Our federal government is beginning the process of creating a UK style NHS, just when in the UK are discussing dismantling theirs due to its problems.
This reference may not be accessible as it is a medical site: http://www.australiandoctor.com.au/arti ... 063C16.asp? So, I'll quote it.
The highlighted bit is the first step ["voluntary"] but the circulating information suggests Nicola Roxon intends to introduce universal capitation fees and fund-holding GP practices, as in the UK.
This would require compulsory registration of patients with specific GP practices, and would require government permission [and delay] for the patient to change practice, as the capitation funds would need to be transferred too.
The sting in the tail is the "pay-for-performance" funding, with "performance" meaning outcomes that match the government's budgetary and bureaucratic aims, not necessarily the best health outcome for the patient.
Several GP groups are saying the only way of resisting this is to cease all bulk-billing now, and not deal with the government, thus making it harder for them to have leverage.
There may be a court case over whether it constitutes "civil conscription" depending what the government's next step is.
I'm glad I'm in a position where in the end, if Roxon gets her way, I can just walk away..
I expect a lot of other doctors, if not still trapped by mortgages and school fees, will do the same.
Funding shake-up 8-Sep-2009 By Paul Smith
DOCTORS can expect the scrapping of fee-for-service funding for all but episodic care, under the reforms being promoted by the Federal Government.
Last week saw the release of the draft National Primary Health Care Strategy, which calls for voluntary enrolment for patients with ongoing conditions, as well as the development of regional primary healthcare organisations and pay-for-performance funding.
But the draft is highly critical of fee-for-service, claiming it is failing to target funding at those most in need.
"The focus is to continue to rely on Medicare rebates for those things they were designed to support and do well -- access to specific episodes of care for illness and ill health," the draft states.
"The MBS does not enable scarce health resources to be targeted where they are most needed and cannot readily respond to emerging challenges or enable reform."
It adds: "Changes to funding arrangements need to reduce the reliance on fee-for-service [and] support alternative funding mechanisms that better support effective integrated teams and models of care."
A supporting report details alleged failures within the current MBS system -- particularly MBS care plans and Team Care Arrangements.
It says: "Chronic disease management items have been criticised in relation to complexity and red tape and paperwork, time constraints, eligibility requirements, overlap and duplication, and lack of understanding, support and remuneration for the roles of other team members within the multidisciplinary team."
Citing state and federal government concerns about the annual 420,000 potentially avoidable hospital admissions for chronic conditions, the report goes on to call for a "new model of chronic disease management".
However, the draft strategy offered few details on what the new model would look like.
Chair of the expert advisory group for the strategy, Dr Tony Hobbs said: "There are a lot of detailed and very complex issues to work through and we need to start carrying out the economic modelling.
"[This strategy] is about making sure we can target resources and services and ensure timely and appropriate care for everyone."
The report raised the idea of "stratifying" patients with chronic illness based on their risk of experiencing an acute event or being frequent users of hospital emergency departments and the number and complexity of the conditions they face.
Packages of care and funding could then be developed according to each patient's health needs.
Federal Health Minister Nicola Roxon stressed the draft primary care strategy "was not a detailed implementation plan".
The government's formal response to the various task forces and groups set up over the past 18 months is due next year.
The medical profession would prefer a much simpler model of fewer time based item numbers with realistic levels of rebate that kept pace with CPI so that they could bulk-bill pensioners, children, and those on Health Care Cards, and just get on with offering the best treatment possible, as I did in the 1980s. The governments over the years since the mid-1980s, however, have lowered the Medicare rebates in relative terms and introduced "practice incentive payments" and new, more complex item numbers, tied to compliance with Medicare's idea of desirable "outcomes" - the latest being the legislation to permit clerks from Medicare to demand to read patient's records and question busy GPs about the details to ensure "compliance". The assumption seems to be that all doctors are crooked and rort the system. [The first big "MediFraud" case, was eventually revealed to be a group of bureaucrats who had been creating fake doctors to make fake claims, but that didn't get the publicity the initial assertion of "Medical Fraud" did.]
Nicola Roxon's views of the medical profession are clear here. http://www.nswalp.com/2008-light-on-the-hill-address
Those who agree with her will like what she does if she can pull it off, until their own health, or that of their family, suffers.
[My own wife died because of restricted publicly funded ambulance services in Victoria resulting in a long arrival delay. I was doing CPR without equipment for longer than was viable.]
I won't work under this much regulation and bureaucratic interference.
I left the public hospital system not primarily for money, but because, even years ago, clerks were trying to tell me which medications I could prescribe for patients with which conditions, and were resistant to suggestions they may not be effective in every patient, or may cause too many side-effects for some - it was "prescribe this it is cheaper", and there were delays in the Pharmacy getting in alternatives.
Most doctors go into private practice for autonomy, and to be able to make the patient's needs their priority, not primarily for money as the bureaucrats tend to suggest.
[I had originally intended to stay in a salaried job in the public service but just got too frustrated to stay after a few years.]
As I said above, I'm in a position where I can walk away and not be touched by it emotionally or financially.
But I do care about good health care results and the patients' right to choice and privacy - that's why I've bothered to post this.
I have made arrangements to work part time to provide support for a local hospital in an area of need, but at the moment I am wondering whether it is worth the bother it is going to cause me in having to deal with this stuff.
PS: I came across this this afternoon.
Abstract: http://www.mja.com.au/public/issues/191 ... 73_fm.html
Objective: To ascertain the retirement intentions of a cohort of Australian general practitioners.
Design and setting: Postal questionnaire survey of members of four Divisions of General Practice in Western Australia, sent out November 2007 – January 2008.
Participants: A sample of 178 GPs aged 45–65 years.
Main outcome measures: Intention to work in general practice until retirement; reasons for retiring before age 65 years; factors that might encourage working beyond chosen retirement age; and perceived obstacles to working in general practice.
Results: 63% of GPs intended to work to at least age 65 years, with men more likely to retire early. Of 63 GPs intending to retire early, 46% gave pressure of work, exhaustion and burnout as reasons for early retirement. Better remuneration, better staffing levels and more general support were incentives to continue working for 46% of the 64 GPs who responded to the question about incentives, and more flexible working hours, part-time work and reduced workload for 41%. Of 169 participants, 65% gave increasing bureaucracy, poor job satisfaction and disillusionment with the medical system or Medicare as obstacles to working in general practice in Australia, whereas workforce shortage, increasing patient demands and diminishing lifestyle through overwork were obstacles named by 48%.
Conclusion: Many GPs are planning to retire early, reflecting an emerging trend among professionals and society generally. Declining job satisfaction, falling workforce numbers, excessive workload and increasing bureaucracy were recurrent concerns of older WA GPs considering premature retirement.
