Health system funding and challenges
Over four weeks ROLAND ROCCHICCIOLI is looking at different aspects of our health care. So far he’s discussed chronic disease and our hospitals, next week it’s health insurance.
Patient A was a late presentation to his GP.
HE had a nagging, irregularly persistent cough and chest infection. He tried several times to make an appointment.
The GP was fully-booked, or away. Finally, he managed to see his GP and was sent, urgently, for chest x-rays. The results revealed advanced lung cancer.
The prognosis was for between three and six months.
Without health insurance the patient’s public hospital referral took a month to process – the time lag exacerbated by years of persistent government underfunding and extra COVID related pressures.
Meanwhile, the patient’s tumour continued to grow, and spread. His prognosis plummets
Was his poor outlook due to his own lethargy; or the health care funding crisis which is engulfing general practice, and the entire health system?
It is an extremely contentious and intertwined question.
On an average day in Australia’s health system $467 million is spent on health, 406,000 visits are made to general practitioners, 777,000 prescriptions are filled under the Pharmaceutical Benefits Scheme, 17,300 hospitalisations and 21,400 emergency presentations are made to public hospitals, and 26,000 specialised community mental health care services are provided.
Self-evidently, the system cannot sustain the expenditure.
It is groaning under the weight of the public’s expectation to treat all illnesses; burnt-out health workers, and increasing levels of illness await.
The system’s significant challenges will intensify in the next 20 years. The expectation of cradle to the grave health care is outmoded.
Australian Prudential Regulation Authority research suggest less than 50 per cent of Australians have basic private health cover.
In the final three months of 2020 in excess of 9000 people dropped private health cover – anecdotally driven by unaffordability.
Ironically, at the end of the 1950s, 85 per cent of Australians had some form of private health insurance.
The state and Federal funding system is, and of itself, complex.
In 2018-19, Australia’s total health care spending totalled $195.7 billion – equating to $7772 per person.
More than two-thirds of health care spending was met by the Commonwealth Government – representing less than seven per cent of its total tax revenue.
State and territory governments contributed $53 billion. The balance was paid by third party organisations, with individual patient contributions making-up the greater portion.
Reincarnated in 1984, Medicare bulk billing was created as a solution for GPs and private and public patients, regardless; however, the Medicare rebate scheme – calculated on 85 per cent of the schedule fee – has failed to keep abreast of the consumer price index.
Consequently, general practitioners are now shouldering the lion’s share of the financial burden.
Their gap – as high as $49.45 per patient visit – is lost income.
Bulk billing has become an expectation, irrespective of financial status. Patient resistance to paying a standard fee has soared. Dissatisfied patients seek more accommodating practices.
The anomaly has generated accumulative disenchantment amongst medicos, and a GP increase in bulk billing cessation.
Routinely, specialists charge any deficit to patients.
Professor Brendan Murphy, head of the Federal Department of Health said, “Australia will remain reliant on international medical graduates until at least half of all medical graduates start entering the speciality.”
This highly contentious and unsustainable policy draws doctors away from countries where they are most needed.
Only one third of Australian medical graduates is opting for general practice. The obvious question is ‘why’, and then ‘how’, does this alter the quality and cost of an increasingly dysfunctional health system?
Rural GPs’ ratio to population is 60 per cent to 80 per cent higher than their urban colleagues, and an anecdotal perception of a widening disconnect from government health officials – one partly driven by the Hippocratic oath, the other by fiscal outcome.
Today, general practice is a specialisation which has been changed by unreasonable patient health demands, workplace agreements, and the evolution of medicine.
Diagnostically, respiratory conditions dominate, but there has been a marked increase in chronic cardiovascular conditions – bizarrely GPs can order an electrocardiograph but are not certified to read them.
Autoimmune, endocrine, metabolic and dermatological disorders demand longer than Medicare’s stipulated six to 19-minute short GP consultation.
The Australian Institute for Health and Welfare has confirmed one-in-five Australians has a mental health condition. GPs are the first port of call.
They are expected to wrestle with these challenges. Repeatedly, they are frustrated by a complex and difficult to navigate system with confusing options enveloping patient management and outcome services. Experienced doctors are retiring, exasperated.
With an ageing population, an expanding demand on health services, and disquieting rates of chronic disease, a medical maelstrom is looming. COVID-19 has revealed the country’s lack of preparedness for a pandemic, and a doggedness by part of the community to flout lifesaving practices.
Unless something changes, Australia is heading toward a two-tier system, and sooner rather than later!
From the rural patient’s perspective, it does not augur well.