Australia - Primary care reform must focus on chronic disease management

Citation

(2010), "Australia - Primary care reform must focus on chronic disease management", International Journal of Health Care Quality Assurance, Vol. 23 No. 7. https://doi.org/10.1108/ijhcqa.2010.06223gab.006

Australia - Primary care reform must focus on chronic disease management

Article Type: News and views From: International Journal of Health Care Quality Assurance, Volume 23, Issue 7

Keywords: Primary Care, Diseases

Australia’s primary care system is not providing optimal care for people with chronic conditions, according to a new study.

“Chronic disease represents a significant long-term challenge for the Australian healthcare system in terms of the number of people affected (or at risk) and the morbidity, mortality and health system expenditure associated with these diseases”, study leader Professor Hal Swerissen, Dean of Health Sciences, LaTrobe University, said.

“Chronic disease management programs in primary care – particularly those offered under Medicare – will play an increasingly important role in helping our health system meet this challenge. Therefore it is vital that they are closely examined, particularly in the context of the current health system reform efforts to improve governance and funding of the health system and strengthen primary healthcare.

“This study considered the current Medicare Benefit Schedule (MBS) framework for General Practitioner (GP) chronic disease management (CDM) and its integration with other aspects of the health and community care system in line with the Chronic Care Model (CCM). The CCM is an internationally recognised framework for improved chronic disease management

“Our analysis focused on a hypothetical patient – a 68-year-old man with Type 2 Diabetes, who is also suffering from obesity, depression and high blood pressure. This patient is typical of those encountered by GPs every day in practices throughout Australia.

“We found that this hypothetical patient could be treated under a number of Medicare programs, including GP management plan, Home Medicines Review, CDM allied health services, GP mental health care and the Diabetes Service Incentive Payment (SIP), as well as receiving care using standard consultation item numbers. The relationship between these programs is complex and often difficult and time consuming for doctors, other health professionals and patients to navigate.

“Problems identified with the current system include seemingly arbitrary caps on services and the potential for overlap between some programs. Overall, the system appears to be designed to manage costs rather than chronic disease and is unlikely to result in the best health outcomes for patients.

“This could be addressed with a better MBS design, particularly around allied health access and a more sophisticated approach to service caps is needed that provides ‘service packages’ in line with assessed patient need, rather than the current one-size-fits-all approach.

“Grading and assessment of patient clinical and psychosocial needs could also be used to offer increased payments to GPs and allied health professionals for the care of patients with complex needs, properly reflecting the increased management requirements for these patients. A complex system such as the MBS, which pays flat rates irrespective of intensity of effort, naturally disadvantages patients with complex needs and those providing care to them.

“The case study also highlights the need to provide support to GPs to deliver chronic disease management and to assist the patient to navigate the system. Future reform efforts must not only address questions of optimal item structure and allied health access, but also provide an adequate support structure to improve routine monitoring and coordination of services for patients with chronic disease”, Professor Swerissen said.

For more information: www.aushealthcare.com.au