DID THE CORPORATISATION OF AUSTRALIAN GENERAL PRACTICE CREATE ‘SAUSAGE FACTORY MEDICINE’?

“Corporate executives are employed by shareholders, not patients. Ultimately the laws of the market demand allegiance to profit over health, and the laws of the land require corporate officers to maximise shareholders’ returns. Should such organisational imperatives govern health care?” (J S Boyd, D.U. Himmelstein, S Woolhandler,The Lancet July 8, 1995 p 64)

If the business model of Corporate Medical Centres is financial growth, how could the proposed co-payment and change to the consultation criteria be the health policy answer to the “budget emergency”? And does the Health Minister really believe that under the proposed system: “appropriate, comprehensive care is better rewarded over patient throughput”?

I am an Australian General Practitioner working in a Doctor-owned medium sized practice in an area with a large elderly population.

As is the case with the vast majority of GP consultations at present, our practice mostly “bulk-bills” and the remuneration is equal to the Medicare rebate. From this a set percentage goes to “overheads” such as reception staff and nurse wages, consumable items etc. These things of course have cost increases with the CPI, while the Medicare rebate has been frozen.

I have contemplated the origins of the problem we find ourselves facing of the Medicare funding of General Practice in this time of Abbott-declared “budget emergency”, where patients are allegedly visiting the GP more often than ever and at times unnecessarily.

Australia is a capitalist society with free market regulation. In this environment, corporations are necessarily run for the profit of share-holders. Thus the corporate business structure is based on the requirement for economic growth.

It seems a natural progression from there to the principles of the so-called Sausage Factory Medical Centre when we consider what would happen if we gave a business advisor the criteria for a Level B (standard) Consultation.

Consultation with a GP, in relation to one or more health related issues, taking six to nineteen minutes.

It is clear to see that if 10 such consultations are booked per hour, the financial reward is 10 x $37.05 = $370.50.

It should be noted that longer consultations are charged at decreasing rates of financial reward, for instance a Level C (long) Consultation of twenty to forty minutes yields a rebate of $71.70.

It is also clear that one six minute problem today and another six minute problem tomorrow will yield 2 x $37.05 = $74.10 while taking 12 minutes with the patient and covering both problems would yield exactly half that reward as it is still a Level B Consultation.

Thus a rational business model is to improve the ability of the doctors to practice six minute medicine. For example, encouraging patients to return for review of all normal results, writing short scripts that need to be reviewed in a follow-up consultation; the list must go on.

I feel the trouble is separating the need for universal access to healthcare, and the ongoing funding of corporate enterprise via the Medicare system.

But above all, we need our medical students and junior doctors to see general practice as a viable career path.

FOR FURTHER READING

A nice proposal from Dr M. Pearce: to fund GPs in allocations of six minutes.

Dr T. Senior explains why the patient doesn’t always know which visits are discretionary.

Dr T. Woodruff shows the perils of a price signal at work.

Dr E. Kruys exposes the major flaws of the proposed changes.

“The Australian Institute of Health and Welfare estimates that in excess of 650,000 admissions to hospital every year could be avoided by timely access to high quality primary care.”

General Practice is good value for money.

Royal Australian College of General Practitioners press release.

Rural Doctors Association response.

AMA –the funding trouble we had already.

And if you would like to do something about the situation: Sign the petition.

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