This submission is in addition to the main submission from the Doctors' Reform Society of Australia, available at http://www.drs.org.au/new_doctor/72/submission.html.

1. The adequacy of current funding levels

Current funding for health services in Australia appears to be inadequate overall, and particularly inadequate for some parts of the health system. Greater resources need to be available to Aboriginal community-controlled health services (Deeble et al 1998) and for preventative activities. Health care, involving as it does more than hospital, medical and nursing services, needs a greater emphasis on the primary care level. This particularly applies to the "allied health" field, such as physiotherapy, occupational therapy and dental services, which are poorly resourced in WA at present.

2. Cost-shifting

A department (Radiation Oncology) within a major metropolitan hospital has been "privatised", with services now provided under Medicare. DRS WA is also aware of instances of the following:

• Referral of outpatients to specialists' private rooms.
• PBS prescriptions provided by hospital doctors.
• Decreasing the quantities of medication available to those discharged from hospital, with instructions to obtain further prescriptions from GPs.

An example of less direct cost-shifting is that the State Government has failed to provide emergency services in particular areas, stating that this is available in private hospitals (which of course charge for services for rebate by Medicare).

3. Impact on consumers of cost shifting

The impacts on consumers include:

• Concern about (or actually) running out of medication until an appointment with a GP can be arranged.
• The consumer's GP not necessarily having the information necessary about which medications are required. There is the potential for the wrong medication, or dose of medication, to be prescribed. It usually takes a great deal of time to access the required information from the hospital concerned.
• Lack of continuity of care leading to misunderstandings, confusions, errors.
• Financial - eg. the cost of medication, or the cost of GP or private specialist visits.

4. Reorganisation of service delivery options

The DRS (WA) believes that health care provision should be entirely the responsibility of the Federal Government. This would confer numerous advantages, which include:

• Greater equity of access to appropriate services across Australia,
• Prevention of the cost-shifting measures discussed above,
• Reduction of duplication of services,
• Improved coordination of services and integration of different levels of care,
• Allowing health care priorities to be more clearly set. For example, allocating increased resources to the areas of preventative care and primary care would result in cost-savings to the secondary and tertiary health care sector, which is administered by the same, rather than a different, level of Government,
• Retention of appropriate levels of service. For example, in Western Australia, when previous Federal responsibilities have been handed to the State, services have almost universally declined. For example, the former Federal scheme of financial recompense for travel and accommodation for country patients to attend services outside their local area was downgraded by the State, and reduced the chance for less wealthy rural people to attend metropolitan services.

5. Better coordination of services

As discussed above, if the one level of Government was responsible for all health services, greater cooperation and coordination of these services would be possible.

There is a need for GPs in particular to be linked more closely to other service providers, including hospitals and individual health practitioners such as community health nurses and "allied health" practitioners. Incentives for this linking could enable this to happen more widely.

6. Impact of the private health insurance rebate

DRS (WA) observes that the private health insurance rebate has not substantially increased the levels of uptake of private health insurance, as it was designed to do. On the whole, it simply provides extra money for those already able to afford private health insurance, rather than those in greatest need of health care. We consider that the funds expended on the rebate would have a much greater impact on the health of Australians if spent within the public health system.

Even if rates of private health insurance were to increase, it would have very little impact on the level of demand for public health services.

7. Public and private hospital interface

The privatisation of public hospitals has led in WA to increased costs and decreased levels of service to the community, as well as managerial attempts to interfere with clinical judgements on what care is required. That such privatisation has no advantages is borne out by numerous studies within Australia and overseas.

Reference:

• Deeble J et.al. 1998 Expenditures on health services for Aboriginal and Torres Strait Islander people: final report. National Centre for Epidemiology and Health and Australian Institute of Health Welfare.

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