Adequate rebates lead to optimal care: Study

New research has backed up GP pleas to better match Medicare rebates with the reality of modern healthcare, proving adequate funding has the potential to save lives.
 
The Preventive health checks in Australian general practice for women during mid-life study, released on Tuesday, found a correlation between which early checks were being carried out and the level of rebate attached to them.
 
‘We found that GPs proactively provide preventive healthcare to those most in need, perhaps at least in part because of sufficiently high rebate levels,’ the study concluded.
 
RACGP President Dr Nicole Higgins told newsGP the research is further proof that a systematic overhaul of Medicare is necessary.
 
‘If you value the knowledge and the learnings of general practice and its role in healthcare, you save money down the track by investing in general practice,’ she said.
 
‘If we’re providing complex chronic care and longer consultations, we need to make sure that’s appropriately remunerated.
 
‘We need to make sure that we have a Medicare system that reflects the type of work that we do, but also that we’re expected to do to deliver the outcomes that we need for a healthy community.’
 
The University of Queensland researchers analysed data from the Australian Longitudinal Study on Women’s Health with the aim of determining whether preventive health checks were being carried out on women aged 40–49 with the greatest need.
 
Checks for women at risk of type 2 diabetes and chronic disease, as well as a heart health check were both examined.
 
They found that 10% of the 10,162 women analysed had at least one health check, while just 44 had a specific heart health check.
 
Of the 1018 women who had at least one preventive health check, just 13 had out-of-pocket expenses.
 
Researcher Professor Jenny Doust said as fewer women underwent heart health checks, this suggests the rebate for the service may be inadequate compared to the rebate for health checks for diabetes and chronic disease.
 
‘It is hard to design healthcare funding so that people who need care receive it, without also incentivising overservicing to those who can afford to pay more,’ she said.
 
‘Partly, we rely on healthcare providers being motivated to provide equitable care and our study suggests general practitioners are doing that.’
 
The study concluded that women were more likely to have had health checks if they had risk factors for chronic disease, and that those who need preventive care the most are more likely to receive it.
 
RACGP SA&NT Women in General Practice Committee Chair Dr Sian Goodson told newsGP while it is positive to hear that women in the study were being checked, it also highlights the need for change.
 
‘In South Australia, public waiting lists for gynaecologists are very long which adds delay to diagnosis and management of conditions such as endometriosis, unless patients are able to afford private care,’ she said.
 
‘We need better rebates for all and improved rebates, especially for longer consults which are often required for in-depth women’s health consultations.
 
‘Better rebates for longer consultations will help, but we also need greater awareness and promotion of the availability of health checks for patients aged between 45 and 49 years old.’ 
 
Women’s health-related matters remain the fifth most reported reason for presentation in general practice, but significant gender-biased barriers persist in relation to accessing care.
 
One in 25 women say they have delayed or avoided seeing their GP at least once in the previous year due to the high costs, compared to one in 40 males.
 
The college has long been calling for significant changes to combat this issue, including providing pregnant patients with access to a higher rebate for complex antenatal consultations, and including additional contraceptive options and menopause treatment to the PBS.
 
At the crux of all changes, the college said adequate rebates for longer consultations are key to giving patients appropriate access and in-depth care.
 
But Dr Higgins said women are not alone in being disadvantaged by Australia’s healthcare system, with female GPs also worse off.
 
‘The majority of people who are providing those longer consultations are women and that gender pay gap is very real, so we need to make sure that Medicare recognises and remunerates the care that’s given,’ she said.
 
‘We need to actually have a look at the structures that we’ve got in place around the regulatory mechanisms, such as the MBS, around how we can ensure that we have equity.
 
‘For women in general practice, we need to ensure that we have equity and that we have a system that allows us to practice medicine in the way that we choose and are expected to.’
 
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