The first Doctors Drum Q&A breakfast for 2016 was a sellout.
The power of the Doctors Drum breakfast is the two-way flow of ideas. The first event of the year was no exception with the panel offering their individuals insights but in turn the entire forum delivering some useful feedback so that the wheels of change could be oiled.
The talk inevitably revolved around price and value of health and how they were determined; how doctors were valued by the government, the consumers and even within the profession itself; and who should foot the bill drove much of the discussion. As one of the panellists suggested – “The relationship between payer and payee in the medical transaction will shape how we will be doing health in the future.”
Role of Private Health Insurance
With the head of one of the state’s biggest health insurer on the panel, there was no surprise that the role of PHI in the health picture was examined at length. The burning question was raised quickly – would PHI become involved in primary care and it seemed an inevitable conclusion that it would, especially if the cost and volume of hospital admissions weren’t curtailed. The health system could not afford to continue to do top-heavy tertiary care.
The cornerstone of a robust health system was the GP and primary care. It was stated that “We end up funding the consequences of poorly funded primary care in the hospital/private sector.” The insurers want a role and it looks like the government wants them to have such a role and the point was made that we can’t expect different outcomes by doing the same thing.
Accompanying this need for increased investment in primary care was the hotly debated need for greater individual accountability and responsibility for personal health outcomes. It is also a business imperative and the reason the current federal government is focusing so acutely on chronic illness. Nationally 2.5% of the population claim 40% of the health costs; the breakfast was told that 10% of one fund’s members claim 60% of the total payout. There’s little wonder the government is tackling these high-cost areas first.
Focus on Medicare
For the GPs in the room, Medicare was their first thought and their disappointment in the current freeze was palpable. It went to the heart of community value of GPs and their sense of entitlement to have their health serviced and paid for by the government. Two doctors referred to the 2008 relative value study which put the value of GPs at $300 an hour. It was suggested at the meeting that figure now was more like $150.
The floor price for a general consultation had to be raised and Medicare had to stop rewarding six-minute medicine, said one. However, another doctor said a lot of good medicine could be done in six-minutes but general practice had to get better at being part of a health care team. “We pay lip service to the team care approach but we don’t know how to use it properly and if we did there would be some health costs that could be shared and we’d still have good outcomes.”
The view that health was a commodity like any other in the market was disputed. Some thought that without some financial contribution, consumers would not value the high quality health service they received. However, for another a co-payment would push people out of the primary system and expose the tertiary system to chronic health problems five, 10 years down the track because of the deterrent of a co-payment.”
But perhaps the last word on this should be from one doctor who said that GPs understand what their patients can afford to pay and everyday there was a Robin Hood scenario – taking from the rich to give to the poor.
Panellist Dr Hilary Fine
Bureaucracy & technology
With the recent Auditor General’s scathing report into WA Health’s wasteful IT program, both bureaucracy and technology came in for some stick. One doctor didn’t think that health costs were down to doctors’ salaries but rather bureaucratic ineptitude. Doctors would be less than impressed if their pay suffered to rectify the $41m shortfall. Another said that the Health Department “did IT really, really badly”.
The growth of the health bureaucracy was another focus. A figure was produced that since the 1970s the clinical staff growth rate compared with health bureaucracy was something in the order of 30:3000. The future must be dedicated to innovation and use of efficient technology to rein in these sorts of costs.
Wastage and inefficiency were rife in the system and there were those who believed the electronic health record would be a saviour. The room was told that My Health Record was imminent with government setting its sights on a July 1 national rollout.
Medical devices and pharmaceuticals also came under the spotlight. Publicity around robotics and wonder drugs raised expectations in the community that their use was part of standard care. There was little understanding by consumers of the size of the gap payments these high-tech procedures incurred. This raised an interesting discussion about relative values versus outcomes. Was a $50,000 gap worth a $1000 gap if the broad outcomes were comparable? Is it a reasonable expectation that the taxpayer/health insurer should pick up that tab?
The breakfast concluded with what was described as the linchpin of the discussion – education and communication. Consumers of the future must be literate and accountable for their own health and have a deeper understanding of relative values of treatments if the system were to flourish.
ED: Medical Forum thanks the sponsors of this Doctors Drum event, IPN and Finance Detective
The Panellists
Rob Bransby, CEO of HBF
Dr Jill Orford, paediatric surgeon
Dr Hilary Fine, GP, representing IPN
Ms Sarah Wells, medical finance specialist
Mr Roger Cook, WA Opposition spokesman for health
Dr Colin Hughes, retired GP