Medicare overhaul:GPs must change their business model to treat chronic disease
GPs must change their business model to treat chronic disease

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Editorial

GPs must change their business model to treat chronic disease

The classic image of a visit to the GP looks like this:a patient has a sickness such as an infection,the doctor examines them and prescribes a pill,and the patient recovers in a few days or weeks.

It is a model that has served Australia well for a long time,buta new report by the respected Grattan Institute think tank has again found it is poorly suited to the complex,chronic conditions such as heart disease,diabetes and mental illness that now dominate GPs’ caseloads.

In 2015 – the most recent data – chronic conditions made up over 27 per cent of GPs’ caseloads,double the level in 1962,and the number will only rise as the population ages.

The problem is the current Medicare public health system,which pays GPs per 15-minute consultations. Grattan says this funding model incentivises through-put but not necessarily patient outcomes.

A Herald investigation in October alleged that some GPs are rorting the system to bill for unnecessary consultations.

But even the vast majority of GPs who are ethical and want to do the right thing by their patients have little time to develop a plan to meet the long-term needs of someone suffering a chronic condition.

Grattan proposes a system of “blended care” where GPs still receive some fees for 15-minute consultations and,in addition,a set annual fee for each chronic patient on their books. The size of the fee will vary depending on the patient’s specific health problem and factors such as whether they are in a rural area or disadvantaged.

The set fee will pay for the GP and a team of appropriately trained psychologists,physiotherapists,paramedics and registered nurses,who together can look after the patient more efficiently.

For instance,rather than a GP making an expensive house call on an immobile aged patient,a paramedic could visit while consulting by telehealth with the GP.

Keeping track of patients’ cases is a vital skill with chronic conditions,but Australian GPs are not all that good at it. Grattan says they are less aware than GPs in many countries of when their patients see a specialist or visit an emergency department.

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The new system will cost more at the start,but evidence from other countries shows blended care saves money. It reduces the number of expensive hospital admissions of chronic patients through better co-ordinated care.

This will be a huge change in many people’s daily lives. They will have to sign up to a single GP but perhaps see less of them.

The bigger obstacle,however,is the attitude of GPs themselves. They are sometimes reluctant to trust non-medical health professionals.

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GPs were initially hostile to the idea that pharmacists could administer COVID-19 vaccines because they said they lacked the training. Cynics would say GPs wanted to keep the business for themselves.

Many GPs are so overwhelmed that they see change as just another hassle. The Grattan report shows the government has run four trials of blended care in the past 25 years. They failed partly because of problems in design,but also because GPs were not committed to the process. For instance,in a federal government trial of blended care for 9000 chronic patients from 2017-2021,even in the participating practices,half the GPs chose not to take part.

Federal Health Minister Mark Butler has pledged $250 million a year over four years to a Strengthening Medicare Taskforce. Rather than just spending the money on Band-Aids such as higher Medicare rebates and more GPs,it should fund a fundamental reassessment,of the kind Grattan proposes,of how GPs operate.

Bevan Shields sends an exclusive newsletter to subscribers each week.Sign up to receive his Note from the Editor.

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