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Enhanced Medicare support for GPs key to containing health costs

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Government efforts to control spiralling health costs must focus on enhancing the role of GPs within the health system, according to AMA President Dr Steve Hambleton.

Addressing a roundtable to mark the 30th anniversary of Medicare, Dr Hambleton said primary health care costs were growing much more slowly than those in other parts of the health system, and improving support for GPs in providing care for complex and chronic diseases would ultimately save the nation billions of dollars that would otherwise be consumed in expensive hospital care.

“GPs are the foundation of primary care, and they save the health system money,” the AMA President said, citing data showing spending on medical services grew by 4 per cent in the decade to 2011-12, well below the annual 6 per cent increase PBS spending and the 9.3 per cent annual jump in the cost of pharmacy products.

Dr Hambleton said that in the 10 years to 2012-13, Medicare benefits paid per service grew by just 4.7 per cent a year, compared with overall health spending growth of 5.4 per cent a year.

“It is clear that the MBS – combined with the private health insurers’ schedules – is an effective price dampener for medical services,” he said, adding that 81 per cent of GP consultations were bulk billed.

He said the figures demonstrated how the recent focus on Medicare costs, including the suggestion of a $6 patient co-payment for GP consultations, was “a bit misdirected”.

“The focus should be on spending that money wisely,” Dr Hambleton said, noting that non-communicable diseases had become the major driver of health costs, necessitating a change in the way the country provides health care, particularly to sharpen the focus on preventive rather than acute care: “Keeping people out of hospital is cheaper, and it frees up resources”.

Dr Hambleton said there was already an example of what Medicare in future should look like.

The AMA President said the Department of Veterans Affairs’ Coordinated Veterans Care (CVC) Program showed what could be achieved with a proactive approach to care based around GPs.

Under the program, GPs receive support to provide comprehensive planned and coordinated care for veterans, with the assistance of practice or community nurses.

GPs treating patients with chronic and complex diseases are given the resources to spend more time with patients who need it, as well as support following up on patients to ensure their chronic conditons are properly managed.

Dr Hambleton lamented that this type of arrangement, which was delivering real benefits for patients and saving the Government money, was “something that Medicare currently works against”.

“We need to look at how we can roll out this type of pro-active approach more broadly,” he said. “It would allow us to invest in a healthier future with better disease management, and prevention of avoidable costly hospital admissions.”

“The overall message,” the AMA President said, “is that if we as a nation do not wish to spend more on health – and that is the clear message coming from the new Government – then we must spend smarter.”

It might need an increased investment from Medicare, not a decrease, he warned, adding that the role of the GP role in safeguarding the health of the population (which would ultimately control costs) must be enhanced by Medicare – not eroded or substituted.

“The AMA strongly believes that 2014 and beyond must be the years of the GP, who can deliver the right care at the right time to the right person,” he said. “Medicare must rise to the challenge.”

Adrian Rollins