Reforming Medicare needs all players at the table

4 minute read

Rheumos weigh in on the Strengthening Medicare Taskforce report and the lack of a whole-of-system approach to reform.

The Strengthening Medicare Taskforce handed down its report in early February, promising $750 million of funding.

But non-GP specialists are barely mentioned in the recommendations.

Dr Sam Whittle, a senior consultant rheumatologist at The Queen Elizabeth Hospital, South Australia, said that there are a number of positives in the report. However, he noted the absence of physicians or other non-primary care specialists on the Strengthening Medicare Taskforce (the taskforce).

“Healthcare is best considered from a systems perspective. Without a whole-of-system approach to reform, meaningful and beneficial change is unlikely to occur,” Dr Whittle said.

Dr Whittle said that attempting to change one part of the system without careful consideration of other components in the system risks failure and unforeseen impacts.

The taskforce report proposes four key areas for reform. One area is “Encouraging multidisciplinary team-based care” and aims to:

“Support local health system integration and person-centred care through Primary Health Networks (PHNs) working with Local Hospital Networks, local practices, ACCHOs, pharmacies and other partners to facilitate integration of specialist and hospital services with primary care, and integrate primary care with mental health, aged care, community and disability services.”

The taskforce called for speeding up the supply and distribution of GPs, rural generalists, nurses, nurse practitioners and midwives, pharmacists, allied health, Aboriginal and Torres Strait Islander health workers and other primary care professionals.

However, when asked at a news conference where an adequate workforce would come from, and whether there were any timelines, Health Minister Mark Butler was short on detail.

Dr Whittle said that the report’s focus on patient-centred care and collaboration was broadly encouraging but that all stakeholders need to be at the table.

“New models for closer collaboration between specialists, primary care and other healthcare providers are clearly going to be an important part of ongoing reform of healthcare in Australia,” he said.

“However, it is vital that specialists – both community and hospital-based – are involved in the conception and development of these new models,” he said.

Professor Susanna Proudman, director of the Royal Adelaide Hospital rheumatology unit, said that almost all forms of arthritis and musculoskeletal conditions benefit from a multidisciplinary approach. She said that access to allied health professionals is essential to enabling patients to be self-sufficient in managing their health.

“The most common issue raised by people with arthritis is lack of access to allied health professionals, mostly due to cost. So inequitable access is a problem,” she said.

Professor Proudman said that navigating the healthcare system to access multidisciplinary care is also a concern of many patients.

“Given the pressures on general practice, coordinated, shared care with allied health professionals could be one solution,” she said.

However, for shared care teams to work they need to be able to share data with each other seamlessly and in real time. This is currently stymied by the absence of standards requiring health software to talk the same language and an underutilised My Health Record.

In a section on data and technology, the report said the My Health Record system should be upgraded, including by “requiring ‘sharing by default’ for private and public practitioners and services, and making it easier for people and their health care teams to use at the point of care”.

The way health data is shared across GP, hospital and other healthcare systems should be improved, the report said, including through legislative measures and the regulation of clinical software and improved technology.

Professor Proudman said that My Health Record could be used more if it was easier to navigate and used more widely by clinicians.

However, digital health experts are divided on whether the ageing My Health Record platform – a centrally maintained and regulated data hub which was old when the very first iteration of it started 10 years ago – can be upgraded to become more user friendly and share data in the way required by multidisciplinary care teams.

Additional reporting by Francis Wilkins

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