Government fails to deliver on Health Care Homes: RACGP

08 November, 2016

The Federal Government’s Health Care Homes model is inadequately funded and will not improve health outcomes for millions of Australians living with chronic and complex conditions, according to the Royal Australian College of General Practitioners (RACGP).

The RACGP has declared its' disappointment following the release of details about practice eligibility, patient eligibility, and payment systems for the Health Care Homes model.

RACGP President Dr Bastian Seidel said the details released on Friday evening confirm that there continues to be a gap between the investment required, and the commitment made by Government.

"Evidence from the National Health Performance Authority tells us that 12.5% of patients account for 41% of health expenditure, and require on average 51 MBS services per year.

"Unfortunately, these patients – who would benefit most from coordinated care – will be disadvantaged under the Health Care Home model.

"Under the announced model support payments for chronic disease management will be bundled, with patients only eligible for five non-chronic disease related services per year.

"On their sixth and subsequent non-chronic disease related visits, they will either have to pay full out of pocket costs for the service, or they will wind up in an emergency department.

"These patients may not be able to afford a full consultation fee without a Medicare rebate. As they do need medical attention, they will then either call the ambulance at an average cost to the taxpayer of $800 per call-out, or present to an emergency department of a public hospital at a cost to the taxpayer of at least $220.

"The taxpayer cannot be expected to foot the bill for the increased use of hospital and emergency services, just because the trial literally excludes those financially vulnerable patients from seeing their GP.

"Introducing a capitation not only on funding for treatment of chronic medical conditions, but also on visits for unrelated acute medical presentations that do need attention, is nonsensical and sets up the Health Care Homes trial to fail.

"It will fail patients. It will fail practitioners. And it will fail to inform health-policy development meaningfully," he said.

Dr Seidel also expressed disappointment at the surreptitious release of the information on a Friday evening.

"For a long time the RACGP and other health bodies have been actively offering to work with the Government on the development of an appropriate model.

"The RACGP was not consulted in this case, nor advised that the information was forthcoming.

"Health Care Homes as outlined in the information provided by the Department of Health is not a major reform and does not reflect the RACGP's evidence-based, best practice model of the medical home, as outlined in the RACGP Vision for general practice and a sustainable healthcare system released in September 2015.

"At best, it is two year underfunded trial on the effects of inadequate capitation funding. It will put financially vulnerable patients at risk of not having access to Medicare rebates when they seek care that is not associated with their predetermined chronic health condition.

"The Federal Government absolutely must fund the Health Care Homes model properly if it wants Health Care Homes to succeed," he said.