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Doctors – stewards of the health care dollar

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AMA President Dr Steve Hambleton sat down with Michelle Grattan from The Conversation early in the month to discuss all things health. (You can listen to their full conversation at http://michellegrattan.podbean.com/2014/04/02/dr-steve-hambleton/).

Dr Hambleton talked about the speculation surrounding health care in the upcoming Budget, arguing that the nation was able to sustain current spending on health care despite concerns about managing an ageing population and increases in the cost of new technology.

The AMA President said primary health care – generally coordinated by GPs – was already an efficient way to spend health dollars, and providing access to GPs was important and should not be restricted.

Dr Hambleton argued that the health system as it currently stood was not free – expenses were already built into the system, it was just free at the point of delivery. He said in areas where people had the capacity to pay for their health care, bulk-billing rates were low, and he did not believe there was systemic overuse.

Dr Hambleton highlighted the fact that, generally, people on higher incomes already paid for much their health care through private insurance premiums, and that the barriers to primary health care should not be increased by asking people to make co-payments, because this would result in higher downstream costs, particularly in hospitals.

Dr Hambleton said there was a need to resolve the Federal-State funding blame game, especially when it came to hospitals, and to join up the system by measuring where and why things were happening. He said there was a need to close the gap between what we know and what we do, and e-health technologies would go a long way toward achieving this.

Currently Australia has a shortage of Australian trained doctors, as the numbers being trained are not sufficient to cope with the increase in population. Dr Hambleton said there was a need for long-term planning to ensure there were the resources and means to train Australian doctors.

Dr Hambleton emphasised the importance of the social determinants of health, particularly among Indigenous Australians, saying education, access to health services and safety were important. He said a new funding system was desperately needed, and that Medicare alone was not going to achieve the outcomes to close the gap. He said investing in Indigenous health was cost-effective, as it would set up families for life and encourage them to gain an education and participate in the economy.

Dr Hambleton also touched on lifestyle interventions, saying there was a need to make it easier to make healthy choices, especially around the use of alcohol and the consumption of junk food.

Dr Hambleton completes his term as AMA President in May, and provided some words of advice for the next AMA President.

He said the AMA must always engage with Government and the Opposition to assist them in making better decisions. It must also look at how the health system is structured, especially if doctors were to be stewards of the health care dollar, and that the profession must closely examine environmental and global health.

Kirsty Waterford