Cost v care con­tro­versy di­vides med­i­cal prac­ti­tion­ers

The Weekend Australian - Travel - - Health -

From Health cover sites across the coun­try. There were two waves of what were known as Co-or­di­nated Care Tri­als, al­though many of the nine tri­als in the first wave and six in the sec­ond were do­ing things in slightly dif­fer­ent ways.

In­stead of the tra­di­tional pat­tern of pa­tients go­ing to see their GP, and then some­times be­ing re­ferred for other treat­ment — such as po­di­a­try for di­a­betes pa­tients, which they might or might not get — pa­tients given ‘‘ co­or­di­nated care’’ were con­sid­ered as a whole, and treated ac­cord­ing to care plans meant to en­sure they re­ceived the ser­vices they needed.

Learn­ing from the bit­ter UK ex­pe­ri­ence, the Aus­tralian ex­per­i­ments were set up with the aim of im­prov­ing care, rather than cut­ting costs. Even so, the first round of tri­als found the pa­tients given co-or­di­nated care did not have sig­nif­i­cantly fewer hospi­tal ad­mis­sions or shorter stays in hospi­tal.

Nolan says the sec­ond wave was more promis­ing: one trial in par­tic­u­lar, in Bris­bane’s GP North di­vi­sion, had proved suc­cess­ful, cut­ting hospi­tal read­mis­sions by 19 per cent.

In ad­di­tion to ATAPS, there is also the More Al­lied Health Ser­vices (MAHS) pro­gram, and var­i­ous af­ter-hours pro­grams, in­clud­ing a suc­cess­ful scheme based in New­cas­tle, NSW.

The AMA’s Rosanna Capolin­gua says the prob­lem with fund­hold­ing schemes is their capped na­ture and the threat of ra­tioning when the money runs out. This in fact hap­pened with one scheme, an early ver­sion of the Bet­ter Out­comes in Men­tal Health.

‘‘ A doc­tor’s re­spon­si­bil­ity is to the clin­i­cal care of the pa­tient, not to the bud­get,’’ she says.

‘‘ It would re­quire lay­ers of ad­min­is­tra­tion, and at the mo­ment dol­lars are pre­cious — it doesn’t make sense to me to al­lo­cate pre­cious health dol­lars into ad­min­is­tra­tion and pa­per­work, when we re­ally need those dol­lars to im­prove ser­vice pro­vi­sion.

‘‘ What’s so wrong with the sys­tem we have now? If there are peo­ple who can’t ac­cess care, let’s ad­dress that — not change the whole sys­tem so ev­ery­one gets pe­nalised.’’

On the other side of the de­bate, Tony Hobbs, chair­man of the di­vi­sions’ na­tional body, the AGPN, says fund­hold­ing pro­grams are purely about im­prov­ing care, or ex­tend­ing ser­vices to peo­ple who for one rea­son or an­other can’t get them — per­haps be­cause there are too few doc­tors in their area.

Hobbs says di­vi­sions are able to at­tract fund­ing that en­ables them to em­ploy a group of pro­fes­sion­als — whether psy­chol­o­gists, nurses or other peo­ple — to pro­vide a ser­vice to peo­ple who tra­di­tion­ally may not have had ac­cess to those ser­vices.

‘‘ How can that be a bad thing?’’ Hobbs says. ‘‘ It works be­cause di­vi­sions . . . are trans­par­ent, are well-known to the Gov­ern­ment, and are well-known to the providers — mem­ber GPs trust them, and other health pro­fes­sion­als trust them.’’

Al­though an AMA mem­ber for 30 years, Nolan also isn’t sid­ing with the as­so­ci­a­tion on this is­sue.

‘‘ The AMA can jump up and down and rat­tle their cage and make all the crit­i­cisms of gov­ern­ment con­trol — but that’s not in touch with what’s hap­pen­ing,’’ Nolan says.

‘‘ This is all about pa­tient care — it’s about pro­vid­ing bet­ter ser­vices to pa­tients who need it. This sys­tem al­lows us to do that.’’

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