Opinion & Commentary
Super clinics are no alternative for hospital beds
The centrepiece of the Rudd government’s plan to take pressure off public hospitals is a national network of GP Super Clinics. These clinics are designed to provide local communities with more and better ‘coordinated’ primary care.
Coordinated care involves a GP or a practice nurse monitoring the condition and managing the care of the chronically ill and elderly patients. The proponents of coordinated care say that ensuring patients receive all available care from a wide variety of allied health providers will prevent conditions from deteriorating to the point these patients require urgent, unplanned, and potentially avoidable admission into hospitals.
The report of the National Health and Hospitals Reform Commission (NHHRC) has fully endorsed the idea that ‘comprehensive’ GP Clinics will take the pressure off overburdened public hospitals.
Unfortunately, the solutions being proposed for the hospital crisis are not evidence-based policy. They are predicated on the misguided idea that the problems in hospitals are because of the hospital-centric health system focusing too much on hospitals and not enough on primary care.
The real problem is that public hospital beds have been cut by 60% since Medicare was established in 1984. This is why emergency departments are overcrowded and their corridors are filled with ailing, mostly elderly patients, who have to wait hours and sometimes days for a hospital bed.
The evidence that alternative community-based models of care can substitute for hospital care has been generously described as ‘weak at best.’ Studies actually indicate that schemes designed as substitutes in practice ended up complementing hospital care. They have resulted in increased hospital activity in the context of rising overall demand and bed cuts.
One of the well-demonstrated effects of coordinated care is to uncover unmet needs. This is no bad thing and hardly an argument against coordinated care. But it does mean that rather than take the pressure off hospitals, coordinated care may well add to the pressure.
The results of the second round of the Australian Coordinated Care Trial suggest we should be sceptical about the effectiveness of alternative models of care in reducing hospital usage by the rising numbers of elderly patients who are putting the most pressure on hospitals.
One of the coordinated care programs studied as a part of the trial, which was conducted in the northern suburbs of Melbourne, targeted the key demographic—elderly chronically ill patients aged 75 and over. Coordinating the care of a trial group of patients appears to have produced no significant reduction in hospital use compared to a control group who continued to receive their usual level of care from their GP.
Except for a period during the 15-month trial, intervention patients had significantly higher use of inpatient hospital services at the beginning, the end, and throughout the trial on average than the control group.
The NHHRC is taking the health reform agenda down the same failed path as in New Zealand. The primary care reforms implemented by the Clark Labour government are singled out as the model for Australia to follow. Never mentioned is that public hospitals in New Zealand (which stopped publishing information about bed numbers in 2000) suffer the same if not more serious problems than their Australian counterparts—the unacceptable clogging up of emergency departments due to the lack of beds.
Boosting primary care is a wrong-headed approach to fixing the hospital crisis. Rising numbers of people are living to older ages and deferring illness to later stages of life. This means that ‘very old’ patients will inevitably get acutely ill and require admission to hospitals.
The truth is that Super Clinics will not solve the hospital crisis. Despite what the government and the commission maintains, better coordinated primary care is no alternative for hospital beds in an ageing Australia.
Dr Jeremy Sammut is a research fellow at The Centre for Independent Studies. His report, ‘Why Public Hospitals are Overcrowded: Ten Points for Policy Makers’, is released by the CIS in July.
