interventions. But do we really need super clinics to provide the stock standard medical care that is delivered every day in doctors' surgeries throughout Australia? Advocates of preventive medicine also talk of education as the key to prevention. Of course, health professionals can give commonsense advice about good diet and regular exercise. But I doubt that many people in high- risk categories will modify their lifestyles while the risk of harm remains relatively remote. Investing in primary care to keep people out of hospital sounds like a good idea. But spending more taxpayers' money on preventive medicine is unlikely to prevent lifestyle disease as promised.
Dr Jeremy Sammut is a research fellow at the Centre for Independent Studies. The first paper in the CIS Health and Ageing Series, The Organisation of Residential Aged Care for an Ageing Population by Warren Hogan, is available online at www.cis.org.au .
