Vital service: GPs are an important entry point to the health system. Photo: Andrew Quilty
From an Australian patient’s perspective, there are two things that matter in our country’s health system: regardless of my financial situation I can see a doctor when I want to, and if something bad happens to me medically I will be looked after.
The first of these is looking shaky after this week. From next July, if the government has its way, many of us will have to look in our wallet and decide whether we can afford, this week, to go to the doctor. Another nail in the coffin of universal health care.
There will be four consequences of this, the first two the government wants. Individuals (i.e. you) will have to pay more to see a GP, and the government will save some money, at least initially. However, it is saving money in a very unintelligent way. In the long run we will see the third and fourth consequences: health outcomes in the country will worsen, and finally, the health system will actually end up costing more.
How can this be?
General practice constitutes about 5 per cent of the health budget, yet it is the most efficient 5 per cent in terms of health outcomes. We are the ones who are best at convincing people to stop smoking, stop drinking too much, get the tests they need or advise them whether that chest pain/lump/discharge is something that needs to be investigated. Patients can’t be expected to know all this stuff; this is why we have doctors. General practice is the entry point to the health system. If you don’t have someone to ask, how can you find out?
Let me give you an example of how this can all fall apart. General practice is dominated by chronic disease, conditions that don’t go away, like diabetes, asthma, heart disease or arthritis. If a patient who is not on a pension but still struggles financially – and I see many of these people at my practice – has say, diabetes, he should come to the doctor to get regular checkups for his eyes, feet, blood pressure, blood tests and other investigations. If said patient doesn’t come to the doctor because of a “price signal” his diabetes may be heading for a complication he doesn’t know is coming. This complication might be, for example, a stroke.
So, this patient has a stroke. He goes into hospital for a few weeks, costing tens of thousands of dollars. He then goes into rehab for a few months, costing tens of thousands of dollars more. He then goes into a nursing home, costing the tax payer for the rest of his life, and no longer contributing to the economy himself through paying taxes. Why? All because he didn’t go to the GP enough in the first place. Dumb, dumb, dumb.
Health economists around the world have repeatedly demonstrated that for every dollar you put into primary care (that is, general practice), the health system becomes more efficient and the health outcomes improve. So why is the government doing this? Myopia. A short-sighted view of cost saving that simply does not make sense in the big picture.
Who is going to suffer? Well, the poor guy in the nursing home after the stroke, for a start. And there will be many of these types of situations, in various guises. It will also be you, paying more each time you visit the doctor, of course. It will also be us as a community, having our loved ones missing out on the care they need, and us as a country, suffering the economic consequences of a less efficient health system.
James Best is an inner-west GP.