Unfair co-payment proposals effectively destroy quality general practice care by stealth, and we are all the poorer for it.
As a general practitioner, my first concern is the health of my patients. It’s pretty depressing to see health care reduced to talk of “price signals” or “co-payments” or “barnacles”. This is not what health care is about.
I have worked as a GP in Mt Druitt for the past 18 years. Our practice is the oldest continuously running practice in the area and has been serving the people of Mt Druitt for 45 years. For those who may not be familiar with the area, Mt Druitt is one of the less well off parts of outer western Sydney, with high rates of unemployment, single parents, indigenous patients, refugees and migrants. It has some of the state’s highest levels of obesity and chronic disease, especially diabetes and lung problems. This can be a challenging but professionally rewarding place to work.
Many of my colleagues run traditional solo practices and rely on bulk billing. We are used to the challenges of patients who have to decide whether to spend $5 on medication or the bus fare home. All too often we see patients needing specialist care but know they won’t be able to get into the public outpatient clinic at the local hospital for months or years.
As GPs, we develop strong attachments to our local communities and I am proud to work in Mt Druitt. We have a strong community of local doctors in the Mt Druitt Medical Practitioners Association, where many members donate their time to lifestyle improvement programs, such as the SALSA program in local schools. We see patient and community needs and we try to find a way to improve them.
I am proud of the practice we have built. When the previous government made available grants to improve practice facilities, our practice applied. This allowed us to engage a range of allied health providers to provide better care for our patients. We have a tightly knit and dedicated team, with a dietician, exercise physiologist, psychologist and community pharmacist available to assist in providing care for our patients.
With innovative programs developed by local endocrinologists and the Medicare Local, we have access to a visiting diabetic specialist. All this allows our patients to access the services they need and make it less likely they will end up requiring more expensive hospital care. We do charge a private fee for those of our patients who can afford to pay, although we bulk bill many who are less well off. This allows us to spend the time needed to better use our expertise to provide better care.
It has been truly disappointing to see the level of debate about general practice since the federal budget. The total amount spent under Medicare on general practice is a fraction of the whole health budget and has risen by less than 1 per cent in the past five years. This is hardly out of control. When you hear health reduced to price signals and fiscal restraint, you really wonder why you bother.
General practice remains the most cost-efficient part of the whole health care system. With more investment we would be able to further lift the level of care we could offer. We could engage nurses and assistants to help us follow up our sickest patients and help them navigate their way through the system. We could make sure Mr Smith, who has been in hospital three times this year, is able to receive assistance with his medications, have the regular follow-up care and not have to go back into hospital a fourth time. We could have more time to spend with patients whenever it is needed.
Unfair co-payment proposals and alternatives such as freezes or cuts to rebates, effectively destroy quality general practice care by stealth, and we are all the poorer for it.
We should always strive to make things better, and this is a challenge my colleagues and I are ready to take. We can build a better, more efficient, fairer health system. This is what health care is about. Our challenge to the Prime Minister is whether he is ready to talk about health.
Dr Kean-Seng Lim is an AMA NSW councillor and Mt Druitt GP.