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

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

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

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

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

System Issues: lack of continuity of care
 Historically GP’s operate within small business model  Doctor to patient relationship rather than doctor to patients & community  Lack of alignment between GP’s & hospitals & GP’s & 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

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

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

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  Australia’s competitiveness at risk in a global health workforce market  Long term outlook mixed: 2020 problem

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

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.

Review of Health

 Prime Minister’s 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

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

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?

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