Public hospitals won’t be fixed until primary care is addressed, it warns in a submission on the National Health Reform Agreement.
The National Health Reform Agreement 2020-2025 Addendum is officially nearing its midpoint, offering medical stakeholders the chance to weigh in on its efficacy so far.
The addendum, which was signed by representatives from all Australian governments in May 2020, is the key mechanism for transparency, governance and financing of public hospitals.
It sets out how much funding the federal government contributes to state and territory public hospitals, as well as long-term health goals to work toward.
In its submission to the mid-term review of the addendum, the AMA asserts that the federal government has failed in key accountability duties.
“Under the Addendum, the Commonwealth affirmed its commitment to funding the Medicare Benefits Schedule to ensure equitable and timely access to affordable primary health care and specialist medical services,” the submission says.
“The AMA argues that this Commonwealth commitment has not been met.
“This is evident by the declining bulk-billing rates and growing wait times for patients to be able to see their GPs.”
Because investment in general practice has not matched the increase in cost and demand for high-quality primary care, which ultimately means some vulnerable patients deteriorate to the point where they present to public hospital emergency departments.
“Lack of adequate planning and [Commonwealth] funding of primary care in aged care over the last 10 years results in aged care type patients increasingly relying on public hospitals, both for emergency care and for extended stays while they await admission to an aged care home or to receive a home care package,” the AMA said.
“The AMA sees this area of significant failure of the National Health Reform Agreement.”
Exacerbating the problem for aged care patients is the lack of interoperability between GP practice software and Aged Care Assessment Teams.
Despite being able to make and send the referral via practice-based clinical information systems, GPs tend to be kept out of the loop with any further developments from the aged care team.
In short, GP software can talk to the hospital software, but the hospital doesn’t reply.
The AMA singled this out as a particularly stark example of government failing to deliver on the priorities set out in the addendum, one of which is progressing interoperability.
“Older patients tend to have long term GPs who often have an abundance of health information available to them, which they could share with the ACAT assessors, without the patient having to repeat their story,” it said.
“However, AMA members tell us that this does not happen. If the systems, primarily My Aged Care and My Health Record and the GPs clinical information systems were interoperable, this information would be readily available to ACATs and vice versa.”
The association also took aim at the National Cabinet, saying that it observed a “significant, troubling reduction in transparency” from health ministers after it changed from being called the Council of Australian Governments.
Its specific issue with accountability is that there are no real consequences for any of the parties failing to implement their end of the agreement.
The AMA can argue until it is blue in the face that the federal government has not kept up its responsibility for maintaining the MBS, but there’s little point when the states and territories don’t have a mechanism to hold it accountable.
This wasn’t always the case; the 2011 version of the addendum had a performance and accountability framework, which the AMA argues should be reintroduced.
The RACGP also provided a submission to the mid-term review, calling for more investment in improving transfer of care between primary and secondary care.
