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2014 holds promise, though funds look tight

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Welcome to 2014. Before we all plunge into another hectic year caring for our patients and keeping up with demands of a busy practice, I thought it was important to pause for a moment to reflect on what it is we collectively achieve on a daily basis.

Glance at any international ranking of population health and medical care quality and Australia is consistently at, or very close to, the top.

Life expectancy in Australia is around the third highest in the developed world, cancer survival rates are up, infant mortality (apart from in Indigenous communities) is very low and smoking rates are dropping.

Of course, there remain plenty of health challenges.

Probably the major challenge for the future is our rate of obesity.  Australia is now one of the fattest nations on earth, bringing with it all the attendant chronic health problems such as diabetes, cardiovascular and cerebrovascular disease, premature joint wear and renal disease.

The country is yet to close the yawning gap between the health of Aboriginal and Torres Strait Islander people and the rest of the community. We need to implement the recommendations that the AMA has repeatedly made in our Aboriginal and Torres Strait Islander health report cards (see 2012-13-ama-indigenous-health-report-card-healthy-ear…).

But there is much that, collectively, the medical profession should be very proud of.

The facts don’t lie – we serve our patients very well.

What is more, we are delivering very high quality care at a fraction of the price paid in many other developed countries, particularly the United States.

This doesn’t mean that things can’t be done better.

As every practitioner knows, several health reforms and initiatives introduced in recent years have fallen well short of the mark.

To take just two examples, the Personally Controlled Electronic Health Records (PCEHR) system has, in its current form, proven to be of little clinical benefit, while Medicare Locals have, by and large, failed to add much to primary health care despite substantial taxpayer investment.

But on both these fronts 2014 promises to be a better year.

I was part of a three-member review panel that has recommended a number of substantial changes to the PCEHR. While I can’t go into detail, it is clear that the Government wants to overhaul the program to realise all the advantages a proper electronic health system can bring.

And, just before Christmas, Health Minister Peter Dutton gave the AMA and doctors an early present by delivering on his promise to initiate a review of Medicare Locals.

It will come as no surprise to you that an AMA survey of more than 1200 GPs, conducted in December, found widespread dissatisfaction with Medicare Locals and the way most have so far operated.

Initial goodwill toward Medicare Locals has since soured in many areas because of a perceived lack of consultation, relevance or support when it comes to providing primary health care.

A common refrain has been that Medicare Locals have provided little or no assistance for the respondent’s practices in preparing for the PCEHR, and their administration of after-hours GP care has increased complexity, reporting requirements and red tape.  

Reflecting widespread disillusion, almost 72 per cent of GPs surveyed by the AMA felt their Medicare Local had done nothing to improve the delivery of primary care and ought to be abolished.

The AMA has presented this detailed feedback to the review, led by former Chief Medical Officer Professor John Horvath, and has high hopes that when he reports in March, Professor Horvath will recommend substantial reforms – not least increased numbers of GPs at the governance level to provide practical, grass roots advice on what is needed, and what works in each area.

I will be meeting with Professor Horvath in early January to press our case in person.

Other challenges remain.

The Government’s contribution to the cost of providing health services continues to go backwards – Medicare rebates will remain frozen until the middle of the year, and there is no prospect that the gap between the Medicare schedule and the actual service cost will narrow any time soon.

Add to this the speculation about a mandatory patient co-payment for bulk billed GP services, and it is clear health costs will be a major issue in 2014, just as they have been in recent years.

Like all countries in the world, we know that health care costs are growing at an unsustainable rate. We do need to participate in prescribing a solution.

It is not just the health portfolio, though, that needs attention.

Frankly, fees are not the problem.

We need affordable housing. We need to ensure good access to early childhood education. We need to make it easier to eat the right quantity of the right food, and to get the exercise we need.

We need better urban design to make it easier and safer to walk or cycle to schools, shops and places of work.

We need to tackle the scourge of alcohol misuse, and to protect our youth from exposure to its advertising.

There is much to be done and, once again, the AMA will be looking out for the interests of its member practitioners and their patients, doing its best to ensure sensible policies and outcomes that keep the country near the top of the table when it comes to the health and wellbeing of Australians, while keeping it affordable and sustainable.

 

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