Public health system needs better and more targeted funding to be truly world-class: RACGP

Doug Hendrie

5/10/2020 5:13:15 PM

The college has outlined its funding priorities in a new position statement ahead of this week’s Federal Budget announcement.

Australia on the globe
Properly funded primary care is vital for a healthy Australia.

Funding for public healthcare is ‘declining and does not match levels seen in comparable countries with high-quality health systems, with patients increasingly required to cover more of the cost,’ the RACGP notes in a new position statement.
In 2018–19, GPs and their teams provided nearly 160 million services ‘at a fraction of the cost of hospital and other medical specialist services, with almost nine in 10 people consulting a GP’.
The existing strain on Australia’s primary care system has only intensified due to the COVID-19 pandemic, while demonstrating the critical importance of well integrated and well supported primary healthcare in managing threats to population health and the healthcare system, according to the new RACGP statement, which has been released in addition to its 2020–21 pre-budget submission
‘In this difficult time GPs and their teams are still providing effective care, while transforming service and business models almost overnight to better meet needs. General practice has, however, struggled with a lack of coordination, information and resources,’ the position statement reads.
Solving the problems plaguing the sector will require a sustained increase in public funding to tackle Australia’s growing and changing needs, while minimising out-of-pocket costs for patients. In the statement, the RACGP questions the tendency for governments to announce ad-hoc funding for specific health issues, which can increase duplication of services and fragmentation of care.
‘Key priorities should be improving the accessibility and capacity of primary care to promote health and wellbeing across the lifespan in a cost-effective way, and integrating services across the health system to ensure comprehensive and coordinated care,’ the college states.

Consumers Health Forum CEO Leanne Wells told newsGP she agrees Australia needs to invest more in primary care.
‘The evidence shows this is the best thing we can do if we want a high-performing health system overall,’ she said.
‘In doing so, we need to recognise that current fee-for-service arrangements can be rigid and a barrier to responsive, personalised care particularly for patients with multiple complex chronic conditions. 
‘We need new, supplementary ways of funding primary care so that practices have the agility to innovate and personalise care further. It is also important that funding reforms are linked to assuring better health outcomes, patient experience and do not impose out-of-pocket pressure on patients.
‘Patients value the personalised care they get through their relationship with their local general practice – and they value choice of GP. The general practice setting featuring GPs working in teams with others such as nurses, pharmacists and allied health is the hallmark of contemporary primary healthcare and the care setting Australians most regularly attend.’
The RACGP is calling on governments to significantly boost health in relative and per-capita terms and to prioritise health spending, supporting ‘access to person-centred, comprehensive and coordinated primary healthcare’ and an ongoing relationship between patients, GPs and general practice teams.
‘It is clear that government support for the health system is not only inadequate but waning, despite frequent claims of record funding and the selective use of bulk-billing rates. At the same time, and perhaps as a result, the community is paying more for health services,’ the position statement reads. 
‘Costs can be a substantial barrier to access, with 1.3 million Australians already delaying or avoiding accessing healthcare due to cost.
‘Australian governments, at all levels, must increase relative levels of funding for healthcare across a range of indicators … to ensure cost barriers to accessing healthcare are removed. This must be done in such a way as to ensure that health inequities are not perpetuated or exacerbated and that vulnerable and marginalised sections of our community are able to access timely and high-quality care.’
However, the RACGP statement points out that ‘expenditure is not an end in itself and does not sufficiently explain an effective health system in isolation … more effective and efficient targeting of health spending should also be a key focus of governments’.

The college outlined its funding priorities in a new position statement ahead of this week’s Federal Budget announcement.

The position statement comes after the RACGP recently updated its Vision for general practice and a sustainable healthcare system, which outlines a better approach to sustainably fund general practice in alignment with international best practice and modern approaches.
The statement also points out the urgent need to adapt to Australia’s changing health needs, given its current health system was devised when acute and communicable conditions were the main focus of care.
These issues have faded as healthcare and medicine have improved, however, with chronic conditions and an ageing population becoming greater concerns. Non-communicable diseases and mental illness now make up almost two thirds of Australia’s total burden of disease, while half of the population has one or more chronic health conditions.
The RACGP states a significant proportion of this can be prevented by addressing other determinants of health, coupled with more effective and equitable distribution of health resources.
‘A focus on primary healthcare, which keeps people safe and well within the community at low cost, provides the optimal model for a modern health system,’ the statement reads.  
The RACGP takes aim at the trend of ad-hoc spending for specific services, which is commonly framed as a way to expand access to healthcare for certain patient groups, target specific risk factors or conditions, or reduce the costs of care.
‘This piecemeal approach often prioritises short-term solutions over longer term strategies or value and can lead to compartmentalised, inflexible, fragmented, duplicated and/or neglected needs, services and funds. In this way, ad-hoc commitments may actually cause perverse outcomes for the community and the health system,’ the statement reads.
Examples of such ad-hoc spending include:

  • a new Medicare Benefits Schedule (MBS) item to support GPs to provide a heart health assessment, when MBS support to access this service already existed for those in need
  • expanding youth mental health services through organisations with limited geographical reach at greater cost and with limited demonstrated effectiveness, rather than through promoting and supporting existing schemes providing access to psychological services
  • prioritising funding for new medications or procedures without consideration of alternative approaches or models of care.
‘Typically, these commitments are made during election campaigns or as part of annual budget announcements. “Taking action” on a particular topical issue can be politically rewarding. However, this can hamper the effectiveness, efficiency, equity and sustainability of healthcare funding,’ the statement reads.
By contrast, the ‘long-term benefits of supporting holistic, comprehensive and patient-centred general practice care are likely to be far greater than irregular, ad-hoc and/or issues-based efforts’.
The RACGP has previously estimated that reducing low-urgency emergency presentations and hospital admissions from preventable conditions through better investment in general practice could achieve savings in the hospital sector of up to $4.5 billion a year.
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