Media Releases

Thirty six percent of sick Australians tell us that they don’t get medical help because it costs too much, according to the latest research from the Commonwealth Fund. That was in 1998. What has the Government done to change that very sad fact? Where is the commitment to strengthening our public health system rather than pretending that our expensive privatized health system will sort out the problems?

Care for the sickest in the community is being ignored, whether it’s the mentally ill, or those with no teeth, or those who can’t afford to see the doctor or simply can’t find a doctor. We have a health system designed to help those who can afford to pay. The proposed reforms ignore the fact that Medicare, fails miserably to provide universal access. In terms of access to affordable health care, we rate at the bottom of the Commonwealth Fund survey, just as bad as the US. In Australia the most needy miss out. The least needy get as much high quality health care as they need as soon as they want it.

We have a flawed system, a reliance on private provision of services through individual doctors and other health professionals. Such a system will never look after the most needy. It simply isn’t profitable. The business model doesn’t work. Health care provision is not addressed through market forces.

Public hospitals if adequately funded, can provide services for all. But the Rudd Government refuses to fund hospitals adequately. GP and specialist care in the community could provide affordable and accessible services for all if the Government is really interested enough in ‘a fair go’, and willing to move away from private fee for service, small, profit making businesses, towards a health system where public service and care for patients is the first priority. It does mean taking on vested interests, but it’s all about ‘a fair go’. Do they care?

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The new funding for health in the federal budget is a step in the right direction,” said Dr Tim Woodruff , President, Doctors Reform Society. “Putting money into front line care, especially when it is directed towards the frail elderly and those with complex care needs, is a welcome change of direction in government policy. It begins to address a glaring gap in health provision badly needed by the most vulnerable in our society and, if policy reform continues to be expanded in this direction in the future, will take considerable pressure off our heavily strained public hospitals, making them more sustainable,” said Dr Woodruff.

“Measures in the budget include an expansion of nurses in GP clinics in urban areas – rather than just rural areas as previously, is very welcome and will be a significant boost to GPs struggling with the increasingly complex demands of treating chronic diseases,” said Dr Woodruff,. However, the Government must ensure that taxpayer subsidy of nurses in primary care does not end up only boosting GP rapid turnstile medicine for the worried well. There must also be a benefit to those patients currently missing out on a lot of necessary care e.g the frail elderly and those with complicated care needs that are currently generally ignored by over taxed and under supported GPs”.

“Funding for the previously announced primary health care organisations now called Locals, is also welcome,” said Dr Woodruff. “Their tasks of co-ordinating care and improving after hours access while laudable, will be very challenging without structural changes to how general practice and the GP are funded, i.e. a change from episodic fee for service payment. Such changes have been almost ignored by the reform proposals to date, although new funding of diabetic care is a notable but small step in the right direction.”

“Funding for ehealth is necessary but the biggest challenge is in its implementation,” said Dr Woodruff. “It is worth noting however that neither ehealth nor increased nurses in GP clinics will necessarily do anything to address the barriers to access suffered by our patients in areas of GP shortage or in areas where GPs require copayments which patients cannot afford”

“Finally, after all the politics of hospital funding, we can see some very welcome increased support for primary care”, said Dr Woodruff. “Whilst helpful, it is not major reform, and will have little effect on the unfairness of our health system, which will remain plagued by patients unable to find or afford a doctor in many poorer and/or country areas. In addition dental care continues to be ignored.”

“The overall changes proposed for our health system will definitely benefit some patients but there is so much more to do to move to a fair, efficient, and co-ordinated health system”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The huge political circus about power and dollars is at great risk of losing the plot” said Dr Tim Woodruff, President, Doctors Reform Society. “Whatever happened to our patients and their constant battles with just finding a doctor to see, or being able to afford the care they need, be it ordinary GP services, mental health, dental care, disability services, allied health services. Whatever happened to concern about their journey through multiple un-co-ordinated parts of the health system to get the care they require and the huge delays in accessing the same health care their richer fellow citizens can easily access.”

“We don’t have a fair health system,” said Dr Woodruff. “The least needy get the most care and the most needy get the least care and the Prime Minister, the Premiers, and the various oppositions are ignoring that fact in favour of playing politics with power and money. Nothing substantial has been suggested to address access problems to non hospital care in a systematic way. Tinkering at the edges, as has been happening for decades, is the best on offer. Nothing substantial has been suggested to address the problems of public hospitals being too full. Aged care funding suggestions remain woefully inadequate.”

“We don’t have an efficient system,” said Dr Woodruff, “and the suggestions on the table to date are about possible marginal improvements in efficiency.”

“We don’t even have a health system. Instead we have multiple poorly connected pieces,” said Dr Woodruff. “For our patients there is the public hospital system, the publicly subsidised private hospital system, the GP system, the community care system, the publicly funded private allied health system, the mental health system, the publicly funded private dental system, the public dental system, the Aged Care system, and a myriad of other poorly connected pieces of a nightmare for our patients to negotiate.”

“And the proposals are about power and money, combined with ‘sweeteners’, extra money to partially address gaping holes in the system, suddenly appearing for political reasons rather than because they are good policy,” said Dr Woodruff, “but nothing to reconstruct the system so that it works for patients. Where are our leaders? Where is the bold reform?”

“Let’s have a single pool of funds, distributed according to need, to regional entities and or States which are accountable to their local communities to deliver the care they need, with a national set of standards against which performance can be measured so that we all know who is providing high quality integrated health care to all Australians, whatever their income, wherever they are. Control of the distribution of funds should not be at the whim of politicians at whatever level.”
“Then we would have bold reform, worthy of leaders interested in patients rather than power, in people rather than money.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

Dr Peter Daovren
President Qld
Doctors Reform Society

Sunday, 11 April 2010

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“Today’s announcement of new direct funding of Emergency Departments indicates an understanding of the difficulties our patients encounter when sick,” said Dr Tim Woodruff, President of the Doctors Reform Society, “but fails to recognise that the main problem with delays in Emergency Departments is ‘access block’, the lack of empty beds into which patients requiring admission can be sent. Emergency Department doctors and the research have been pointing this out for years.”

“But the reasons for ‘access block’ are predominantly a lack of Federal funding and Federal reforms ie Aged Care and Medicare/GP/Primary Care. There are not enough Aged Care places for patients who are in hospital and inadequate primary care leads to too many patients presenting to Emergency Departments and requiring admission with problems which good primary care could have treated,” said Dr Woodruff.

“Both primary care and Aged care are predominantly a Federal responsibility (Mr Rudd) but instead of addressing these issues Mr Rudd’s treatment of the problem in Emergency is to give some minor funding to States contingent upon them meeting targets which are unachievable because there are no empty beds,” said Dr Woodruff. “That approach will promote gaming of the system which has already been identified as a problem in Victoria where hospital funding depended on achieving unrealistic targets. “

“It’s time Mr Rudd told us and the States what he proposes to improve his areas of responsibility (Medicare and Aged Care) rather than pressuring States about their performance. Then the States and the Australian public might be more convinced he is genuine about fundamental reform of the system and improving access and quality of care for our patients.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“Today’s announcement of specific funding for GPs who have enrolled patients with diabetes is to be commended as a recognition of the importance of primary care of chronic disease in our community and the need for an integrated approach to managing such diseases,” said Dr Tim Woodruff, President, Doctors Reform Society.
“This program has the potential to benefit many patients with diabetes and to improve the primary care approach to this chronic disease,” said Dr Woodruff. “But we need a systemic approach to improving primary care and to improving management of chronic disease. Targeting one disease ignores others. Targeting a disease by funding through doctors ignores patients who don’t see doctors often enough or at all.”

“Patients who have difficulty getting to see a doctor will not have any extra funds spent on their care. Patients who can’t find a doctor with whom they want to enrol will not have any extra funds spent on their care. Many of the most needy patients in our community, in nursing homes, boarding houses, and rural and remote areas, who already seldom see doctors except when they need admission to hospital, will be unaffected by this program”.

“This is another program which will deliver some benefits, and has some excellent principles such as voluntary enrolment of patients”, said Dr Woodruff, “but it is still just another program run from Canberra, ignoring local needs, with yet another layer of red tape paperwork for doctors. Whilst 30% of preventable admissions to hospitals are related to diabetes, that means 70% are not, and this small but important program ignores all those patients.”

“What we need are structural changes to how we fund and run primary care to focus on all patients; not on specific diseases, not on doctors, not on nurses, so that those patients in need, whatever their disease, have access to integrated care, rather than just the universal entitlement to care under Medicare”, said Dr Woodruff. “What we need after nearly three years of consultation is a vision of a health system which is patient centred, needs based, structurally integrated, and accountable. We hope the major reform announcements are still to come.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The Prime Minister’s defence today of the hospital funding reform proposal against the anti-reform agenda of the Opposition Leader is to be commended,” said Dr Tim Woodruff, President, Doctors Reform Society, “but we are still waiting for reform proposals for the total health system”.

“Our health system consists of public hospitals, private hospitals, GP services, community services, mental health services, dental services, aged care services, and much more. So far, we have heard plans for the single most expensive part of the system, the public hospitals, and for increased doctor training,” said Dr Woodruff. “But nothing is to be done for four years to address the current Federal funding shortfall to public hospitals. Nothing is to be done to address the taxpayer funded support of the growth of publicly funded private hospitals which attracts specialists away from public hospitals. And we know nothing of reform of the non hospital sector.”

“There is little so far to convince us that we are heading for an equitable, universally accessible, integrated, patient centred health system based around the health of patients from cradle to the grave.”

“The issues about which we have heard nothing are at least as important as, if not more important than the announcements so far”, said Dr Woodruff. “Addressing current problems whilst planning reforms for the whole system would do much to convince our patients and us that Mr Rudd is genuinely committed to a health system for all Australians.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The Prime Minister’s announcement of a significant increase in funded training places for GPs and specialists is a welcome recognition by the Federal Government that workforce shortages must be addressed for our health system to be reformed,” said Dr Tim Woodruff, President, Doctors Reform Society.

“The future of our health system depends upon strengthening primary healthcare,” said Dr Woodruff. “GPs are crucial to improving that care, and medical practices in areas of need are desperate for GP trainees but haven’t been able to find them. This initiative could be a real boost for such practices, if the funding model is correct.”

“Thus it is important to fund these training places by salary, rather than fee for service,” cautioned Dr Woodruff. “That is how specialist trainees in hospital are paid and that means they have the opportunity to learn rather than just provide a service. It is a funding mechanism proposed previously for GP trainees by a former Liberal Health Minister, Michael Wooldridge. Salary rather than fee for service removes perverse incentives to practice turnstile medicine. It promotes interaction with and learning from medical and non medical colleagues, which is exactly what is required to build a team based integrated approach to primary health care.”

“With plans for hospitals and medical workforce announced we await further details of reform, especially how to control the increasing privatisation of our health system and the inequity and inefficiency which inevitably accompanies it.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The Prime Minister’s proposed shake up of public hospital funding has the capacity to reduce waiting lists to see specialists, to have surgery, and to get seen in Emergency department when needed,” said Dr Woodruff, president, Doctors Reform Society.

“It appears however, that Primary Care, ie care in the community from GPs, nurses, psychologists, and other allied health professionals, is a very low priority with minimal changes suggested, said Dr Woodruff. ” Whilst the idea of funding nationally and organising the provision of services locally is the basis for the reformed hospital funding model, such a model has not been suggested for Primary Care, despite the obvious appalling inequities in access to such care, and the inefficiencies and lack of co-ordination in Primary Care. Canberra based programs and policy will not address these issues. Neither Superclinics nor some extra money to Divisions to carry out some preventive care will address this problem.”

“The issue of workforce to carry out the increased workload has not been addressed,” said Dr Woodruff. “Indeed, there has been a consistent refusal to accept that taxpayer support for private hospitals attracts specialists away from the already under-staffed public hospitals.”

“National standards and performance measures are essential to determine what is working”, said Dr Woodruff. “But if such measures are to be required of publicly funded public hospitals, why will they not also be required of publicly funded private hospitals. It is imperative however, that performance measures are adequately adjusted for the many risk factors which influence health outcomes.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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