Choice of doctor
The health reform agenda now includes a proposal to deny choice of doctor to patients with diabetes, under a proposed registration and fundholding scheme. This will be the first time since 1 February 1984 that a patient seeing a medical practitioner will not receive a rebate from Medicare.
AMA supports all Australians maintaining choice of doctor. Our five point plan says:
Choice of doctor
Patients must retain the right to choose their own doctor.
Doctors and patients know that a trusting relationship with a family doctor is the cornerstone of quality care.
Patients need to have great confidence in their family doctor – if they don’t they must have the choice to find another.
Family doctors need to earn the confidence of patients to provide the best care or risk them moving to another doctor.
Models that remove this choice are bad for doctors and patients and bad for health.
At the moment, doctors receive payments from patients for services rendered, covered by Medicare. The Government wants to change this to a capped system that treats patients like a number, not a person.
The Prime Minister announced his proposal of patient registration with general practices for patients with diabetes on March 31 2010. There is a description of the proposal here.
AMA President Dr Andrew Pesce held a press conference on the proposal on March 31 2010. Click here for the transcript.
The AMA released it's alternative plan to improve care for patients with chronic and complex diseases. It is based on arrangments that
- Provide GP-coordinated access for patients to services based on clinical need;
- Provide a patient’s usual GP with the support they need to improve the care they can provide/organise for patients with chronic and complex disease;
- Support GPs to facilitate access for their patients to other members of a multi-disciplinary primary care team;
- Continue to ensure that funding follows the patient;
- Lead to better collaboration with existing service providers; and
- Simplify and enhance the existing MBS chronic disease arrangements.
Chronic and complex disease care: the AMA proposes a better way
The AMA recognises the need for more efficient arrangements to support the provision of well-coordinated multidisciplinary care to patients with chronic and complex disease. If access to coordinated multidisciplinary care is improved then patients will benefit, the number of avoidable hospital admissions can be reduced, and long-term savings to the health system will be generated.
Read the plan here.
NHHRC recommendation 18: “We recommend that young families, Aboriginal and Torres Strait Islander people, and people with chronic and complex conditions (including people with a disability or a long-term mental illness) have the option of enrolling with a single primary health care service to strengthen the continuity, coordination and range of multidisciplinary care available to meet their health needs and deliver optimal outcomes.
“This would be the enrolled family or patient’s principal ‘health care home’. To support this, we propose that there will be grant funding to support multidisciplinary services and care coordination for that service tied to levels of enrolment of young families and people with chronic and complex conditions; there will be payments to reward good performance in outcomes, including quality and timeliness of care, for the enrolled population; and over the longer term, payments will be developed that bundle the cost of packages of primary health care over a course of care or period of time, supplementing fee-based payments for episodic care."
The NHHRC recommends an additional payment of $100 per enrolled patient, meaning a total annual cost of $341-682m (NHHRC p. 256).
Supporting materials
- The Draft National Primary Care Strategy does not contain clear recommendations, but patient registration is discussed as an option at element four (pp 66, 73-74). THe draft strategy also considers fund-holding and capitation payments, with pros and cons listed at table 11 (pp. 134-35).
- AMA Victoria held a forum on patient registration in October 2009. See the report here.
- AMA Victorian Bendigo Subdivision Chair Dr Tali Barrett gave a speech at the Bendigo subdivision on 28 April 2010 in support of voluntary patient enrolment. Her speech, 'Voluntary patient enrolment with a single primary health provider: should we consider it?' can be found here.
