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Keep GP costs down to win fight against rich world’s biggest killer, OECD says

Decades of success in cutting deaths from heart attacks and strokes are at risk unless governments ensure patients have affordable access to primary health care, the Organisation for Economic Co-operation and Development has warned, adding to pressure on the Federal Government to dump its controversial freeze on Medicare rebates.

As the AMA intensifies its campaign against the four-year freeze, which is set to drive down GP bulk billing rates and force up patient out-of-pocket costs, the OECD has said that affordable and accessible primary care is essential if the world is to build upon a 60 per cent decline in the cardiovascular disease mortality rate in the past 50 years.

In a major report on cardiovascular disease and diabetes released overnight, the OECD said although massive strides had been taken in reducing deaths from cardiovascular disease (CVD), it still remained the most common cause of death in developed countries, and rising rates of obesity and diabetes threatened to slow or even reverse these gains without a greater focus on preventive health, accessible quality primary care and more effective hospital systems.

“The prospects for reducing the CVD disease burden are diminishing, and the pattern of declining mortality is coming to an end or even reversing amongst some population groups, particularly younger age groups,” the Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care report said. “Rising levels of obesity and diabetes are reducing our ability to make further inroads into reducing the CVD burden.”

The OECD warned that, on current trends, almost 108 million adults across the OECD would have diabetes by 2030, while an extra 23 million would have greater health needs and a higher risk of complications.

The report paid much of the credit for the decline deaths from heart attacks and strokes in recent decades to public health campaigns, particularly on smoking.

All OECD countries have taken anti-tobacco measures including mass media campaigns, higher taxes, advertising bans and quit services, with the result that between 1997 and 2009 the proportion of adults lighting up daily fell from 28 to 20 per cent.

“Smoking policies have been shown to be highly effective. Tobacco control policies…have saved lives,” the OECD said.

It said that although evidence about the effectiveness of Australia’s world-leading tobacco plain packaging laws was still being gathered, the initiative “may provide the next set of policy instruments for governments to help further reduce the harmful impact of smoking”.

But governments have so far been much less successful in curbing rates of obesity and diabetes, which the OECD said would instead revolve around the strength of a country’s primary health care system.

“Primary care is the centre of the health care system, and is particularly so for CVD and diabetes,” it said, emphasising the importance of affordable and accessible quality care.

“A highly accessible primary care system has the capacity to reduce inequalities in health outcomes and deliver care to those who stand to benefit most,” the report said. “This is particularly important for diseases such as diabetes, which is far more prevalent among lower socio-economic groups.”

It is a timely warning as the AMA ramps up its campaign against the Federal Government’s plan to freeze Medicare rebates until mid-2018.

AMA President Professor Brian Owler has criticised the policy as a “co-payment by stealth” because rising practice costs will force many GPs to dump bulk billing and charge their patients out-of-pocket fees.

Professor Owler said this was concerning because it raised the risk that patients would put off seeing their GP until their health problem became so serious it required hospitalisation.

It is a concern shared by the OECD, which warned that how primary care was funded had “enormous implications” for access to care and health.

“Higher out-of-pocket costs will lead to a lower use of primary care services, particularly among the poor,” it said. “By foregoing routine visits…patients are exposed to greater risk leading to a worsening of health status.

“It is therefore essential that primary care remains highly accessible to all.

“Good access is a necessary requirement to enable primary care practitioners to have regular contacts with patients, assess patient risk, monitor progress, deliver care and adjust treatments when required.”

As part of its report, the OECD examined ways to improve the quality of primary and acute care, including using digital technology to share up-to-date patient information and monitoring their health, as well as pay-for-performance schemes, better hospital access and public reports on the relative performance of hospitals and other health services.

It found that although there was some evidence that pay-for-performance schemes, under which doctors are paid for outcomes – usually in chronic and preventive care – can achieve some improvements, this is often highly contingent on a range of other conditions being in place, meaning great care had to be exercised in implementing such a payment model.

While lauding the success of recent decades in curbing CVD mortality rates, the OECD nonetheless said that it remained the “number one killer” in most member countries, and there were concerns about riding rates of obesity and diabetes, and gaps between recommended health care and that which was actually provided.

The Organisation said it was not just a matter of more money.

“The evidence on what constitutes good quality care has been I the public domain for decades, but many OECD countries are still coming to terms with the changes that need to be made in their health systems to deliver such care,” it said.

The OECD said that one of the most significant challenges was to take evidence about best treatment and make it part of everyday practice.

Adrian Rollins