Medicare is ill-equipped for 21st century doctor and patient needs, a new Grattan Institute report has found. It recommends a drastic overhaul of Australia’s universal healthcare system to fix the frontline of general medicine and bring it up to speed with the country’s growing caseload of chronic disease.
The report paints a grim picture of general medicine in which GPs are harder to access, patient numbers are up, and presentations are increasingly acute and complex. Patients need more time with GPs who are being encouraged to move in the opposite direction and trim down consultations.
The institute points to a lack of human resources and funding.
“Australia has spent 25 years on a merry-go-round of tests and trials that have not changed the system, and our rates are holding steady,” the report said.
So what’s different about this approach?
Much of the conversation has centred around the need for attracting and retaining more doctors. The report acknowledges that GP numbers are down (or absent) in rural regions but finds this to be an issue with distribution rather than a lean workforce. Australia’s GP per person ratio is higher than most wealthy countries.
The bigger problem, noted in the report, is that general medicine is modelled on individual doctors serving individual patient needs. One of the institute’s key recommendations is to turn general medicine into a “team sport”.
Australia’s current regulatory and funding set-up encourages lone operators, but the report finds that instituting a bit of workplace hierarchy would go a long way.
In short: better primary patient care and follow-through.
GPs make up about 74% of the clinical staff in Australian general practices and yet for every 10 GPs there are fewer than three nurses or other clinicians to support them. Compare that with England, which is at a ratio of 1:1 of GPs to supporting clinicians.
In Australia, GPs do all the work, with supporting staff delivering close to 0% of primary care. The US (a health system Australia prides itself on beating in every way) allocates about 11% of the workload to nurse practitioners and physician assistants.
General practice is deemed the “best place to tackle chronic disease”, but the report finds funding continues to favour the hospital system.
All patients and doctors suffer as a result, but poorer Australians are disadvantaged the most — they are twice more likely than a wealthy Australian to have a chronic health problem.
The authors note the system is in crisis and reform is “overdue” but an opportunity has arrived in the $250 million set aside by the federal government to respond.
