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COAG health system improvements 'threatened' by Budget measures

12 June, 2014

There are some notable health system improvements detailed in COAG Reform Council Healthcare Performance Report, however these could be reversed as a result of the government's latest Budget measures, AMA President A/Prof Brian Owler said in a recent statement (12 May).

A/Prof Owler said there is some good news in the COAG report.

"Across the population, life expectancy, and rates of child death, heart attacks, lung cancer and deaths from circulatory disease, have all improved over five years," he said.

"But the report also shows that public hospitals are already stretched to meet demand. Waiting times in emergency departments have improved (72 per cent), but have not achieved the target set by COAG (80 per cent by 2012-13).

"Elective surgery waiting times have increased nationally, from 34 to 36 days.

"Access to important surgery varies significantly by levels of disadvantage. For example, it takes 42 days longer for cataract extraction for people in disadvantaged areas.

"Our hardworking doctors and other health professionals are doing their best with limited capacity, but our public hospitals will now have to cope with the effects of the government's Budget measures.

"The government is reducing public hospital funding by $1.8 billion over the next four years and reneging on the guarantee of $16.4 billion additional funding under the National Health Reform Agreement over the next five years.

Co-payment caveat

"The COAG report also highlights the dangers of implementing the government's poorly-designed model of co-payments for General Practice, pathology and imaging services, and increasing co-payments for PBS medications.

"According to the COAG report, in 2012–13, 5.8 per cent of people delayed or did not see a GP due to cost.

"Over the same period, 8.5 per cent of people given a prescription by their GP delayed or did not fill it due to cost.

"One in eight people (12.4 per cent) in the most disadvantaged areas delayed or did not fill a script due to cost (36.4 per cent for Indigenous people).

"Under the government's proposed model, there are co-payments applied at multiple points in the health system – and these are excluded from the Medicare Safety Net.

"A patient who is sick and needs tests, repeat GP visits, and medication during an episode of illness would face an accumulated financial burden.

"Overseas experience has shown this to be a significant barrier to care for people in disadvantaged groups.

"Doctors know that medication non-compliance, including not filling prescriptions, has serious consequences for health care.

"Research shows that an increase in patient share of medication costs is significantly associated with a decrease in adherence.

"The rates for not filling scripts in the COAG report can be expected to increase significantly with increased co-payments for PBS medicines. This would have serious consequences for downstream healthcare costs.

Pathology, diagnostic imaging services and vaccinations

"A similar impact will occur with co-payments for pathology and diagnostic imaging services.

"With less diagnostic information, treating doctors will be hampered in their diagnosis and treatment of their patients.

"Mandatory co-payments for GP services will also affect vaccination rates, leading to complications and preventable hospitalisations for some patients. Vaccine preventable hospitalisations have increased by 16 per cent over five years.

"The good news in the report about improved health outcomes is overshadowed by the risks of the government's co-payment model, with the potential for even more people to delay or not access essential treatment.

"This will inevitably increase costs in other parts of the health system.

"The rest of the world is lowering barriers to primary care to improve overall health outcomes and make their health systems sustainable. But Australia is moving in the opposite direction - even though our health costs are not rising relative to the total Budget.

"The government did not consult with the profession over the design of its co-payment model – and it shows.

A/Prof Owler concluded: "The government must scrap the current co-payment model and seek expert health advice on a better policy direction."

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