Cost v care controversy divides medical practitioners
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.’’