CHALLENGES FOR PRIMARY HEALTH CARE IN AUSTRALIA

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• CHALLENGES FOR PRIMARY HEALTH CARE IN AUSTRALIA
• Qld Divisions of General Practice 29 October 2004
• Robert Wells

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From General Practice to Primary Health Care

• Early 1990s GP Reform Strategy
• Vocational Registration- provider number controls
• Practice Improvement schemes PIP etc
• Practice accreditation
• Reform of GP training- GPET
• Practice nurses
• MBS items for nurses AHPs

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What is Primary Health Care?

• Socially appropriate, universally accessible,
  scientifically sound first level care provided by
  a suitably trained workforce supported by
  integrated referral systems and in a way that
  gives priority to those most in need, maximises
  community and individual self-reliance and
  participation and involves collaboration with
  other sectors. It includes the following
• health promotion
• illness prevention
• care of the sick
• advocacy
• community development

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The Australian Context

• General Practice most common PHC setting 100m
  attendances in 01-02
• Clinics operated by states/NGOs, eg drug
  alcohol services, HIV/AIDS, family planning
• Aboriginal Medical Services
• Hospital emergency departments
• Data issues few reliable data outside GP area
  GP data relate to attendances not much clinical
  information

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System Issues Lack of direction

• No national health or PHC plan
• 8 separate health delivery systems
• Lack of agreed national objectives performance
  indicators for PHC
• Separate funding streams within jurisdictional
  programs at both state commonwealth levels
• Lots of attention to access not so much to
  outcomes

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System Issues lack of continuity of care

• Historically GPs operate within small business
  model
• Doctor to patient relationship rather than doctor
  to patients community
• Lack of alignment between GPs hospitals GPs
  other community care, eg mental health
• Model not conducive to population level health
  promotion illness prevention programs
• Model not best suited to chronic disease
  management

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System issues funding chaos

• Commonwealth/state funding divide
• Funding complexities within jurisdictions, eg
  separate funding buckets for state programs
• Complexity of Practice Improvement Program
  Incentives red tape review
• Complexity around safety nets
• Different approaches to co-payments between MBS
  PBS

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System Issues models of care

• Funding approaches have skewed treatment options
  for patients
• Medicare funds GPs predominantly
• State systems have increasingly restricted access
  to other primary care, eg limited access to
  long waits for public dental services allied
  health
• Private health insurance provides broader access
• Recent commonwealth initiatives have opened up
  restricted access to other services via GP
  referral
• Also practice nurse initiative
• However initiatives have been somewhat ad hoc

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System issues workforce

• Shortages and maldistribution
• Declining hours of work workforce participation
  by doctors
• General practice comparatively less attractive
  for doctors
• Poor data on other health workforces, but strong
  anecdotal evidence of similar problems
• Australias competitiveness at risk in a global
  health workforce market
• Long term outlook mixed 2020 problem

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Directions in Government Policy access

• Coalition election policies around access
• Increased private health insurance subsidy for
  65
• Continuation of safety net
• Extension of 7.50 rebate increase
• Rebate for GP services increase to 100 of
  schedule fee
• More after hours incentives

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Directions in Government Policy mental health

• Extension of Better Outcomes in Mental Health
  Care
• Continued funding for beyondblue
• New measures funding for mental health in young
  people including addiction problems.

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Review of Health

• Prime Ministers announcement on 22 October
• Task Force on health
• Look at operation of health policy, in particular
  Commonwealth/state issues
• Possibly change some areas of the interface
• Aim is to better align national, state local

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Future health systems

• Flexible use of resources including workforce
• Safe and effective care the best care available
  for the needs of the patient
• Technology more care can be delivered away from
  hospitals
• More attention to management of risk factors and
  prevention of disease
• Patient-centred accessible whole needs

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What sort of health system do Australians want?

• What values do we have for the health system?
• Equal access for everyone irrespective of status
  or wealth?
• Generally equal access but capacity to improve
  access by spending own money?
• Get what one can afford but with a basic
  protection for everyone for essential care?