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On budget night Dr Wooldridge, referring to the health initiatives, said the government’s budget measures focused on "people, care and quality". We can only applaud this agenda. The fact that $900 million has been injected into Medicare demonstrates that the government has recognised, in an election year, the strong feelings of Australians about their health system.

However, we must bear in mind that the $900 million over four years is a pittance compared with the $12 billion to be given to the private health insurance sector by taxpayers over the same period of time. Imagine the benefit to the public sector if that sort of money became available!

What are these budget promises?

"The government will boost payment to doctors by an average by $13,900 per year for them to diagnose, treat and provide tailored management plans to patients with illnesses such as depression, asthma and diabetes. Doctors will also be paid incentives to undertake screening for cervical cancer" (The Australian May 23, 2001).

To GPs it means that they can provide longer consultations without loss of income. Targeting these chronic conditions demonstrates that the Minister understands GPs’ current workload. Depression - including alcoholism and drug related conditions - affects an estimated 3 million Australians, asthma more that 2 million and there are probably 500,000 diabetics who have not even been diagnosed.

Trying to help this growing segment of the community requires a lot of time. But we GPs are constantly frustrated by our inability to give patients the time we know, in our hearts, is needed. We cannot afford to treat adequately, as we were taught in medical school. Anyone looking at the position of GPs in today’s environment has to sympathise with their dilemma.

Patients are actually not getting very good value and the job is not being done well. What patients often need is time with a professional to understand what is going on. In that sense, Dr Wooldridge’s initiatives are definitely helpful.

For doctors, the advantage seems clear. A recent editorial in the BMJ, 5 May 2001 p 1073, entitled "Why are doctors so unhappy" yielded 1,400 E-mail responses in two weeks, largely from GPs. This indicates that we’re not just dealing with "whingers". It is a really pressing matter.

Doctors are seriously demoralised and it is important for policy makers to recognise that. The most common complaints were overwork and a feeling of being undervalued. Since the votes came from more than 90 countries, there seems to be a global consensus. The common factor is lack of commitment to and underfunding of primary care.

A health system which ignores and devalues primary care is en route to the paradoxical outcome of being expensive while being generally considered unsatisfactory - as is currently the case in the USA.

Australians are happy with the principles of Medicare in keeping with our egalitarian ethos.

So, giving GPs an incentive for longer, more thorough and more skilful consultations makes sense. It will provide for better doctor-patient relationships and more work satisfaction. The associated budget provision funding practice nurses recognises the usefulness of the doctor/nurse partnership and is obviously designed to achieve the same end.

The DRS endorses any step in the direction of better care for patients and more job satisfaction for doctors. It would be churlish to be critical of the Health Minister’s moves away from superficial medicine. The combination of a fee-for-service system with an inadequate rebate was bound to lead to perfunctory work, dissatisfied patients, and unhappy doctors.

The importance of the doctor-patient relationship has clearly been understood in these budget changes. The time has come for our policy makers to go even further, with the creation of alternative payment systems within a revitalised Medicare framework.

Judging from the response to the BMJ editorial, the rest of the world would look on with great interest.

Dr Alf Liebhold

Dr Liebhold is a GP and member of the Doctors Reform Society executive.

This article was published in Australian Doctor 8 June 2001.

.		.	The Doctors Reform Society of Australia, Box 14, 4 Goulburn Street, Sydney 2000. Phone 02 9264-9084 Fax 02 9267-4393.	.
			This page was last updated on 30th January, 2003.
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