REDESIGNING the health care system to reduce the demand on hospitals is a major financing problem for Australia.
Reviews of the Medicare Benefits Schedule
and primary care
will be wasted if opportunities are not taken to the realign the roles and services provided by GPs and hospitals as part of a strategy to reduce health costs.
So how could funding changes help to redesign the health care system in Australia so it provides more efficient, effective care and reduces hospital admissions?
One suggestion is to reinvest in general practice infrastructure so GPs can provide minor accident and emergency (A&E) services.
Analysis of Medicare data clearly document the decline of A&E type activity in general practice over time. As an example, I have put together a graph that demonstrates decreased laceration repairs in general practice over 20 years.
Similar declines have been noted in Medicare data for other GP-based A&E services including fracture management, removal of foreign bodies from eye/skin, and abscess/haematoma drainages. Clearly, the general practice role in providing minor A&E services is in decline.
Conversely, hospital A&E activity
is increasing and the cost of delivering minor A&E care has become exorbitant.
Emblematic of the absurdity of health funding in this area is the cost to hospital emergency departments when patients don’t wait to be seen.
The Independent Hospital Pricing Authority report
released earlier this year found that the “national efficient price” was $198 (based on the efficient price formula of 0.04 x $4971) for a patient attending a hospital emergency department who left a hospital without receiving any services.
This equates to almost two-thirds of yearly costs of care for a patient seen in general practice
and would cover several minor A&E attendances.
According to the IPHA, even the most basic hospital A&E presentation is “efficiently” priced at over $250. This contrasts with Medicare rebates of $44‒$99 for GPs to manage common laceration repairs [items 30026-30045]. Similarly, basic wound management is costed at $245 for hospitals, yet only $37 for general practice.
The price differential is simply irrational health funding. It is folly to think general practices would provide these services at a loss. It is policy madness to think that patients will go to a GP and be charged, when they can receive this service free at a hospital.
This incongruity in funding of minor A&E services has contributed to the patient shift from GP to hospitals at a considerably higher cost to taxpayers. The systemic divestment of GP-based A&E services over the past 20 years has contributed to higher health care costs.
If governments want a high performing, efficient health system they should promote general practice for minor A&E services to minimise attendances at hospitals.
Critical in this model is the establishment of the medical home. The rationale for the GP medical home is to dedicate a medical practice where minor A&E services can be provided to patients rather than relying on hospital A&E departments.
Providing facilities and services to perform minor A&E procedures similar to a hospital would establish a clinical alternative to encourage patients back to general practice. This should also include allowing GPs to dispense a limited group of emergency drugs, to effectively become a one-stop-shop for patients.
The result would be a convenient, effective place for consumers to address their A&E needs, without the long wait times often experienced in hospital emergency departments.
Current funding disparities have created a hospital-centric health system that is generating rising health costs. Reviews which simply look at the funding of existing services will not supply the answers we need.
If Australia wants to address health challenges in a cost efficient and effective manner, funding opportunities to realign work practices between hospitals and GPs must be examined.
Re-establishing minor A&E services within general practice is a step towards reducing health costs that is simple and effective, and is something that Medicare reviews and political parties should consider.
Dr Evan Ackermann is a GP at the University Medical Centre, Southern Cross University, Gold Coast, Queensland, and the chair of the Royal Australian College of General Practitioners National Standing Committee – Quality Care.