Monday, January 14, 2008

Changes to Medicare

Recently appointed Federal Minister of Health, Nicola Roxon, has indicated she would like to see changes to Medicare, specifically, changes to the fee structure. At present Australian GP's are paid the same fee regardless of the length of consultation. In effect this means they receive more for short consults than they receive for longer consults. Put another way, those patients requiring a quick consult with their GP are subsidising those that require a longer consult. The outcome of this is that it is in the financial interests of the GP to move patients through in the shortest time possible; thus maximising the number of patient visits and their revenue.

The Federal Government is concerned that such a practice results in less time being spent on the health management of those with complex health needs. If this were true then it is possible such practices also contribute to longer hospital waiting lists.

The intent of any such changes is admirable. Reducing hospital waiting lists is a good outcome for the public - and a good political outcome also. The question that needs to be examined is this. Will a change in the fee structure of Medicare actually result in improved health management of those with complex needs? In theory, a GP will want to spend more time on those patients with complex needs as the GP will be paid a higher visit rate. However note this is a visit rate not an hourly rate. At which point does it become more profitable for a GP to see 'X' number of short visit patients rather than a single long visit?

An increase in fee structure may result in GP's spending more time with certain categories of patients, however spending time with someone doesn't necessarily mean 'quality' time is spent. In other words it may not be that management of complex needs is in the best financial interests of the GP. Should the patients needs be managed to well then they may not need to visit the GP as often, possibly resulting in a reduction in revenue.

The other aspect to consider is this. What will happen to those patients that presently only require a short consultation, maybe a check up for blood pressure or a discussion about a seemingly innocent symptom? GP's, assumably spending more time with those patients with complex health needs will have less time to spend on those with less complex needs. It is possible some of those with less complex needs will defer GP visits, or see their GP less frequently. In some instances seemingly innocent symptoms may be misdiagnosed or even missed altogether by the GP during a hurried consultation. How many currently low complex patients may develop into highly complex patients in these circumstances. If that were the case, how many of them would require hospitalisation and how might that impact upon the hospital waiting lists?

No doubt the Minister will undertake a process of consultation. One can only hope such concerns are addressed during that process and that the final outcome doesnt, perhaps inadvertantly, in the pursuit of a highly public, political, outcome, create more problems for the public, and for our health system, than already exist.