OPINION: Hospitals bear brunt of primary care cuts

MANY in the Hunter are awaiting the outcome of the Commonwealth Government’s Commission of Audit. The question is not whether health will be cut, but where.

Health is one of the fastest growing and biggest expenditure areas of government. A Productivity Commission report showed federal spending on health grew 4.9per cent a year over the past 10years. Health spending per head by all governments rose 37per cent over the same period. This is not a uniquely Australian trend.

Everyone in the health system knows we need to improve the cost-effectiveness of our system, while not detracting from the patient experience and health outcome.

Commenting on the Productivity Commission report, Health Minister Peter Dutton said the figures highlighted the challenge the government faced in placing health on a stable financial footing. The government aims to cut waste and invest in areas where the benefit to patients is greatest.

Last year, Professor John Horvath, a former Commonwealth chief medical officer, was appointed to head a review into the operation of Medicare Locals. Formed in 2011-12, Medicare Locals evolved from Divisions of General Practice. In the Hunter, the former Hunter Urban Division became the Hunter Medicare Local. Many people would be aware of Hunter Medicare Local through the GP Access After Hours service, which runs five after-hours GP clinics in the Hunter.

Hunter Medicare Local is confident that any considered examination of the system will confirm what has been consistently demonstrated in international studies for more than a decade: the sustainability of any health system is improved by strengthening primary healthcare.

It just makes sense to treat health problems before they become serious and require more expensive hospital care.

Unfortunately, what we know is that primary care and preventive programs are often the first to go when health budgets are trimmed. By far the biggest and fastest-growing spending category in health is hospitals – they receive almost $18billion more in real terms than they did 10 years ago.

A significant percentage of the patients in hospitals – the most expensive part of our health system – could be and should be receiving more appropriate community-based care.

If we are to get better health outcomes at a time of fiscal constraints we need to start using a more business-like approach to spending, not just continually pour more oil on the squeaky wheel of acute care.

Good businesses base their spending on developing a sustained income stream through improved effectiveness and efficiency. To achieve their goals, they take a longer-term view of where they will get “the best bang for their buck”.

Hunter Medicare Local can show it is delivering better health outcomes and better value for money through programs such as Connecting Care in the Community. This program supports people with chronic disease to better manage their condition to improve their health, well-being and quality of life, prevent complications, and reduce the need for hospitalisation.

Studies involving patients from Maitland and Newcastle show a 32per cent reduction in emergency department presentations, a reduction of 12per cent in the number of admissions, and a reduction of 32per cent in the length of stay in hospital.

Millions of dollars have been saved by this program alone, not to mention the benefit of improved health for the patients involved.

Hunter Medicare Local is strengthening our primary health system, reducing the demand for more expensive hospital care and providing better, more efficient access to services closer to where people live.

Some say health decisions are really not about health, but about money. From our perspective, you can apply good business principles to achieve better health outcomes, and Hunter Medicare Local has demonstrated this.

Investing in primary care is very clearly an investment in improving health outcomes, but it is also an investment in ensuring the sustainability of our health system into the future.

Despite uncertainty, the Hunter Medicare Local board is continuing to take a bold and innovative approach to healthcare, one that is acknowledged nationally.

We look forward to bringing a final plan to the public in the coming months.

Meanwhile, we wait to see if the government will not only continue to support primary care, but also invest in building a more sustainable health system for all of us.

Karen Howard chairs the Hunter Medicare Local.

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