FIRSTLY, the core principles are: the Hippocratic oath; the health system is fair; the health system is affordable; the people of Australia pay for all the medical expenses through tax, insurance and out-of-pocket costs; first-world medicine for all Australians; doctors are doctors for a reason; nurses are nurses, and pharmacists are pharmacists.
The current government is trying to implement measurements to lower the Medicare expenses. They wanted to reduce the bulk-bill fees and attack short consultations. The government failed to liaise with not only the GPs but also the public. The public loves bulk-billing; however, a gap fee for income earners is discussable.
The government also failed to study the way Medicare costs are distributed. There is no up-to-date information readily available on the net as to how the Medicare money is spent. We know from BEACH that general practice stayed affordable in the last decade. It’s efficient and economic.
Ninety per cent of all medical work is done by GPs for 10% of the costs. Specialists do 10% for 90% for the costs. It seems logical to look at the big spenders first to reduce the costs.
There is a big income discrepancy between specialists and GPs. Specialists make 4.3 times the average wage, compared with 1.7 times the average wage for GPs. This income cap pushes new doctors away from general practice.
This gap is not compatible with the core principle of a fair system.
Earlier this year, Liberal MP and former ophthalmologist Dr Andrew Laming declared war on the so-called cowboy GPs and their “two-minute consults”. He was the pot who called the kettle black. Eye specialists are famous for their revolving-door medicine.
If you want to fix Medicare, you need to have the full picture. The government only shows us a small piece of the pie. A complete financial report is essential before changing any policies.
WHAT I WOULD DO
Create a strong general practice where the GP is the gate keeper of the medical system.
Patients should dedicate a GP or GP practice as their health manager. A contribution fee is paid by Medicare to the GP. In exchange, the GP manages the medical file. All health providers who treat a patient must report to the GP manager of the patient. These other health providers could be other GPs and specialists but also chemists, etc.
(Doctor-shopping is a big problem in Australia. Proof of this is the challenge we have with codeine addiction and pseudoephedrine use, along with inadequate asthma control. Patients who do not like their doctor addressing lifestyle issues over and over again will go to a GP who is less proactive. A manager GP will help prevent this.)
Specialist GPs: Give GPs the opportunities to specialise, as they are highly skilled and much cheaper than a specialist. Skin cancer clinics are a great example where GPs filled the niche. GPs could, for instance, be trained for ENT examinations, ear toilet, grommets, eye checks, scopes, etc.
Normalise the income gap between specialist and general practitioners. The income gap is too big. This moves young doctors into the specialist pathway. Smaller income gaps and interesting career opportunities should attract more doctors to general practice.
PRINCIPLE OF WORK ETHICS
The problem of ‘lack of doctor supply’ is not fixed by replacing doctors with non-doctors. Doctors are doctors for a reason. They have been trained for many years and they took an oath. Do not deny history. Doctors diagnose and prescribe, pharmacists suspend, nurses work under supervision of doctors.
It is very difficult to find exact numbers about how much money is spent on hospitals and specialists. A comprehensive study has to be done to discover the figures. This information is needed for future policy making.
A public/political debate should be initiated to discuss core questions. The public pays all the costs, so they should have a say in future policies. Is the system fair? Is the system affordable? What should the role be from the insurance companies? Is there a need for public and private? And what are reasonable salaries for specialists and generalists?
Also some hardcore ethical questions must be asked to manage future health costs. For instance, how much money do we want to pay for a human life, or for an unborn life, or a terminal patient? These are cruel questions that don’t necessarily deserve answers, yet they need to be asked.
• Create a strong general practice (the health manager and specialist GPs)
• Reinforce the fact that doctors are doctors, non-doctors are not
• Normalise the income gap between GPs and specialists
• Prepare a comprehensive study of specialist/hospital spending (a need for future policy)
• Engage the public strongly in future policies.
15th Feb 2015
Author – Dr Gaston Boulanger