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Further calls for government focus on general practice


Morgan Liotta


31/01/2020 3:55:42 PM

Despite consistent growth since 2011–12, government healthcare expenditure per person has dropped. What does this mean for general practice?

Plus sign and dollar sign
The RACGP continues to call for greater investment in general practice.

Much the same as previous years, the latest report on government services from the Productivity Commission reveals.
 
Out of a total healthcare expenditure of $185.4 billion in 2017–18, government expenditure on healthcare services was 126.6 million, a 2% increase from the previous reporting year. Government expenditure on general practice in 2018–19 was $9.8 billion, up slightly from $9.7 billion in 2017–18.
 
In 2018–19, the Federal Government spent $391 per person on general practice visits, down from $395 in 2017–18.
 
According to the RACGP, this decrease indicates funding for general practice services is not keeping pace with the rising costs of health service provision and Australia’s ageing population.
 
Public hospital expenditure per person has risen, indicating that more people are choosing to visit the hospital – where they do not incur a cost – over their GP.
 
GP-type individual presentations to public hospital emergency departments in 2018–19 (2,902,605 presentations) increased by 2% from 2017–18 (2,850,013 presentations).
 
While the figure has slightly decreased from last year’s report, there is still a reasonable proportion – 3.4% – of people deferring or delaying access to general practice services due to cost. The report also showed that 7% of the population delayed or did not fill a prescription due to cost.
 
RACGP President Dr Harry Nespolon said inadequate Medicare rebates for GP visits are responsible.
 
‘Some of these people who are delaying or avoiding a trip to their GP [due to cost] will end up in a hospital bed with a far more severe condition,’ he said. ‘This compromises their care and places a huge burden on the nation’s health system.
 
‘Being a GP is an incredibly rewarding profession; however, decisions such as the Medicare index freeze mean that patient out-of-pocket costs are increasing year on year.’ 
 
The proportion of patients who reported waiting more than 24 hours for an appointment to see a GP has not changed significantly over the past five years.
 
Government expenditure on the Pharmaceutical Benefits Scheme (PBS) was around $8.2 billion – $325 per person – in 2018–19. This is the lowest since 2014–15 when expenditure was $305 per person.
 
Total spending on the PBS for veterans has nearly halved over the past decade from $557 million in 2009–10, to $263 million in 2018–19. PBS medicines supplied to Aboriginal Health Services in remote areas also decreased, from $39.9 million in 2017–18 to $36.9 million in 2018–19.
 
GP mental health-related encounters continue to rise steadily, with an additional 316,680 encounters recorded in 2016–17, compared with 2015–16. The RACGP continues to advocate for a review of MBS mental health item numbers to accurately reflect the complexity of these encounters.
 
For the past two years, the General Practice: Health of the Nation report has identified mental health as the number one issue faced by Australian GPs during their two million weekly consultations, and the area they are most concerned about for the future.
 
Dr Nespolon also highlighted the need for greater focus by government on chronic disease management.
 
‘There needs to be better integration and support for GPs dealing with patients with chronic medical conditions,’ he said.
 
‘Unless the Government takes action, people across Australia will be forced to make impossible decisions such as whether they can afford groceries, school supplies for their kids, overdue repairs to the family car, or a trip to the local GP.
 
‘Their health may not take precedence, no one wins in this scenario.’
 
Patient satisfaction ratings of GP services continue to be high, with a significant majority reporting that they felt their GP listened carefully to them, that they were shown respect, and that sufficient time was spent with them.
 
The RACGP continues to advocate for the Federal Government to invest further in general practice, in particular:

  • restoring rebates to accurately reflect the cost of service provision
  • appropriate and genuine indexation of rebates
  • building a stronger Medicare to improve access and health outcomes, and reduce patient out-of-pocket costs
  • support for the delivery of comprehensive, coordinated and team-based care.
The college’s Vision for general practice and a sustainable healthcare system outlines a model of care that would address many of Australia’s longstanding healthcare issues.
 
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Dr Peter Robert Bradley   4/02/2020 1:09:55 PM

I see no mention amongst the above dot points, of the one suggestion that would stand to make a difference to the practices out there struggling to stay financially viable. That being to pressure the govt to face reality, and as pleading for meaningful rebate increases is not going to deliver, to lobby for the freeing up of the rule that prevents direct bill plus upfront gap charge. It was a plank that helped get Harry elected. He has gone quiet on it sadly. I'm retired now, so if that got up, even as a pensioner now, (in itself an indictment of the financial health of GP), I'd have to start paying something to see our doc, but I would, and gladly, because I just know all too well how close to the financial viability wind, most are now sailing.