League Table Could Be The Best Medicine
Sydney Morning Herald
Saturday August 23, 2008
Health is a centrepiece of the Rudd Government's reforms. "Bold", says the minister, Nicola Roxon. "Ravenous", says the Australian Medical Association, anxious for the role and power of doctors.
Roxon's "bold" reforms so far have encompassed a possible federal takeover of hospital funding, a $10 billion health and hospitals fund, GP super clinics and a new primary health-care strategy. But health reform is a game in waiting. Roxon's program could deliver new medical service systems - and competition among health providers. Take primary health care. Roxon has a review scheduled to report next year. Chronic diseases cause nine out of 10 deaths. Diabetes doubled in the 10 years to 2004-05. The life expectancy gap for indigenous Australians is 17 years. Roxon has already flagged reallocating tasks between GPs and other health professionals. As well, she seems keen on allowing pharmacists to deliver some basic health screening, including repeat prescriptions. It's a great idea. Patients get annoyed at having to make a GP appointment - and pay a bill - to secure a repeat prescription. But if pharmacists want to provide competition to GPs, they should be prepared to accept competition from supermarkets. It's about time the ban on pharmacies in supermarkets was lifted. Allowing pharmacists to write some prescriptions is tickling at the edges of reform. Will the review give Roxon a far-sighted strategy to tackle primary care for chronic illness, and reward disease prevention? It need look no further than New Zealand to do so. The Kiwis have Primary Health Organisations that involve doctors and other health professionals, such as Maori health workers, dietitians, pharmacists, physiotherapists, psychologists and midwives, to serve local communities. The big difference is that PHOs and their GPs are paid on a capitation basis (the number of people enrolled), not on the number of times a provider sees a patient. The idea is that payments are to provide new and improved services to keep patients well, not just to visit a doctor. The concept is being whispered in Roxon's ear. The AMA is on full alert, as one might expect given the long-standing Australian commitment to fee for service. While supporting enhanced team-based primary health care, the AMA wants extra support for GPs so they can deliver more preventive health services. GPs would always act as the "gateway", with the "overall care" of patients remaining in their hands. But competition in health provision could come from a different direction. Roxon's fundamental review of hospital funding for a new health-care agreement with the states has set in train an intense internal debate on clearer, more transparent performance measures. A "reformist, outcomes-based" approach needs such transparency to measure progress, Roxon says. New performance indicators would not only encourage competition and innovation but also give the public "a more meaningful measure", she says. Performance measures could show which hospitals were best at combating killer superbugs, she says. But she doesn't say they could also deliver "league tables" on which hospitals were best at different kinds of operations (heart, knees etc). Medical league tables! There's an idea guaranteed to send the medical profession into a coma. Australians are kept in the dark on who does what best medically. New York and some other US states publish a league table of successful heart operations that lists the surgeons. In Britain the combative Health Minister, Ben Bradshaw, is forcing GPs in the National Health Service to publish on the NHS Choices website details of the quality and range of services provided at their practices. Medical report cards infuriate doctors, who say riskier operations would not be done as a result. But a study in north-west England found a link between hospital league tables and lower death rates after major heart surgery. There's no reason why, in Australia, medical performance indicators (league tables) should not trickle down from hospital data to surgical and doctor practices. It's ridiculous that the only product and price competition medical consumers now see is between private health insurance funds - and even that is limited.
© 2008 Sydney Morning Herald
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