Issue 38 / 8 October 2013

SADLY, health policy was not a prominent focus of interest for the public during the recent federal election campaign.

A certain sense of “business as usual”, and even signs of a protean convergence between the two major parties, seemed to emerge on some broad positions.

The threatened demise of Medicare Locals under a coalition government seems to have been toned down to a “review” of the previous government’s foray into primary health care reform.

While public jousting over measurables such as waiting times will likely continue, the real business of health proceeds relatively quietly and nowhere more so than in general practice. Here, the work of influencing population health at the individual level takes place irrespective (or perhaps in spite) of a shifting parliamentary political environment.

But such care is responsive to new knowledge, societal changes and evolving policy.

Recent research in gastroenterology provides knowledge that helps make sense of the apparent grab bag of “functional” gastrointestinal disorders that cause concerning and distressing symptoms, and for which patients commonly seek care. An editorial in the MJA argues that eosinophil-predominant gut inflammation might explain these disorders, opening up entirely new ways of management.

The known genetic and disease associations suggest this eosinophilia may be a manifestation of atopy (from the Greek atopos, meaning “remarkable” or “unusual”).

When it comes to another, better understood manifestation of atopy — atopic dermatitis (AD) — general practitioners need to be aware of social and cultural influences on adherence to treatment strategies. A Clinical Focus article highlights the problems in encouraging parents to apply the recognised medical treatment (topical corticosteroids) to their affected children.

“Steroid phobia” in family and social networks, the use of complementary medicines and parents’ search for a definitive cure can hobble effective treatment.

The high-profile, unusual case of a young child who died from secondarily infected AD after her parents opted to avoid topical steroids certainly grabbed mainstream attention. But many parents in more ordinary circumstances, in attempting to seek the best care, also risk harming their children by excluding steroid therapy.

Discussions of Medicare rebates are frequently politically charged and cause ongoing consternation for GPs, both in terms of their own remuneration and the effect on their patients of out-of-pocket expenses. A research article reports that in Australia’s universal health care scheme, up to around 9% of annual household income goes towards out-of-pocket expenses, with expenditure on practitioner fees being a major component.

Copayments for GP consultations account for up to around 9% of this expenditure, but GPs refer patients to specialists and dentists, for whom out-of-pocket patient contributions are substantially higher and can run into thousands of dollars.

In public discourses of tighter microeconomic management and greater individual responsibility, the pressure to expand out-of-pocket contributions will likely continue. This will have consequences for the accessibility of the health care provided by GPs.

In his address to the World Organization of Family Doctors (WONCA) earlier this year, WONCA president Michael Kidd talked of how ensuring access to health care is part of GPs’ core business:

“I believe this is the beginning of a new Golden Age for family medicine … Because in countries all around the world, the message is getting through about the importance of strong primary care and the role of family doctors in ensuring universal access to health care and equitable health care outcomes.”

This seems somewhat promissory, when, even in a fortunate country like Australia, there are serious disparities in access to health care. But there is cause for optimism.

Politics, knowledge, societal values and health policies may change, but adapting to these environments to provide effective primary care still is a case of “business as usual”.


Dr Astika Kappagoda is deputy editor and Dr Ruth Armstrong is senior deputy editor of the MJA.

This article is reproduced from the MJA


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