The Australian Medical Association came out swinging yesterday in response to an article in The Medical Journal of Australia by Dr Tony Webber, a GP who until recently headed the Medicare watchdog, the Professional Services Review.
In his article Webber estimates that $2-3 billion dollars are wasted annually through misuse of the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme and the Medicare Safety Net. The AMA was wounded at the suggestion that doctors were rorting the system, suggesting Webber was attributing the actions of a few bad apples to the wider medical community, and the media up and ran with that line yesterday.
But as Croakey‘s Melissa Sweet points out today, there’s a very big difference between dismissing doctors’ rorts and taking a very serious long view at waste within our health system. And there’s plenty of that to go around. Consider cost shifting between the federal government and states, the use of unnecessary or inappropriate tests and treatments, onerous red tape and the waste that comes with complex, inflexible systems for starters.
All of which leads in very neatly to kicking off a new project in Croakey. The Naked Doctor, conceived and run by Dr Justin Coleman, is dedicated to examining over-diagnosis and over-treatment in our health system. In Dr Coleman’s words, the project “aims to encourage discussion and awareness of the opportunities to do more for health by doing less”.
It might be a novel way of thinking about how our health system functions, but doing nothing, or more specifically, focusing on preventative health, is a concept worth considering in the context of Webber’s paper — and far less easy to dismiss than a few “bad apples”.
Dr. Webber’s first suggestion, that doctors are rorting the system, is absolutely correct. I spent 50 years in the health system as a nurse/midwife and manager, and I could (but won’t) tell you hundreds of stories about just that. And if other nurses/managers are honest, they could do the same. Far from being furtive about it, many doctors are quite open about screwing the system ( when other “lesser” beings who work along side them are present), even to the extent of boasting about it. Their excuse: they don’t make enough money following the “rules”.
Webber is right – there should be a root and branch review of all spending on health care. And it should be far more comprehensive than just “over-servicing and over-treatment” by the doctors. Until we can find some way of controlling what doctors’ charge for ALL types of treatment, then the taxpayer pays twice – firstly, the Medicare levy/Private Health Insurance, and secondly, the infamous gap, for just about everything. When are we going to learn in this country that we must abolish the sacred “fee-for-service” RORT, and introduce salaried doctors for much of the medical care we receive. The current system just puts ANY extra government funding straight into the pockets of the medical profession. Any health economist worth their salt knows that – so the expensive game continues.
It’s hardly arguable that most of the ‘medical’ treatment sought by most people from GPs is useless at best and positively harmful, not just to the individual but the community in general – eg the scattergun approach of wide spectrum antibiotics.
Except for major trauma & life threatening conditions, the most useful response to the psychosomatic dis-ease so prevalent today is “take this placebo and you’ll be cured in seven days. Or don’t take it and you’ll be better in a week”