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ausdoc . com . au 13 SEPTEMBER 2024
Urgent care clinics versus MyMedicare
Where does Mark Butler ’ s real interest in general practice lie ?
ANALYSIS Paul Smith
THE health minister ’ s speech to the AMA faithful last month had a theme running through it that was something like : Do you remember the bad old times ?
This was about the rocky history Labor governments have had with Australia ’ s biggest doctors ’ union . Clearly , the cuts go deeper than political flesh wounds .
Mark Butler spent some time reminiscing about the ‘ doctors ’ dispute ’ days when Neal Blewitt ( health minister 40 years ago ) was introducing Medicare , with full-page AMA ads in the newspapers , threats of strikes in hospitals and AMA injunctions to doctors never to bulk-bill .
He also referred to Ben Chifley introducing the PBS ( 80 years ago ) and Gough Whitlam introducing Medibank ( 50 years ago ).
“ Anytime a Labor government has introduced a really big , serious reform in health , we have generally had to battle with the AMA ,” Mr Butler said .
It is a sunnier relationship now he believes .
But he noted there were still some disagreements , referencing his vast investments in creating urgent care clinics , which he says , despite the wait for the evaluation report , are already doing wonders given the 600,000 patients who have walked through their doors .
He was also proud of the billions in additional funding flowing through to general practice , including those tripled bulk-billing incentives .
The freeze
He described the increases as “ historic ” and , later in his speech , as a “ blockbuster for general practice ”, given the hard years of the Big Medicare Freeze . And on many levels he is certainly correct in that assessment .
But he does need reminding of two things .
First , the freeze as a health reform was Labor ’ s bright idea ; he was there at the time as a junior minister when the freeze was applied for six months as a “ reset ” in 2013 but one which effectively stripped $ 664 million out of general practice over the next four years .
The sins of what came after , of course , are certainly not Labor ’ s fault , but just for factual accuracy , it is worth stating .
The second issue is that , despite his references to historic blockbusters , the rebates still have not been increased to the level they would have been had the freeze all been a bad dream . The cuts have never been reversed ; that is a mathematical fact .
Unlike the AMA ’ s opposition to what all but a few would consider an invaluable social good , they remain historical acts still inflicting damage to patient care .
Mr Butler probably also needs reminding that he has been doing the job for two years now .
Mark Butler .
For all the talk about fee-for-service no longer being fit for purpose , about the need for new mechanisms to support chronic disease care , when you look at the landscape , nothing has changed much .
MyMedicare
He mentioned MyMedicare — the patient registration scheme meant to change the future — and the 6000 GP practices and 1.4 million patients who have signed up .
“ We want MyMedicare to be the basis on which we build a stronger and more personalised Medicare built around multidisciplinary teams led by general practice , strengthening the individual
patient ’ s relationship and their general practice ,” he declared .
He went on to say “ broader MyMedicare funding packages ” were needed , stressing that both patients and practices needed a compelling value proposition to get involved .
So far , there is nothing beyond the option of a long MBS telehealth consult .
It was noticeable that the minister did not stay around to answer questions from the AMA faithful .
One of the questions would have been to explain why we should bother with MyMedicare patient registration at all when the other reforms being unleashed ( pun intended ) seem engineered to trash the concept of the GP medical home : pharmacist diagnosers and prescribers , allied health specialist referrals and other thought bubbles being blown by the Scope of Practice Review .
Some will also mention the $ 600 million being spent on his urgent care clinics , whose work many will argue could and should be done within mainstream general practice .
Compared with that election flagship , how big is MyMedicare going to be ? Is there any ambition in it ?
During a conference session on
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MyMedicare a few hours later with just a handful of people present , a department official explained there were no big plans to promote the reform to the public anyway .
What about that value proposition then ? Was there any plan to make the MBS care plan items exclusive to MyMedicare patients — one material means of making the reform worthwhile ? He said no .
Mr Butler , not to be outdone on the key performance metric used to judge his predecessors , was already announcing more reviews within a few months of taking over the health portfolio in 2022 .
We had just come out of the end of Greg Hunt ’ s barren 10-year primary care plan
‘ We want MyMedicare to be the basis on which we build a stronger and more personalised Medicare .’
which achieved nothing . Surely , no more thinking time is needed .
But as a result of Mr Butler ’ s desire for yet more chit-chat on what is to be done , there are now four reviews pertaining to general practice in production , and according to the department , the results of these deliberations will help shape MyMedicare and its future .
That Scope of Practice Review is one and will apparently hand its deliberations over to the minister sometime in October or November .
Incentives
Another emerged last month in draft form , looking at the effectiveness of the various GP incentive schemes such as the Practice Incentive Program and the Workforce Incentive Program .
It is suggesting simplified payments to practices based on patient complexity , rurality , the costs of co-ordinating care and their after-hours commitments .
In return , practices will hand over data on the care they are delivering and outcomes and signing up to MyMedicare will be required to access the money .
But it is clear that without serious money , money that is still going PAGE 15
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Local recommendations include the use of a transdermal estrogen for : 4
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The American Association of Clinical Endocrinologists , the American College of Endocrinology , the Endocrine Society and the British Menopause Society also recommend micronised progesterone where progestogen is necessary . 1-3
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References : 1 . Stuenkel CA et al . J Clin Endocrinol Metab 2015 ; 100:3975 – 4011 . 2 . Cobin RH et al . Endocr Pract 2017 ; 23 ( 7 ): 869 – 880 . 3 . Hamoda H et al . Post Reprod Health 2020 ; 26 ( 4 ): 181 – 208 . 4 . Australian Menopause Society . Combined Menopausal Hormone Therapy ( MHT ). Available from : https :// www . menopause . org . au / hp / information-sheets ( accessed July 2024 ).
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