新的医疗保险：加强全科医疗（英）

Australia’s universal healthcare system, Medicare, started in 1984. Much has changed in the four decades since, but the government’s approach to general practice – the backbone of our health system – hasn’t kept up.

As this report shows, a system designed for an earlier era hasn’t been updated to respond to the rise of chronic disease, or to tackle gaping disparities in access to care, rates of disease, and life expectancy.

The complexity of GP work has grown immensely, as the population has grown older and rates of mental ill-health and complex chronic disease have climbed. But the model for general practice has changed little. GPs are struggling to fit more and more care into appointments that still average 15 minutes, and lack the support of a broader team.

Other countries have reformed general practice, and their rates of avoidable hospital visits for chronic disease are falling. Australia has spent 25 years on a merry-go-round of tests and trials that have
not changed the system, and our rates are holding steady. We are spending more and more on hospitals, while neglecting general practice: the best place to tackle chronic disease.

Patients suffer the consequences. People with chronic disease live shorter lives, with more years of ill-health, and lower earnings. The effects are worst for poorer Australians, who are twice as likely to have multiple chronic diseases as wealthy Australians.

Australia’s health workforce is also struggling. Hospital staff are overwhelmed with demand. And GPs report being stressed, disrespected, disillusioned; struggling to meet increasingly complex demand in a system that does not support them.

More of the same won’t work. To turn the tide on chronic disease, Australia needs a new Medicare, with three big changes.

First, general practice needs to be a team sport, with many clinicians working under the leadership of a GP to provide more and better care. This is common overseas and evidence shows it can deliver excellent results. Australia must dismantle the regulatory and funding barriers that force GPs to go it alone. To accelerate change, 1,000 more clinicians, such as nurses and physiotherapists, should be employed in general practices serving the communities with the biggest gaps in care.

Second, Australia needs a new way to fund general practice. The current model is broken, actively discouraging team care and rewarding speed, not need. Australia is one of the last wealthy countries to fund general practice this way. Practices should be able to choose a new funding model that supports team care and enables GPs to spend more time on complex cases, by combining appointment fees with a flexible budget for each patient that is based on their level of need.

Third, general practices cannot keep working without clarity and support from government. They need a clear vision about where general practice is heading, with support and accountability for getting there. Primary Health Networks should roll out key recommendations in this report and monitor a new set of measures that show how well the system is working. That will help them guide and improve the system, including improving people’s access to healthcare in rural areas.

Reform is overdue, but an opportunity has arrived. The system is in crisis and the Federal Government has set aside $250 million a year to respond. That money can fund the recommendations in this report; repairing the foundation of our health system and creating a new Medicare that is ready for the decades ahead.