If the federal government ends the Medicare rebate freeze, a leading think tank wants it to demand data from doctors in return to start modernising our health system.
There is speculation the government will lift its freeze on payments to GPs in the 9 May 2017 budget, a move likely to cost at least $500 million over the next four years.
The Grattan Institute says spending that much money offers a unique opportunity for the government to set the health system on a path to reform.
In a new report, the institute says Medicare – designed five decades ago – focuses on one-off conditions that can mostly be managed in a single doctor’s visit. But now with an ageing population, chronic disease is an increasing burden on the health budget and the system isn’t designed to deal efficiently with patients with complex needs.
The failure to properly co-ordinate primary health care, particularly for those with chronic illnesses, is leading to more people going to hospital, which is much more expensive for taxpayers.
However, the steps to overhauling the system have to start with getting better information.
“We’re flying blind at the moment. We know what the sort of fees charged are but we don’t know why people attend or what the outcomes were ,” Grattan health program director Stephen Duckett said.
“If the only thing you know is whether it was a short, medium or long consultation, you can’t do any adjustments for complexity of the patient or anything.”
The Grattan Institute says the government should use the money for the Medicare rebate indexation to pay doctors to provide information to primary health networks, protecting patient privacy.
Duckett wants the Senate, which will have to approve increases to the Medicare rebate, to pressure the government to make the data deal.
Once the data about doctor visits is being collected, Duckett says governments can look at making longterm changes to the way doctors are paid.
The existing fee-for-service rebate creates incentives for GPs to see more people for shorter visits, meaning they get paid more if they schedule a second consultation with someone rather than dealing with all the patient’s problems in a single, longer appointment.
“In a number of countries now, practices that do better, have better processes and better outcomes, their patients get rewarded financially for that,” Duckett said. “But without data you can’t actually design those sorts of things and you can’t implement them.”
Future reform also hinges on better co-ordination between governments, and an end to buck-passing.
“The commonwealth and the states need to stop bickering and sign up to joint agreements,” Duckett says.
He recommends governments sign new agreements that commit the states to supporting the primary health networks, thus reducing demand on hospitals, and with specific goals and joint accountability for failing to meet them.