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Insurers could dig further into primary care with after-hours review

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Hopes for an overhaul of Medicare rebates for after-hours care have been dealt a blow after they were excluded from a review of after-hours primary health care services commissioned by the Federal Government.

Health Minister Peter Dutton ruled out after-hours Medicare Benefits Schedule items from being included in the review, to be headed by former Royal Australian College of General Practitioners President Professor Claire Jackson.

Instead, it is likely to include suggestions for greater private sector involvement in the provision of after-hours care – a potentially contentious area given grave concerns held by the AMA about the push by private health funds into primary care.

The review’s terms of reference, unveiled by the Minister, include looking at “opportunities for improved engagement with the private sector”.

“The Government is committed to fixing Australia’s health system and to improving frontline services to meet community needs, including after-hours services,” Mr Dutton said. “Professor Jackson will provide advice to the Government on the most appropriate and effective delivery mechanisms to support ongoing after-hours primary health care service provision nationally.”

The review has also been directed to look at policy setting required to generate “innovative solutions”.

The Minster has set Professor Jackson a tight deadline for the review, asking her to report back with recommendations by 31 October.

AMA President Associate Professor Brian Owler has voiced major fears about the potential for increased private sector involvement in general practice to open the way to US-style managed care.

The AMA has been watching with concern a trial arrangement between Medicare Private and primary health provider IPN under which the insurer contributes to practice administrative costs in return for privileges for its members, including a guaranteed GP appointment within 24 hours.

In a major speech to the National Press Club in July, A/Professor Owler warned that “the stage is being set for a US-style managed care system in both the primary care and hospital settings [and] I am concerned that the Government is also looking towards such a system.”

Professor Jackson’s inquiry comes against a turbulent backdrop for general practice. Not only is the Medicare Local scheme to be scrapped and replaced with Primary Health Networks, but Government plans for the introduction of a $7 co-payment for GP services remains in political limbo and the speciality is still trying to absorb the implications of wholesale changes to GP training arrangements, including the abolition of General Practice Education and Training and the absorption of its functions within the Health Department.

The Government has identified arrangements for the provision of after-hours GP services as one of its biggest concerns.

Under the Labor Government, Medicare Locals were given responsibility for contracting and coordinating after-hours GP services within their catchment areas.

But the process has been dogged by problems and complaints, and former Chief Medical Officer Professor John Horvath recommended in his report on the on the flawed Medicare Locals scheme that the provision of after-hours primary health care services be reviewed.

AMA is preparing a submission to the Jackson review.

Mr Dutton said current arrangements for after-hours services would be maintained until the end of Medicare Locals on 30 June next year, and “new funding arrangements will be transitioned from 1 July 2015 to ensure continuity of after-hour service provision”.

Questions and comments regarding the Jackson review can be sent to afterhoursreview@health.gov.au

Adrian Rollins