ROXON TAKES ON THE DOCTORS

Doctors do not have monopoly on care: Roxon

Mark Metherell, smh

September 20, 2008

DOCTORS face pay cuts if they insist on doing work that nurses could perform just as easily.

The message, to be delivered tonight in a speech by the Health Minister, Nicola Roxon, is likely to anger the medical profession.

Her remarks indicate the Government is thinking of using financial disincentives to drive doctors to relinquish their monopoly on procedures which can be done safely by other professionals, such as delivering babies, issuing repeat prescriptions and wound management.

The speech, to be made in Bathurst tonight at the "Light on the Hill" oration, will call for an end to the "historical anomaly" of doctor-dominated health care. The annual event commemorates Prime Minister Ben Chifley, who fought an intense campaign by doctors against the Pharmaceutical Benefits Scheme, established in 1948.

Ms Roxon, who said Labor also had to overcome entrenched resistance from doctors to introduce Medibank, then Medicare, already has a combative relationship with the president of the Australian Medical Association, Rosanna Capolingua.

"Doctors must and will remain central to our health system. But to date, professional resistance and government funding have prevented the development of a health sector in which services are delivered not only by doctors, but by other health professionals who are safe, potentially cheaper and, most importantly, available," Ms Roxon says in notes for the speech.

But change would be likely to require "pricing signals", she says. "Doctors will need to be prepared to let go of some work that others can safely do.

"To ensure this transition, there needs to be an incentive for doctors to eschew less complex work, and focus on the work that does require their high-level skills and expertise.

"Or if doctors do not want to let go of it, to accept being paid less for devoting their highly skilled and heavily trained selves to less complex tasks then they might."

Ms Roxon points to the need for big changes to Medicare and the way doctors are paid, pointing out that general practitioners are paid for the number of patients they see, not for any health impact they might deliver.

"The current Medicare structure means a GP will receive more money for seeing 10 patients in an hour then they will for seeing three patients, each for longer periods."

This meant there was a financial disincentive for GPs to provide longer, intensive visits that preventive approaches demanded, including showing patients how to lose weight, keep fit and avoid diabetes.

For GPs to be required to undertake prescribing a repeat for the birth control pill was "an extremely economically inefficient proposition".

"There is a longstanding historical anomaly here. Our health system, including funding for health services is organised almost entirely around doctors."

By implementing these reforms, Australia would not only be "redressing the historical bias towards medical intervention and acute care, we will be redressing the historical bias against the traditionally female nursing workforce".

"A few good Labor principles all tied up in one set of reforms."