status quo of quo vadis? - KCE

34 Quality development in general practice in Belgium: status quo or quo vadis ? KCE Reports 76
2.4.5 Australia
2.4.5.1 Organisation of the health care system, with focus on family medicine/general
practice
Medical care in Australia is largely funded by subsidies from the national/federal
government: Medicare is a social insurance system funded by revenue from the federal
government. Private health insurance is an emerging market with financial penalties for
patients who take out coverage after the age of 30 years. Private insurances cover some
extras and out of pocket payments. Public hospitals are free of charge. There is an
extensive network of private hospitals, mainly in urban centres.
The GPs (60 percent of the medical workforce) have a gatekeeper’s role and handle the
bulk of medical problems. The number of GPs is about one for 1100 patients, with
significant variation between rural and urban areas. Most practices are run as small
business. There are approximately 6000 practices and about 2.8 full-time equivalent
general practitioners per practice. The costs of medical care per capita are somewhat
higher than the European average. 84 The Health Authorities have three main objectives
for the organisation of health care: equity, efficiency and quality. 84
Patients are not registered with a GP and patient choice is a well-accepted principle.
Individuals are free to choose the general practitioner they consult, restricted only by
availability and ability to pay. However, they need to obtain a referral from a general
practitioner before any consultation with a specialist. Patients may consult more than
one general practitioner, since there is no requirement to enrol with only one practice.
Patients may also exert a choice over the referral made by their general practitioner to
a specialist or to a hospital. 84
Australia has a model mixing fee for service and payments for specific tasks. The model
includes:
• Fee for service (from the patient to the doctor);
• Direct payments to the doctor (from the national government);
• Practice based payments (from the national government to the practice);
• Payments to general practice networks/divisions of general practice (from the
national government).
Practice based incentives are available for information management and technology,
after hours, teaching medical students, rural and remote practice as well as for specific
clinical outcomes for asthma, cervical screening, diabetes, mental health and
immunisation. It seems likely that over time the balance will shift in favour of payment
for clinical outcomes delivered by a primary care team, rather than by the individual
GP. 123
General Practice Teams are emerging. In larger practices, the teams are composed of
GPs (‘chief diagnosticians’), practice nurses, practice managers and other ancillary and
allied personnel. Practice nurses become more prominent in the health care system and
may generate income for the practice by performing tasks under the supervision of the
GP. The number of single-handed general practitioners is decreasing. 124
New trends are the large scale Primary Care Corporations. These are for-profit
organisations that employ medical and para-medical workforce and may have radiology,
laboratory facilities and pharmacy facilities. They have been referred to as ´shopping
centres of general practice´.
Since 2000, substantial attention has been paid to the GP role in health care delivery.
Reforms in the national payment scheme include fee for service and practice based
payments. 125 Examples are new arrangements for after-hours medical care and chronic
disease projects (e.g., the GP Asthma Initiative, National Integrative Diabetes
Programme). 84