The Budget papers for the health portfolio are littered with references to the importance of policies backed by evidence. If the Government wants to put its rhetoric into action – and find better ways of spending tens of millions of dollars each year – the Budget should have targeted the money being spent each year on GP assessments of the elderly.
In 1999, the then Government introduced a new Medicare item under which GPs are reimbursed for an annual health assessment for their elderly patients aged 75 and over and for Indigenous patients aged 55 and over. Doctors receive $171.15 for an assessment done in their offices and $242.05 for an assessment done in the patient’s home.
The rationale for the program was work done in Scotland and Europe in the 1980s showing that comprehensive geriatric assessments conducted in the home by specially trained healthcare workers helped identify those who would benefit from medical and social interventions to prevent functional impairment, delay the onset of dependence, and reduce emergency department visits and hospital admissions.
Unfortunately that seems to be the last time that evidence informed this policy initiative, and as a consequence the funding allocated to these health assessments has essentially been wasted.
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In 2001, a study from the Department of General Practice at the University of Adelaide concluded that this intervention did not provide any improvements in health status, and recommended that funding should be better targeted to home assessments of people with mild impairments to their activities of daily living.
That finding was supported by an international analysis in 2002 of 18 such studies which showed that preventive home visits are cost-effective only if they are targeted at the population which is most likely to benefit and include multiple follow-up home visits to ensure problems, once found, are addressed.
A paper published in 2004 reported that health assessments for Australian veterans and war widows made no significant difference to the probability of hospital admission or death and that the small benefits in quality of life did not justify the costs involved.
An analysis of Medicare data shows that in 2006-07, 265,652 75+ health assessments were conducted. Over half of these were done in GPs’ surgeries. The total cost was $53 million, well above the budget of $30 million. In fact, since 1999, this program has exceeded its budget by more than 60 percent or $93.7 million.
In contrast, there was no need to worry about blow-outs for Indigenous services. Only 3,400 services were provided at a total cost of $610,000. It seems that Dr Puggy Hunter, an Indigenous doctor who was to die aged just 50, was right when he said about the 55+ Indigenous health assessment: “We’ve got major problems at a really early age . . . to do these elderly health assessments, are they going to dig us up? We’re dead and buried by then. We might as well set up a clinic next to the cemetery.”
Apparently unperturbed by budget blow-outs and cost-effectiveness, the Government last year reauthorised this program for four more years at a total cost of $234.6 million.
There are so many ways in which this money could be better used.
For example, Melbourne’s Sunshine Hospital has substantial data, published last year in Australian Health Review, showing that care facilitators can help older people with multiple health problems to identify and access the healthcare they need and facilitate their communications with their healthcare providers, which reduces their use of acute hospital services. In contrast, a GP health assessment itemises healthcare needs, but there is no guarantee these will be addressed.
If the Treasurer wants to ensure real value for the health dollars spent, he might like to nudge the Health Minister to revisit this program, before the next Budget.