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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