Medicare reform or Medicare revolution?

Question: Hi Paul. What do you think is happening in General Practice? Any hints on what to expect? How do I get ready for any changes?

The answer.

“All revolutions are conceived by idealists, implemented by fanatics, and its fruits are stolen by scoundrels.” -Thomas Carlyle

There is a rare absolute consensus in the primary care industry. All people agree that the current Medicare system is not working.

There are reports by esteemed think tanks written by the people who never set foot beyond GP Reception. Medical professionals suggest economic reforms in healthcare. Healthcare bureaucrats propose to adopt some failed overseas systems that give them, the bureaucrats, additional powers. There are several publications every day that suggest the Medicare reform or revolution written by recent journalism graduates.

Doctors propose economic reforms. Bureaucrats provide directions for the best clinical care. Academics give business advice. Older GPs with no interest in personal financial betterment propose idealistic scenarios leading to doctors becoming monks making the vow of poverty. Young doctors escape General Practice because they are averse to the idea of the vow of poverty. What could go wrong with reforming Medicare by this camarilla?

I am not very hopeful about the upcoming reforms. Here is what may happen. In point form:

• The Government has no intention to allocate more money for General Practice. They only gave 250 million dollars to produce the report that something needed to be done.
• The Government will redistribute the existing pool of money between the bureaucracy, GPs and new allied health. Naturally, the losers in this redistribution will be GPs and patients.
• The Government will create a complex system of allocating funds per chronically ill patient who signs up to attend the same GP clinic.
• The Government will fund nurses and physiotherapists in GP clinics, taking money from GPs. Most clinics cannot afford that because the funding will unlikely be full. Besides, most of the practices do not have rooms available.
• GP funding will be given to local health bureaucracy – PHNs. Guess where the money for PHN workers will come from?

What to expect? How to prepare for the future?

Once the details of the ‘reforms’ become clear, practices will have to make a choice. Some will become purely private, and some will succumb to living off the generosity of the local health bureaucrats. We need to watch out for any solutions to utilise both systems if that is possible.

In any case, build the clientele, get the best doctors and scan the newspapers for any news.

What would I propose?

Australian General Practice already has everything to manage the epidemic of chronic disease. We have a nearly perfect system of Care Plans and GP Mental Health Plans. The system provides for a multidisciplinary approach.

GPs are either poorly informed or just scared to use this system. I would propose better GP education on multidisciplinary care. Medicare compliance must become stronger. Instead of focusing on punishment and recovery of funds, Medicare compliance must concentrate on propagating knowledge and confidence among the users – GPs.

I propose that we abandon moratorium restrictions and abolish all health bureaucracy. Provider numbers must be unrestricted.

In market we trust.

Instead of the moratorium, I propose tiered Medicare rebates. The rebates in inner city areas should be lower, and rebates in rural areas must be higher. In other words, take from the wealthy areas and give to the low socio-economic areas. Doctors will go to rural and outer suburbs if the rebates are significantly higher. A small reduction of the rebates in the inner city will result in a huge pool of money available for the rural GPs because most people live in the cities.

What will really happen?

The reforms will bring a complicated, ineffective system that will benefit the scoundrels.

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