Do deputising services save taxpayers money? It depends on whose figures you believe
Fevered growth in the after-hours home-doctor business is giving way to a chill sense of threat as the industry awaits the outcome of an inquiry focusing on its practices of aggressive advertising and use of urgent MBS items.
In an apparent reference to the RACGP, the sector claims it is being undermined by “vested interests” waging a turf war. A media campaign is under way, portraying home-doctor services as lifesavers that save taxpayers millions by keeping patients away from hospital emergency services.
More precisely, a Deloitte Access Economics report, commissioned by the National Association of Medical Deputising Services, reckons after-hours visits to households and aged-care homes represent a saving to taxpayers of $181 million a year.
“The main salient point is that it saves the Australian taxpayer money by diverting people from hospital emergency departments,” association President Dr Spiro Doukakis said on national radio last week.
Dr Doukakis said the success of home-visit services reflected the success of government policy, initiated under former Prime Minister John Howard, to make after-hours calls more attractive for doctors and raised consumers’ awareness of their options.
“Now that’s occurred and with that has come growth. Now we have 80% of the Australian population covered, including regional and rural towns, where five years ago less than 50% of the population had access to after-hours care,” he said.
As a result, the association’s campaign claims low-acuity presentations at hospital emergency departments have dropped from 54% to 47% since 2006. The calculation of taxpayer savings, however, stems from a survey of patients who said they would have sought care at an ED or clinic if no home doctor was available.
But doctors say there is no evidence of such an impact on ED visits, nor on GP-run extended-hours clinics. Commonly, however, they report an erosion of daytime GP services.
“Association is not the same as causation,” GP Dr Lee Fong said, noting the Deloitte report itself observed the decline in category 4 and 5 ED presentations related to a “complex number of factors” including care options, demographics and triaging.
“When looked at on a national scale, these complex interactions are like a foggy haze that makes causation very hard to discern,” Dr Fong, who is medical director of Hunter GP Access, said. The leap in more than 500,000 home visits annually in the past five years comes amid growth in ED visits nationally, he added.
In Canberra, where after-hours home visits jumped more than a 1000% in a year after a major deputising service arrived in 2014, ED visits are stable and patient volume is steady at the CALMS after-hours clinics run as a cooperative by local GPs.
“CALMS numbers have not changed, either up or down. The (home-visit) patients have not come from accident and emergency, either. Low-acuity ED presentations have increased in the period,” CALMS president Dr Ian Brown said.
“From my experience as a daytime GP, I suspect there has been a fall across every general practice in Canberra of late-afternoon presentations of a relatively elective nature.”
At a time of tight curbs on health dollars, doctors deplore the explosion in use of urgent after-hours claims by deputisers. Medicare outlays on item 597 alone have jumped from $91.4 million in 2012-13 to $197 million in the year to June.
The RACGP is hoping to see curbs on the deputisers’ ability to advertise directly to patients, giving them more of a back-up role for patients’ regular practices, and wants their workforce limited to qualified GPs and supervised GP registrars. It is understood that would eliminate half the deputisers’ current workforce.
A report is expected soon from a working party led by Dr Steve Hambleton, a GP and former head of the AMA, as part of the MBS review.
