Our 6.3 GP visits per year are more likely to be the result of a sick health system, rather than Australians becoming sicker

by on 24 February, 2010

Monique-Beguely We aren't necessarily getting sicker, despite the statistics, writes Monique Beguely.

News that Australians are becoming sicker than ever with an average of 6.3 GP consultations per annum, the highest in the Commonwealth, is more likely to be a result of systemic problems within Australia’s health system – not because Australians are becoming sicker than ever, as the new reports are claiming. 

Consider some of the following facts that could contribute to this allegedly higher number of GP visits:

  1. The Medicare system itself.  My lawyer charges $440 per hour, my accountant is not far behind him!  I can visit my GP for $60 and the government/Medicare will refund me $32.80.  My out of pocket expense for this visit is $27.20.  If I should become eligible for the Safety Net at any stage during the year, I will receive an additional refund of $21.75.  The cost of my GP visit will be reduced to $5.45 per consult for the rest of the year, regardless of my level of income.  I am going to seriously debate with myself whether I really do need to visit my lawyer or my accountant, I am not going to think twice about whether or not I need to see my GP.  I think that the Medicare system leads Australian’s to devalue the services that GP’s provide, and in some cases leads to abuse of this system (by both patients, and in some cases by the GP’s themselves – I will come back to this point later).
  2. Due to the laws governing issues of privacy and confidentiality GP’s no longer provide test results over the telephone, as they previously did.  The patient is required to make an additional appointment to find out their test results. 
  3. Most GP’s no longer write out a repeat script for their patients to pick up at reception, as they routinely did in the past.  They now require you to make an appointment for something as simple as a script, and then bill a Medicare consult accordingly.  In some cases (e.g cholesterol drugs and contraceptives),it is possible to get up to five repeats . However, some medications allow only one, (as in some instances no repeats), requiring the patient to visit their GP every two to three months for the same basic complaint – which could be something as simple as eczema!
  4. Most employers these days require their employees to provide a Medical Certificate if they are off sick for more than one day.  You know you only have a cold, you know you just need a few days of rest in bed, you know you won’t be prescribed antibiotics (as they are now the big bad “no no” of the medical world), you know your GP will just tell you to get some rest and go next door to the pharmacy to buy cold and flu tablets and throat lozenges  – yet you still need to visit your GP unnecessarily to get a Medical Certificate so that your boss will pay you!
  5. The alleged “swine flu” epidemic.  Due the pandemonium about the “pandemic that never was”, the public were urged to see their GP even for the most mild of flu systems, and  even if they did not feel especially unwell, just in case their symptoms developed into swine flu.  This is fair enough, as if it was a genuine case of swine flu, these people needed to be taken out of circulation due to the high level of contagion it presented.  However this alone would have caused a spike in GP visits.

If you take all of these facts into consideration, it is no wonder Australian’s are visiting their GP’s over six times per year on average – but it may have nothing to do with our health worsening.

Some simple solutions could be:

Link the Medicare rebate amount to the CPI.  The rebate reduces each year by an amount equivalent to the prevailing CPI.  The cost of a visit to the GP will increase slowly over time, making Australian’s attach more value to the services GP’s provide and consider whether their symptoms really do require a face to face visit.  The safety net is still there to protect the chronically ill and concession card rates are still available to the poorer members of society.

GP clinics could employ a person specifically to deliver test results that are negative that require no further action – either face to face, or perhaps they could contact you via telephone.   This person could also be utilised to write out repeat scripts for patients. It is possible that a nurse or a medical student could serve in this capacity.

As is currently being considered, allow pharmacists to issue medical certificates where they see fit, so that only patients requiring actual medical attention go into the GP system.
Remove systemic abuses from the medical system:

As I alluded to in an earlier paragraph, as a visit to the GP is relatively cheap (compared to my lawyer!), once you have reached the safety net threshold, this can lead to abuses in the system by both patients and doctors.  In my previously Iife I was employed as a Medical Representative for a large International pharmaceutical company.  Yes, one of those nasty people who force GP’s into prescribing the most expensive drugs available so that large MNC’s can make ridiculous profits, and in doing so contribute to the imminent collapse of the health system as we know it!  (Just kidding, if only you knew what the job was really like!) 
As a result of this I sat in the waiting rooms of doctor’s surgeries over the entire state of QLD for approximately 3 to 4 hours per over a period of three years.  I would spend my time observing and talking to patients and support staff, as well as the GP’s.  Here, I witnessed some absolute atrocities.  A doctor who required a patient to attend their surgery every day to have their blood pressure tested – imagine the strain this behaviour puts on the Medicare system.  I am not a Doctor , but if you really required this level of monitoring, shouldn’t you be in a hospital?  It is yours and my tax dollars that are paying for this!  I know of other patients who have purchased their own blood pressure monitors to use at home, and only present to a surgery once their blood pressure goes over a level pre-determined by the patient’s GP. 
I once met a patient who advised me that he came into the surgery every day!  He was extremely proud of this fact! I don’t know if he was actually seen by a GP every day or not, but this is scary behaviour!
I also noticed in a large number of small country towns, that the Doctor’s Surgery seemed to be the hub of social activity.  Older people (in general) would drop in around morning tea time to say hello to the staff and their friends in the waiting room.  (Whatever happened to bingo!).  On many occasions the visit was followed by the following words directed at the reception staff, “I only popped in because I saw “X” through the window, but now that I’m here I might as well see the Dr”.  You would not believe how many times this request was granted.
Part of my role also included visiting pharmacies, where I witnessed even more abuses of the Medicare/PBS system.  Patients would proudly say to me (whilst I was waiting at the counter to see the pharmacist) that “I have no idea what this medication is for, but I guess I should get it filled anyway”,  or  “the Dr says I should take these, but I’m not going to, but I’ll get the script filled anyway in case he finds out !”  Any pharmacist will tell you a story about visiting the house of a patient who has passed away recently and finding up to $5000 worth of prescription medications in the ex-patients cupboard, many of which have expired and can no longer be used, that they have to remove and destroy.  This is exacerbated by the safety net in the PBS system.  Once some patients reach the PBS threshold, the can received scripts for around $5 for the rest of the year, regardless of the cost of the drug.  This leads to some patients filling as many scripts as possible before the end of the year so that come January 1, they do not have to pay the higher PBS price.  Many of these drugs will pass their use by date and end up being flushed down the toilet!
Once again, this could be put down to patients not valuing the service they are receiving.  Some drugs that we pay between $5 and $35 dollars for, can cost anything up to $1500 a go!  This is an extreme example, but there are many that cost in the hundreds.  The TGA looked at addressing this issue in the early 2000’s.  They suggested that the full price of the medicine be placed on the bottle/ packet , next to the actual price paid by the patient – so that the patient could see how much the Government was subsidising their medication and thus treat it with a bit more respect, i.e. to encourage patients not to stockpile expensive drugs as above.  If I memory serves me correctly, it was decided not to proceed down this path. The reason given was that some people would see this information, consider themselves a burden to society, and then either not take medication that they definitely required, or in extreme cases, might kill themselves!  I think that the Australian public needs to be given a bit more credit!
These are just a few examples of some of the abuses of our Medicare and PBS system that I witnessed over a 3 year period.  I can see why the system in its current form is unsustainable, and this is only the GP system, imagine what the hospitals are like!  I am sure that if some of these issues were adequately addressed million, if not billions of dollars, could be wiped off this budget breaker – without even needing to go down the unpalatable, “never happen in an election year” , path of means testing for Medicare.   I believe that the safety net systems in Medicare and the PBS are essential for the poorer people in society, those with large families, and for the chronically ill, but something definitely needs to be done to address the waste and the abuse inherent in these systems so that Australian’s do not end up losing the healthcare systems that they are so proud of and reliant upon.
Monique holds a Bachelor of Arts degree from Auckland University, and a Diploma of Financial Services from FINSIA (formerly the Securities Institute of Australia). Monique has also completed a Graduate Certificate in Applied Finance and Investment with FINSIA, majoring in Derivatives/Options. Monique was awarded the Bank of Queensland Prize in 2007 for achieving first place in Queensland in her Diploma of Financial Services.

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