Medi­cos seize the mo­ment

Doc­tor or­gan­i­sa­tions are press­ing the main par­ties for more health com­mit­ments ahead of next month’s poll. Health ed­i­tor Adam Cress­well re­ports

The Weekend Australian - Travel - - Health -

BA­BIES born in hospi­tal toi­lets or on wait­ing-room floors, el­derly women wheeled into med­i­cal store-rooms, op­er­a­tions re­peat­edly post­poned de­spite hos­pi­tals be­ing choked by pa­tients need­ing help: cases like th­ese have hor­ri­fied the pub­lic and pro­pelled health into the front row of elec­tion is­sues.

As a re­sult, the news spot­light has fo­cused on the fed­eral health min­is­ter, his La­bor shadow and their teams more in­tensely than it oth­er­wise might, as they have been busy visit­ing health fa­cil­i­ties, be­fore and since the elec­tion was called, meet­ing doc­tors, nurses and con­stituents, hear­ing their sto­ries, and mak­ing pol­icy an­nounce­ments.

But there have been other teams busy at work, out of the spot­light, as the elec­tion cam­paign gets prop­erly un­der way: those of the med­i­cal or­gan­i­sa­tions, which sense an un­usu­ally good op­por­tu­nity to se­cure some real wins for the health sys­tem gen­er­ally, as well as for their own pet causes.

In a pro­fes­sional arena that has in the past been riven with ri­val­ries and dis­unity, the groups in the lead-up to this elec­tion are also un­usu­ally uni­fied in their po­si­tions — par­tic­u­larly on the cru­cial area of rural health.

Last month the most prom­i­nent of the doc­tors’ in­dus­trial lobby groups, the Aus­tralian Med­i­cal As­so­ci­a­tion, re­leased a 22-page doc­u­ment cov­er­ing the mea­sures it con­sid­ers nec­es­sary to knock the health sys­tem into shape and get health out­comes back on course. The doc­u­ment cov­ers 18 sep­a­rate is­sues, from pub­lic hos­pi­tals to global warm­ing. Some of its rec­om­men­da­tions are more vul­ner­a­ble than oth­ers to the charge of self­in­ter­est — such as the re­quest, al­ready agreed to by the fed­eral Gov­ern­ment, to pay doc­tors more to ad­min­is­ter the Medi­care Easy­claim sys­tem, a move in­ter­preted by some as the Gov­ern­ment ‘‘ cav­ing in’’ to the pow­er­ful doc­tors’ group.

But plenty of oth­ers are aimed squarely at what the AMA and oth­ers see as the most press­ing gaps in health ser­vice pro­vi­sion, and flaws in the sys­tem’s struc­ture.

Cru­cially, the AMA has also mended fences with the peak rural med­i­cal group, the Rural Doc­tors’ As­so­ci­a­tion of Aus­tralia, and the two bod­ies are now singing from the same song sheet. Pre­vi­ously the two groups had been at log­ger­heads over the RDAA’s 10-year-old de­mand for a sep­a­rate set of Medi­care re­bates that would ap­ply only to rural doc­tors, and pay them (or their pa­tients, if not bulk-billed) more money in recog­ni­tion of what the RDAA said were the ad­di­tional costs and disad­van­tages of rural prac­tice.

The other main med­i­cal group with an in­dus­trial voice, the Aus­tralian Gen­eral Prac­tice Net­work, also re­leased its own list of elec­tion pri­or­i­ties last month, fo­cus­ing on fix­ing work­force short­ages, im­prov­ing pa­tients’ ac­cess to care, and other is­sues.

As­so­ci­a­tion pres­i­dent and Perth GP Rosanna Capolin­gua told Week­end Health the main is­sues boiled down to pub­lic hos­pi­tals, in­dige­nous health, rural is­sues, train­ing, help­ing GPs through mea­sures such as sim­pli­fy­ing Medi­care, and pub­lic health ini­tia­tives on smok­ing, al­co­hol and drug mis­use.

So good is the present op­por­tu­nity to in­flu­ence health pol­icy that the AMA’s ex­ec­u­tive team was this week dis­cussing how to get the as­so­ci­a­tion’s mes­sage out to vot­ers in cru­cial mar­ginal seats — as a round­about way of ap­ply­ing pres­sure to the pol­icy ma­chin­ery of each ma­jor party.

On hos­pi­tals, the AMA sup­ports the cur­rent state-fed­eral fund­ing split but says the fed­eral share has slipped too low and Can­berra needs to ‘‘ front-load’’ some fund­ing to re­dress the bal­ance. It also needs to in­crease the cur­rent an­nual in­dex­a­tion, now 5 per cent, to 8 or 9 per cent to en­sure bud­gets re­main ad­e­quate.

But the AMA also says the states have been spend­ing ‘‘ too much . . . on plans and re­views’’ and the Gov­ern­ment needs to use the next Aus­tralian Health Care Agree­ments to ‘‘ pres­sure the pro­vide ser­vices’’.

On train­ing, the as­so­ci­a­tion says Can­berra must stump up an ex­tra $100 mil­lion over four years to train more med­i­cal stu­dents in a gen­eral prac­tice set­ting, and an­other $80 mil­lion per year to get more doc­tors who had not yet cho­sen their even­tual spe­cialty into un­der­manned GP surg­eries.

Capolin­gua says now the fed­eral Gov­ern­ment has in­creased un­der­grad­u­ate med­i­cal school places — which will nearly dou­ble by 2012 — Can­berra must also help pay for the ex­tra clin­i­cal train­ing places in hos­pi­tals, which will be re­quired to train th­ese stu­dents once they progress through their cour­ses.

‘‘ We now need to see the com­mit­ment of the Gov­ern­ment in fund­ing (places) and pro­vid­ing sup­port for train­ing of th­ese (new) doc­tors,’’ she says. ‘‘ We want both state and

states and ter­ri­to­ries

to fed­eral gov­ern­ments in­volved in that.’’

Work­force prob­lems are one of the most press­ing prob­lems in health — they also come top of the AGPN pol­icy, which calls for a huge in­crease in GP nurses to help shoul­der the load — and this also has im­por­tant im­pli­ca­tions for rural health.

Af­ter a rural health sum­mit last month, the RDAA and AMA are now jointly back­ing a new plan to at­tract more doc­tors to rural ar­eas by in­creas­ing the fi­nan­cial in­cen­tives avail­able to them. The RDAA’s old plan, now scrapped, pro­posed an en­tirely sep­a­rate ta­ble of MBS items solely for their use. The new plan — which the groups es­ti­mate would cost $300 mil­lion to $400 mil­lion an­nu­ally — pro­poses keep­ing the ex­ist­ing MBS struc­ture, but cre­at­ing new load­ings that will rise in line with the re­mote­ness of the doc­tor’s lo­ca­tion.

The load­ings would be paid in two

Pic­ture: Ray Strange

Cam­paign­ing: Rosanna Capolin­gua’s AMA is look­ing at how to achieve its goals through cam­paign­ing in mar­ginal seats

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