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Cost-effective GPs a health saving

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A major study has found that the nation’s GPs are playing a vital role in holding health costs down, calling into question the Federal Government’s push to gouge money out of primary care to boost the Budget bottom line.

Sydney University health researchers have found that GPs are playing a crucial role in caring for aging patients with multiple and complex health problems, helping them lead longer and healthier lives at a fraction of the cost of other health systems, particularly the United States.

The conclusion is politically awkward for the Federal Government, which has targeted the health budget for cuts, claiming that Medicare expenditure is out of control.

The Government has imposed a four-year freeze on Medicare rebates, and Health Minister Sussan Ley has directed a review of the Medicare Benefits Schedule to achieve savings that can be ploughed back into general revenue.

The Minister has sought to justify the cuts by accusing doctors of manipulating and exploiting the Medicare system for personal financial gain – a line of attack that AMA President Professor Brian Owler has condemned as deeply offensive.

The latest report from the long-running Bettering the Evaluation and Care of Health (BEACH) study being undertaken by the Family Medicine Research Centre backs AMA warnings that the Government’s attack on primary health care funding is misguided and will cost both patients and the country dearly.

The BEACH report found that the aging of the population is imposing an increasing burden on the health system.

While less than 15 per cent of all Australians are aged 65 years or older, they are twice as likely to see a GP, have a pathology test, see a specialist and be on medication as the rest of the population.

This is due, to a large extent, to the fact that they tend to have multiple chronic health complaints – the study found 60 per cent of them had three or more health problems, and a quarter had five or more.

And the health demands of older Australians are growing quickly – their use of GP time, diagnostic tests, medicines and referrals is expanding much more rapidly than their numbers would imply.

But, despite this, Australia’s total health spending as a proportion of GDP is on a par with countries such as Britain, Canada and New Zealand while achieving among the longest life expectancies in the world – and is far better than the United States, which spends double the amount but whose life expectancy is four years shorter.

The BEACH researchers attributed this world-class result to the work of the nation’s GPs and central role they play in the health system.

“One of the biggest differences between the health care systems in Australia and the United States is that primary care is the core of Australia’s system, with GPs acting as ‘gatekeepers’ to more expensive care,” they said. “If general practice wasn’t at the core of our health care system, it is likely the overall cost of health care would be far higher.”

The BEACH researchers said that the early diagnosis of health complaints and increasing life spans meant people were living longer with complex conditions, adding greatly to health costs: “This is the price Australia pays for good health, but we would argue this price is very reasonable”.

GPs are central to holding costs down, in large part because of the work they do in co-ordinating the care provided by hospitals, specialists, allied health professionals and community and aged care services.

The BEACH researchers said this coordinating role was crucial because it cut down on duplication of tests and helped ensure continuity of care – both considered vital in sustaining health and holding down costs.

They found that 98.6 of older patients had a general practice they usually attended – a de facto ‘medical home’.

“If our Government wants to make our health care system sustainable, it should invest in primary care to improve the integration of, and communication between, these different parts of the health system,” the researchers said.

“Further strengthening the role of general practitioners will reduce unnecessary interventions in the secondary and tertiary health sectors.”

Adrian Rollins