RACGP Policy and Advocacy 1
Track 10
| Thursday, October 26, 2023 |
| 2:05 PM - 3:40 PM |
| Darling Harbour Theatre |
Speaker
Dr Michael Wright
Chief Medical Officer
Avant
General practice funding reforms – What is the key to success?
11:45 AM - 12:40 PMSummary
Purpose:
To understand the future of primary care funding by examining the historical approach since the introduction of Medicare in 1984.
Discussion:
The focus of most general practice funding reforms has been on supporting the delivery of coordinated, integrated and continuous care through general practices and their teams. The Coordinated Care Trials, undertaken 1997-1999 and 2002-2005, highlighted the importance of reform buy-in from primary care providers, investment that is commensurate with the delivery of care, and flexible funding approaches. These findings were affirmed by the later Diabetes Care Project , run between 2011 and 2014, which also iterated the role of the ‘health care home’ in funding reform. More recently, the Health Care Homes trial built on these earlier learnings and demonstrated how funding needs to be designed with a clear incentive to provide better care, and with appropriate practice support.
The chronic disease management item numbers introduced to the Medicare Benefits Schedule (MBS) in 2005 demonstrated the potential to utilise fee-for-service funding models to support enhanced multidisciplinary care. The rollout of funding for General Practice Respiratory Clinics, telehealth and COVID-19 vaccination programs also represent reforms that used fee-for-service funding to support care. While not without its flaws, the COVID-19 approach underlined the value of aligned objectives across multiple funders and integrating funding reforms with the business models in general practice.
Conclusions:
A key failing of numerous approaches has been their short-term nature. Funding reforms can take decades to show their impact, both intended and unintended. The reality also is that reforms are likely to require significant upfront investment before leading to downstream savings. However, the evidence we do have from decades of trials and interventions has shown the key elements required for successful general practice funding reform.
To understand the future of primary care funding by examining the historical approach since the introduction of Medicare in 1984.
Discussion:
The focus of most general practice funding reforms has been on supporting the delivery of coordinated, integrated and continuous care through general practices and their teams. The Coordinated Care Trials, undertaken 1997-1999 and 2002-2005, highlighted the importance of reform buy-in from primary care providers, investment that is commensurate with the delivery of care, and flexible funding approaches. These findings were affirmed by the later Diabetes Care Project , run between 2011 and 2014, which also iterated the role of the ‘health care home’ in funding reform. More recently, the Health Care Homes trial built on these earlier learnings and demonstrated how funding needs to be designed with a clear incentive to provide better care, and with appropriate practice support.
The chronic disease management item numbers introduced to the Medicare Benefits Schedule (MBS) in 2005 demonstrated the potential to utilise fee-for-service funding models to support enhanced multidisciplinary care. The rollout of funding for General Practice Respiratory Clinics, telehealth and COVID-19 vaccination programs also represent reforms that used fee-for-service funding to support care. While not without its flaws, the COVID-19 approach underlined the value of aligned objectives across multiple funders and integrating funding reforms with the business models in general practice.
Conclusions:
A key failing of numerous approaches has been their short-term nature. Funding reforms can take decades to show their impact, both intended and unintended. The reality also is that reforms are likely to require significant upfront investment before leading to downstream savings. However, the evidence we do have from decades of trials and interventions has shown the key elements required for successful general practice funding reform.
Takeaways
1. A key failing of numerous approaches has been their short-term nature.
2. Funding reforms can take decades to show their impact, both intended and unintended.
3. Reforms are likely to require significant upfront investment before leading to downstream savings.
2. Funding reforms can take decades to show their impact, both intended and unintended.
3. Reforms are likely to require significant upfront investment before leading to downstream savings.
Biography
Michael is a Sydney-based GP and Avant’s Chief Medical Officer. His career includes general practice work in both urban and remote settings and across culturally diverse populations. He has been a practice owner and a salaried and contracted GP. Michael is also an experienced researcher with a PhD in health economics, and a strong advocate for improving Australia’s health system.
