Simon Willcock’s concerns (“A GP’s lament: the patients who get a raw deal“) echo those of many in lamenting the inequitable access to services under our current models of primary health care. The current system of primary health care funding in Australia creates serious barriers to people whose personal resources affect their ability to fund out-of-pocket costs for services that are not bulkbilled.
Australians are facing increasing out-of-pocket costs health care costs and an increasing number are failing to seek essential health care because they can’t afford it.
An international comparison of health care by the Commonwealth Fund (USA) has revealed that in recent years, 34% of Australians have either not filled a prescription, had a health problem but didn’t see a doctor, or failed to complete a recommended medical test, treatment or follow-up, because of cost.
And 43% of Australians have needed dental care but did not see a dentist because they couldn’t afford it. Australia ranked fourth out of the six countries surveyed in these measures of access to care. It is a disgrace in a country as wealthy as ours, with a supposed universal health care system, that people are unable to access essential health care.
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One of the essential principles of health care in a modern democracy is that access to health care is a right, and should be available on the basis of need, not the ability to pay. The current system of primary health care funding in Australia, however, creates serious barriers to effective health promotion and chronic disease management, and is limiting its effectiveness in terms of equity, access and value for money. Major reform is needed.
The current system in Australia of primary health care is more appropriately described as primary care – familiar to most Australians as a trip to the GP.
More often than not, primary care in Australia (as researcher Helen Keleher describes): “involves a single service or intermittent management of a person’s specific illness or disease condition in a service that is typically contained to a time-limited appointment”.
However, primary health care, as identified in the international Treaty of Alma Ata, is characterised by a focus on the promotion of health and the prevention of illness, according to principles of equity, access, and community empowerment, and achieved by care delivered by multidisciplinary teams.
An example of a more effective model of primary health care, for both people using the services and the professionals providing the services, is that of primary health organisations (PHO) in New Zealand, where salaried health professionals offer well-integrated multidisciplinary patient centred care to an enrolled population. People using the services are able to have comprehensive health care needs met by the most appropriate health professional, and health professionals have the benefits of working in a collaborative environment with support from their multidisciplinary colleagues and the satisfaction of working in a team to share the care of the community they provide services to.
Evidence suggests that this model is not only more cost effective than fee-for-service models, where costs blow out in an uncapped system, but it provides for the delivery of high quality best practice care, as it offers greater scope for better utilisation of available skills and the ability to provide services that are responsive to community needs.
A centre such as the NZ model employing a range of health care professionals – nurses, doctors, allied health professionals, counsellors, dieticians, and psychologists — can also provide a much more holistic and effective form of primary health care than a solo GP.
A mechanism for funding this, as in NZ, could be a population-based capitation as a mechanism for improving access to, and coordination of, primary health care services in Australia. This is something the health reform commission, in its charter to “improve frontline care”, would do well to consider.