If the whispers are right, the Medicare rebate freeze will be partially lifted in next week’s federal budget, at a cost of half-a-billion dollars.
The previous Labor government introduced the freeze in 2013 as part of a A$664 million budget savings plan. The freeze, which the Coalition extended, effectively meant GPs and other medical specialists would be reimbursed the same amount for delivering health services in 2020 as they were in 2014, despite rising costs in other areas.
Many will welcome the move to lift some of the freeze because it will help reinforce bulk billing as a pillar of Australia’s health system. But it will be a wasted opportunity if the extra money that will go to GP clinics is not used to buy better general practice.
General practice in Australia needs reform. In late 2015, the government’s own primary care advisory group called for change. Last year, a Grattan Institute report, Chronic failure in primary care, identified numerous potential improvements, notably updating the payment to GPs from fee-for-service to a system that will encourage better care of the increasing number of Australians who suffer from chronic conditions.
The main reform on the table now is development of so-called Health Care Homes. The policy is designed to improve the way GPs work with other health professionals to treat patients with chronic disease. It’s a valuable government initiative, but more needs to be done.
A Grattan Institute report released today, Building better foundations for primary care, describes primary care as a renovator’s opportunity. The additional funding to GPs from lifting the rebate freeze should be used to buy better data, so future reform can be based on sound evidence about what works, and what doesn’t, in general practice.
No measurement, no management
The eminent physicist Lord Kelvin once said:
When you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.
So it is with general practice policy in Australia today.
Unfortunately, government and taxpayers know little of what goes on in general practice. We know what was billed for – essentially how long the consultation was. There is no knowledge outside the practice about why the patient presented, what the GP did, or whether best-practice guidelines were followed.
By contrast, much more detailed information is available – in a way that protects the privacy of patients – about hospital care, both public and private.
The absence of data about general practice has real consequences for patients. In the absence of information from practices about the complexity of their patients’ problems, the government cannot make appropriate payments to Health Care Homes.
Without better information about whether practices are properly monitoring patients who have chronic conditions, the government cannot properly reward practices that get the best results for their patients.
With the government about to invest more than A$500 million in lifting the Medicare rebate freeze, the time is ripe to change this.