Even before COVID-19 struck, moving from volume- to value-based models of healthcare delivery – as per a worldwide paradigm shift – seemed like a difficult task.
As the Australian population ages, chronic disease is rising, with 90 percent of residents now seeing their doctor at least once per year. In 2019 there was also a sharp increase in patients presenting with chronic mental health problems, amid the Black Summer bushfire crisis.
Compounding this, GP supply shortfalls were present and predicted to worsen. Last year there were just 103.5 GPs per 100,000 people in major Australian cities – and 70.5 per 100,000 in remote areas – compared with 253 per 100,000 in some parts of Europe. According to Deloitte’s 2019 General Practitioner Workforce Report this shortfall is set to grow with general practice to be understaffed by almost 10,000 doctors, by 2030.
Post-COVID, conditions will undoubtedly become more challenging. According to the World Health Organisation (WHO), COVID-19 is believed to cause persisting health problems for up to 20 percent of the people who contract it. This statistic does not capture the spike in COVID-induced mental health problems among the broader population.
To top it off, healthcare budgets are ever-constrained, with the Medicare Benefits Schedule (MBS) patient rebate structure continuing to reward shorter GP consultations and undervalue longer sessions, which are arguably necessary for complex problems.
As highlighted by the Royal Australian College of General Practitioners (RACGP), MBS rebates for mental illness are also lower than those for physical illness. For example, the rebate item 2713 for a 20+ minute mental health consultation is $72.85. Meanwhile, a standard 20+ minute consultation pays patients $73.95.
Health Economist and think tanker, Stephen Duckett of the Grattan Institute, believes a restructure may be in order as general practice grapples with the COVID-19 fallout.
Ahead of the Australian Healthcare Funding Summit, he makes three key suggestions on how this restructure might look.
#1 – Keep, but refine, telehealth
“One of the things that has worked well throughout the COVID-10 crisis is telehealth,” said Stephen. “Everyone seems to love it and it has proven useful and accessible by all age groups, improving uptake of GP consultations considerably.
“With that said, we need to think about how telehealth can become a viable and permanent fixture within our healthcare system.
“Some refinement has already happened, with governments tightening up on eligibility criteria. But’s likely we will need to rethink the system further, particularly as we consider how to manage our country’s worsening mental health epidemic.
“Not everyone is tech savvy, nor does everyone have a good internet connection. There is also a risk of cost blow-out if we don’t design it properly.”
#2 – Better coordination with federal and state departments
“Coordination between healthcare departments needs to improve,” said Stephen.
“This has been on stark display throughout the COVID-19 pandemic, where we have seen duplication of policy initiatives and a lack of clarity on the ground.
“Although the National Cabinet was a great innovation early in the pandemic, we are now seeing regular sniping between federal and state leaders, demonstrating that it was only possible for politicians to unite to fight the pandemic for so long before politics came to the fore”.
The result of the fracturing consensus, he said, has been, “Competing responses on the ground, separate Commonwealth and state funded testing, and separate mental health responses”.
#3 – A mandatory review process
“While some states have taken the initiative to conduct reviews of healthcare delivery throughout the pandemic, others haven’t,” said Stephen.
“Queensland, for example, has established a COVID-19 taskforce to derive key learnings. Meanwhile, other state and territories have largely been dormant on this front.
“I think this is more than a shame. The pandemic has provided a rare opportunity for us to unveil blind-spots and weaknesses in our healthcare system and it’s important we take appropriate action to avoid a repeat.
“The measures we implement from this crisis will have a lasting impact and help us combat the issues we were already grappling with before the crisis took hold. If we don’t properly document what went wrong, it’s an opportunity missed,” he concluded.
Stephen Duckett is Director of the Health Program at Grattan Institute and a Fellow of the Academy of the Social Sciences in Australia and of the Australian Academy of Health and Medical Sciences.
Join him for more in-depth discussion on this issue at the Australian Healthcare Funding Summit – held as a virtual event on 27-28 October, 2020.