Case 1

 

Hazel is having trouble with her arthritis...

 

 

 

 

This 76-year old woman illustrates a number of concepts central to population health. The case begins with an outline of various sources of health data in Australia, including clinical practice guidelines. The concept of a population approach in the GP setting is then developed. Finally the national policy framework for primary care and healthcare funding mechanisms are discussed.

 

Because GPs work within the community and have clinical contact with its people we are in an important position to apply population health strategies to our patient group. This implies a shift in focus from the individual to the population. This case demonstrates the link between the individual and population approaches. In practice, this shift of focus is not always easy to make as we often feel that our obligations are to the individual patient rather than to the population; this case will demonstrate that these approaches are complementary.

 

 

 

 

 

Learning Objectives

·        Understand the Australian health care system (including funding mechanisms and policies)

·        Be aware of the sources of population health data in Australia

·        Understand the role of clinical practice guidelines

·        Understand the need for organisational change within practice to integrate population health strategies such as screening, recall and the use of clinical practice guidelines

·        Understand the principles of self-management as they apply to chronic diseases in general practice

 


 

 

Hazel’s Clinical Summary

 

Past Medical History:

            Osteoarthritis

            Hypertension

 

Past Surgical History:

            Nil

 

Allergies:

            Nil known

 

Meds:

            Panadeine forte ii qid prn

            Indomethacin 50 mg tds prn

            Tritace 5 mg daily

            Aspirin 100 mg daily

            Ibuprofen 200 mg daily

 

Social History:

            Nil cigs or ETOH

            Lives alone in a ground floor unit

            Pensioner

 

 


Case Notes:

 

Hazel is a 76-year old woman whom I saw today with a flare up of her osteoarthritis.

She takes Ibuprofen daily for pain control but regularly uses Indomethacin

50mg tds when her pain flares. She put her most recent exacerbation down to a change in the weather. I have seen several people this week who have also complained that the weather has worsened their osteoarthritis pain. I seem to have a lot of patients in my practice with osteoarthritis. Is this normal? Where can I go to find out how common arthritis is in my community?

 

An Overview of Chronic Diseases:

 

Chronic diseases are becoming more of a problem for our health care system. Over the next 40 years, total expenditure on health care is projected to increase from just under 10% of GDP to between 16 and 20%. Most of this growth in demand will come from the burgeoning chronic disease burden, which is increasing in both absolute as well as relative terms and is estimated to grow from the current 70% of the total national burden of disease to 80% by 2020. The ageing population demographic and increasing prevalence of some risk factors are the key drivers behind this increase. The attached document provides a more detailed overview of chronic diseases in Australia.

 

 

Sources of Health Data:

 

Data collections enable us to understand the ways in which the chronic disease burden is changing. Data regarding the health of the Australian population are collected in three main ways:

·        Firstly, as the population has contact with the health care system, data is collected. Hospital admission statistics, general practice consultations (which simply record the doctor and item number), and the registration of births and deaths are examples of this type of data.

·        Secondly, specific registries of diseases, risk factors, treatments or at-risk groups exist to provide data regarding specific health concerns. For example, each State and Territory has a cancer registry that collects essential information regarding all pathologically confirmed malignancies within the State. Other registers you may be familiar with include the Australian Childhood Immunization Register, the Australian Cervical Smear Register, and rheumatic heart disease, diabetes and methadone program registers.

·        Finally, government, research organisations or peak bodies, conduct population surveys from time to time. Some of these surveys are conducted nationally and on a regular basis, such as the National Census and the National Health Survey conducted by the Australian Bureau of Statistics (ABS) http://www.abs.gov.au, while others might be longitudinal studies such as Tasmania’s Older Adult Cohort Study (TASOAC), and Australia’s Childhood Determinants of Adult Health (CDAH) study. Many surveys are conducted on an irregular basis – for example the National Heart Foundation Risk Factor Prevalence Surveys (http://heartfoundation.isa.net.au/sepa/back.html) and general practice activity surveys (BEACH report).

 

Each source of health information has its advantages and limitations. Hospital morbidity data, for example, is useful in monitoring diseases because each admission is coded for disease using the International Classification of Disease (ICD-10). However comparisons of admission rates over time have to be interpreted with caution as they can be influenced by other factors such as bed availability or changes in methods of hospital funding. Statistics derived from contact with the health care system are also influenced by access to the system. Self-reported measures of morbidity, such as national health surveys, are subject to the individual’s knowledge of and response to illness.

 

The Australian Institute of Health and Welfare (AIHW) is a good starting point to look for information about common health problems in the Australian population. The AIHW was established under Commonwealth legislation. Its mandate is to monitor and report on morbidity levels in Australian society. The AIHW produces a biennial publication ‘Australia’s Health’ which collates and summarizes information from many sources. Their website is http://www.aihw.gov.au.

 

 

A more detailed discussion regarding measuring health and disease is included in the following document:

 

 

Issues to Consider:

Use the above data sources to answer the following questions:

a)       How common is arthritis in the Australian community?

b)       Where does osteoarthritis rank in Australia in terms of its economic burden on the health system compared with other diseases (that is 5th, 23rd etc)?

c)       Estimate the number of times you manage osteoarthritis per 100 patients in your practice.

 


Case Notes:

 

Hazel’s knee was hot and swollen when I examined her. I wondered whether I could offer her anything else apart from NSAIDs and what I was going to do when these stopped working. What is ‘best practice’ in the treatment of arthritis? Are there any guidelines I should be following? If my treatment was in line with current guidelines, I would feel reassured that Hazel’s treatment was the best it could be.

 

 

Evidence-based Medicine:

 

To manage chronic diseases as efficiently as possible, we need to be offering treatment that is effective. As GPs we have both the personal desire and the professional obligation to offer our patients the best treatment. We want our management to be based on valid scientific research. Evidence-based medicine is our attempt as clinicians to do this. Evidence based medicine (EBM) became popularized in medical jargon in the 1990s with the development of information technology and the ‘information explosion’ that came with it. Professional interest in the effectiveness of medical care was also growing, driven largely by increasing governmental pressure for efficiency and cost-savings. The fundamental premise of EBM is that our clinical practice ought to be based on the best quality, scientific evidence.

 

Clinical Practice Guidelines:

 

We can systematically apply the results of research to our patient group by the use of evidence based clinical practice guidelines (CPGs). These are usually developed through a process of searching and appraising the peer-reviewed medical literature on all possible interventions and then adapting this knowledge to local circumstances, with resource constraints in mind. Guidelines are rarely 100% evidence based because for many of the problems that arise in clinical practice there is not enough evidence available to make definitive statements about the best thing to do. In these situations the guideline developers have to rely on a combination of the evidence and their knowledge and experience to make recommendations. Likewise GPs need to assess each guideline on its merits and tailor their responses according to each clinical situation.

 

Clinical practice guidelines can be used as tools to improve the health of your practice population if they are implemented in a systematic way. The National Health and Medical Research Council and the Royal Australian College of General Practitioners both maintain websites where up-to-date guidelines can be accessed.

 

 

 

Guidelines in Practice:

 

Not all guidelines are of high quality. You should perform your own assessment of the quality of guidelines before applying them to your patients. High quality guidelines will have the following features:

 

  1. The guideline will be recent
  2. The guideline will be referenced and based on high levels of evidence such as systematic reviews, meta-analyses, or randomized controlled trials
  3. The guideline will have been developed with resource constraints in mind e.g. a guideline that recommends MRI scans of the whole population would not be able to be resourced
  4. The guideline will have been developed with access and equity issues in mind e.g. a guideline that recommends treatment with an expensive, unfounded medication would exclude people who were unable to afford the treatment
  5. The guideline will be applicable to your patients e.g. some guidelines are well researched and based on good evidence but are difficult to apply in practice.

 

Once you have assessed a guideline as being of high quality and suitable for your patients, the guideline needs to be implemented in your practice. Implementing guidelines in practice is often difficult. There are barriers which are logistical, patient-related and environment-related and which might require a change in the processes or function of the practice. It is often these organizational changes that are the crucial steps in realizing the benefits of guidelines. This issue will be discussed in the next section.

 

Issues to Consider:

 

a)      Using the above resources, locate clinical practice guidelines for the management of chronic pain in your patients with arthritis.

b)      Applying the criteria for high quality guidelines outlined above, what are the strengths and weaknesses of these guidelines?

c)       What do you consider to be the main barriers to implementing these clinical practice guidelines in your practice? Name at least four main barriers. Discuss these with your supervisor. Discuss ways you, your colleagues, and practice support staff (e.g. practice nurses, Divisions of General Practice) may address these barriers.


Case Notes:

 

Hazel came in for a long consultation, to discuss her arthritis management at length. Her major complaint was a swollen and painful knee, and stiffness in her hands. I had reviewed clinical practice guidelines for the management of osteoarthritis, and had some ideas about ways we could improve Hazel’s management. We discussed and selected alternative treatment options, consistent with current guidelines. Within 4 weeks Hazel was back, with significant improvement in her symptoms. This got me thinking - how many patients with arthritis do I have in my practice? Is there any way I could improve their management as a group?

 

Population Approaches in Primary Care:

 

Over the past few years there has been an increasing emphasis both in government policy and within clinical practice to use a ‘population approach’ instead of only a ‘problem-based approach’ in the prevention and treatment of illness. What is the population approach? What evidence is there that it works? What does this mean to the general practitioner?

 

The Problem-based Approach

 

Clinical practice is largely problem-based. That is, a patient comes along with a problem and we go through the process of history taking, examination, investigation, diagnosis and treatment in response to this problem. We are responsive to the immediate concerns of the patient. The patient gets better (or has his or her immediate needs satisfied) and we have done our job. This process has been reinforced by our system of remuneration that pays us per episode of care or visit.

 

The Population Approach

 

An alternative to the above is a population approach. Population health approaches are effective and cost effective as risk factors for chronic diseases are widespread across the population and cumulative over an individual’s lifespan. The attached document provides a description of the population approach to chronic disease management in Tasmania.

 

 

What might a population approach for arthritis look like in practice? Approaches I might take include the following:

 

Conduct a practice audit, then apply clinical practice guidelines to their management

 

·        First, I would find the patients with arthritis in my practice using my practice records.

·        Then, I would extract from the data held in my records, information about my patients with arthritis – for example, their age and sex profile, their co-morbidities and their medications and other forms of treatment such as physical therapies they use.

·        I might then make an assessment of their needs and health status by some form of organized inquiry, such as a practice survey.

·        I could then look up best-practice treatments in evidence-based guidelines, and assess whether these could be established and perhaps modified for the specific purposes of my practice population.

·        I could then apply the best-practice treatments in a systematic way to my practice population, mindful that each may have to be adapted to suit the needs and desires of each patient.

·        I would need to ensure that the changes I made were sustained by periodically reviewing the guidelines; to make sure I was still offering ‘best practice treatment’ and periodically reviewing my patients with arthritis. A recall and reminder system might be one way I would do this. Alternatively, encouraging my patients to make a regular appointment, specifically for the purposes of managing their arthritis, might be a way I could do this.

 

Conduct a needs assessment of my patients with arthritis

 

If I wanted to know whether there were specific barriers to physical activity in the lives of my patients with arthritis, I could conduct a needs assessment. Without such an assessment, the main sources information I would have on which to assess this would be those kept by government agencies, such as mentioned above. Even if we could get this information, these routinely collected statistics are often more likely to reflect the agency’s activities rather than the situation of each patient. The beauty of the needs analysis is that it informs me about real patient needs rather than leaving it to providers to guess or assume what is best for the patient. Further methods conducting needs assessment in general practice are available in the RACGP Green Book “Putting Prevention into Practice”.

 

 

A full needs assessment is a large and complex task and would be difficult to do in a practice, even if there were adequate resources. It relies on the collection of data not just from patients but also from the community and other health service providers. However, there are other ways to assess need that are less onerous – for example, asking consecutive patient with arthritis specifically about a particular need, or conducting a practice audit and surveying my patients with arthritis might be options I would consider. The needs my patients identify might be individual needs, for example, a need for more specific advice about the types of activities they should be doing, or needs for my patients with arthritis as a whole, for example a need for warm water exercise classes to be offered free or at low cost at the local pool. If this were the case, networking with other GPs, GP organizations and organizations such as Arthritis Tasmania to advocate for services in my area might result in better access to services for my patients. The Enhanced Primary Care item numbers also give GPs an opportunity to do a small-scale patient-based assessment and be remunerated for it for those patients over 75 or with chronic disease that are under 75. The issues raised from a well-performed health assessment will be adequate to inform further planning and possible interventions at a practice level, fulfilling the aims of a needs assessment.

 

There are lots of reasons not to practice population health strategies. To us as GPs it might seem to be an inefficient use of our time, not least because there is no remuneration. We are too busy responding to the explicit and immediate needs of our patients to go looking for new reasons to intervene or new strategies to try. There is neither an immediate health gain nor an immediate patient need to satisfy, so there is minimal reward for the patient or the GP. Besides, our obligations ought to be to our patients rather than to the nebulous concept of population.

 

However, if we think that we have a professional responsibility to maximize the health and well being of our patients rather than just to fulfill their immediate needs, we ought to think about our practice population as a whole. We can be confident that the benefits of using this approach are likely to appear down the track. By ensuring that all our patients are systematically offered management that is both evidence based and up-to-date, we are, at least, providing the best we can offer and maximizing their chances of remaining healthy. At best we might make a measurable and noticeable difference!

 

Issues to Consider:

 

a)      What do you consider to be the main barriers to implementing a population approach to chronic disease in your practice? What are the four main barriers? Discuss these with your supervisor. Discuss ways you, your colleagues, and practice support staff (e.g. practice nurses, Divisions of General Practice) may address these barriers.

b)      Use the Practice Prevention Inventory (Appendix 1 of the RACGP Green Book) to assess putting prevention into practice in your own practice.

c)      Time is a commonly cited barrier because we are often too busy doing the day-to-day work to be able to sit back and take a whole-of-practice view. How could you incorporate some of these population strategies into your practice in a time-efficient way? Can you think of a role for practice support staff (e.g. practice nurses, Divisions of General Practice) in helping you with population approaches to your patients?

 

 

 

 


Case Notes:

 

Hazel has seen a leaflet for a chronic disease self-management program being offered by Arthritis Tasmania. She is keen to know your thoughts about whether the program would be a good idea for her.

 

Chronic Disease Self-Management:

 

What?

Self-management is about training and supporting patients to better manage their chronic condition(s).

 

How?

The underlying philosophy is that patients will improve their management of their own chronic disease if their knowledge, skills, confidence and ability to communicate about their disease are improved.

 

Why?

Chronic diseases are common and are on the rise. The worse they are managed, they more they cost the government. Ways to improve self-management are therefore being evaluated to improve outcomes for those with chronic diseases and to curb rising costs of care.

 

The 1999 / 2000 Department of Health and Ageing (DoHA) Enhanced Primary Care (EPC) package included the Sharing Health Care Initiative. The purpose of the initiative was to: “help patients improve their management of their own chronic disease by developing their knowledge, skills, confidence and ability to communicate about their disease”.

 

The evidence was reviewed to look for different self-management models. Then a series of demonstration projects were set up to test them out and see how the different models worked.  Now the boffins are looking at ways to translate these ‘learnings’ into a model of delivery of self-management in the real world, including via general practice.

 

Programs

There are lots of chronic disease self-management programs around. The most famous and probably the earliest was the Stanford Model, discussed below. Since then, others have popped up.

  • The RACGP, in partnership with DoHA, has one for GPs called ‘Sharing Health Care’.
  • The ‘Good Life Club’ is one from Victoria.
  • Arthritis Victoria has one specific for arthritis sufferers.
  • There are also self-management programs around that are specific for diabetes, stroke, mental illness.
  • SA has the Partners in Health scale from Flinders.

 


Chronic Disease Self-Management ‘In Practice’

The common factors that are associated with chronic conditions include:

  • Use of medications, sometimes multiple medications
  • Co-morbidities
  • Lifestyle and social factors that exacerbate health problems
  • A need for coordinated, multifaceted care
  • Prolonged nature of their condition
  • A need to change behaviours
  • A need for ongoing monitoring of physical and emotional status
  • Low self-esteem
  • Loss of income / other stressors
  • A need to develop new coping strategies

 

The Sharing Health Care process identified factors to address to help people to manage their chronic diseases better:

  • Medication use
  • Behaviour change related to lifestyle and activities
  • Pain control
  • Adjustment to change
  • Coping with emotional reactions
  • Effective use of community resources
  • Changes in disease symptoms

 

Approaches to self-management included:

  • Education
  • Writing self-management programs
  • Symptom action plans
  • Diaries
  • Motivational interviewing
  • Peer support

 

Approaches have to be patient-centred. In the jargon of self-management, patient-centred means:

  • Exploring both the condition and the patient’s illness experience (FIFE – feelings, ideas, functional impact, expectations)
  • Understanding the whole person
  • Finding common ground
  • Incorporating prevention and health promotion
  • Enhancing the GP-patient relationship
  • Being realistic

 

Approaches also have to be sensitive to the patient’s ‘stage of change’. Practitioners are encouraged to assess where the patient is ‘at’ in relation to their stage of change, and to motivate patients to change using the A-H model:

A – give advice, B – remove barriers, C – provide choice, D – decrease desirability, E – practice empathy, F – provide feedback, G – clarify goals, H – active helping.

 

Practitioners encourage patients to set goals. Goals should be SMART:

S – specific, M – measurable, A – achievable, R – realistic, T - timely

 

Stanford Model

The whole chronic disease self-management bandwagon has its formal origins in the Stanford model, although informally the idea has been around longer. This is much talked about in the self-management literature. A researcher by the name of Kate Lorig, who works for Stanford University, started designing and evaluating programs around self-management over 15 years ago. She started with arthritis, then moved to a more generic program, for most chronic diseases.

Strictly speaking, the real Stanford Chronic Disease Self-Management Program is a series of workshops two and a half hours long, given once a week for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with chronic diseases themselves.

 

Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, and, 6) how to evaluate new treatments.

 

Each participant in the workshop receives a copy of the companion book, Living a Healthy Life With Chronic Conditions, 2nd Edition, and an audio relaxation tape, Time for Healing.

 

It is the process by which the program is taught that is supposed to make it effective. Classes are ‘highly participative’, where ‘mutual support and success’ build the participants’ confidence in their ability to manage their health and maintain ‘active and fulfilling’ lives.

 

The evidence suggests that undertaking this type of ‘training’ will result in a delay in disease progression, reduced unplanned hospital admissions, and improved symptom control.

 

Many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

 

The Good Life Club Model

The Good Life Club project was a 3 year demonstration project funded by the Commonwealth Department of Health and Ageing (DOHA). The project utilised a number of interventions to support people with diabetes to improve self management of their condition and more effectively utilise existing local health services. These included:

  • individual telephone coaching by practice nurses and allied health professionals to support behaviour change of participants
  • club activities, eg. walking groups, nutrition and healthy cooking sessions, supermarket tours, using the internet to find health information
  • regular club newsletters
  • client health website at: www.goodlifeclub.info, and
  • email newsletters.

 


Australian Health Policy:

 

To make more sense of government decision-making in relation to primary care, we need to have understanding of the policy process – how health policies have evolved, and how policy decisions are made. The following section is a brief overview of healthcare policy and financing in Australia. For a more detailed description of Australian health policy you may wish to review the textbook ‘Health Care and Public Policy’ by Palmer and Short or refer to the attached document ‘The Australian Healthcare System: An Outline’.

 

 

Australian governmental health policy has historically been concerned with the provision of health services rather than the improvement of health per se. The early eighties marked a change in this approach when there was a national response to the World Health Organisation’s ‘Health for all by the year 2000’ initiative, outlined in the WHO Declaration of Alma-Ata of 1978.

 

 

This declaration is compulsory reading for those interested in a public policy approach to primary care because it has influenced international and national policy regarding health care provision ever since. To some extent its philosophy underpins the Australian trend towards population-based primary care provision that we are witnessing today.

 

In 1985, the Australian Health Ministers Advisory Council (AHMAC) established the Health Targets and Implementation (Health for all) Committee. The committee made a series of recommendations. Their aim was to reduce inequalities in health status by meeting a series of health goals and targets. The recommendations of the committee were implemented but did not deliver the predicted health gains.  In 1993 a further report entitled ‘Goals and Targets for Australia’s Health in the Year 2000 and Beyond’ was produced. This became the template of national health policy for the rest of the 90s. This initiative targeted four main disease areas, namely cardiovascular disease, cancer, injury prevention and mental health. For each of these areas specific targets were set for the year 2000 and strategies developed and implemented to reach these targets. Since then three other areas have been added, namely diabetes, asthma and arthritis and musculoskeletal conditions. These are now referred to as the ‘National Health Priority Areas’ (NHPAs). Each of these areas has a specific policy, implementation strategy and reporting procedure.

 

 

Apart from the NHPAs there is at present no all-encompassing national health policy guiding government strategy in primary care at the federal level. Initiatives in general practice and primary care, such as the establishment of GP Divisions and Enhanced Primary Care, continue to be delivered in a piecemeal fashion rather than as part of a coordinated policy approach to improving the delivery of primary health care.

 

Healthcare Funding Mechanisms:

 

The aim of the national health care funding system is to give universal access to health care while allowing choice for individuals through a substantial private sector involvement in delivery and financing.

 

The major part of the national health care system is Medicare. It is financed largely from general taxation revenue, which includes a Medicare levy based on a person’s taxable income. Commonwealth funding for Medicare is mainly provided as:

 

  • Subsidies for prescribed medicines and free or subsidized treatment by practitioners such as doctors, participating optometrists or dentists (specified services only);
  • Grants to State and Territory governments to contribute to the costs of providing access to public hospitals at no cost to patients; and
  • Specific purpose grants to State/Territory governments and to other bodies.

 

State and Territory governments supplement Medicare funding with their own revenues, mainly for funding public hospitals.

 

Members of the armed forces and war veterans are covered by additional special arrangements through the Department of Veterans Affairs, while remaining eligible for mainstream Medicare coverage. Other forms of financing cover some injuries and illnesses - for example, compulsory workers’ compensation insurance covers work-related injuries and illnesses, and injuries from motor vehicle accidents may be covered by compulsory third person motor vehicle insurance.

 

Residential aged care is financed by the Commonwealth Government by means of subsidies paid to service providers, based on the level and type of care needed by the individual. Residents may pay daily care fees and accommodation payments related to the level of care, with special provisions for residents who have difficulty paying these charges. The Commonwealth decides the allocation of new residential care places by an annual regional population based planning process, inviting providers to bid to provide the new places.

 

Community care services for the frail aged and the Commonwealth, State and Territory Governments jointly fund people with disabilities. For community care, clients pay different fees for services depending on the type of service and the client’s capacity to pay. The Commonwealth funds intensive Community Care Packages of coordinated care to enable older people to continue living at home, who might otherwise require low-level residential services.

 

New Medicare Items for the Management of Chronic Disease

 

Click link below to view Slideshow of Chronic Disease Management

 

K:\gpttweb\Population Health\Chronic Diseases\Hazel H\Hazel H.htm

 

 

Eligibility for Medicare

 

Medicare covers people residing in Australia who are Australian citizens, New Zealand citizens or holders of permanent visas. Some visitors and temporary residents, from countries with which Australia has made reciprocal health care agreements, are eligible for Medicare with some restrictions.

 

Hospital care under Medicare

 

All people eligible for Medicare are entitled to a choice of:

• Free accommodation, and medical, nursing and other care as public patients in

State/Territory-owned hospitals, designated non-government religious and charitable hospitals, or in private hospitals which have made arrangements with governments to care for public patients; or

• Partially subsidized treatment as private patients in public or private hospitals, with some assistance from governments.

 

Other services under Medicare

 

Costs incurred by patients receiving private doctors’ services and some optometry services and dental surgery, whether in or out of hospital, are generally reimbursed either fully or in part by means of Medicare benefits.

 

Medicare benefits cover services by doctors, refraction testing by optometrists, and, in some circumstances, certain specialized dental surgery services. Medicare benefits are payable for services by nearly all doctors currently registered in an Australian state or territory. Newly registered doctors are generally required to enter further training before their services can attract Medicare benefits, unless they have already qualified as general (primary) practitioners or as formally recognized specialist doctors.

 

Medicare benefits are not payable for medical services rendered outside of Australia. The Commonwealth Government’s Medicare Benefits Schedule lists the consultations, procedures and tests for which claims can be made, and the Schedule fee applicable for each of these items.

 

Although Schedule fees are used to calculate Medicare benefits entitlements, doctors can charge whatever fee they wish, provided the service is not ‘bulk-billed’. The rate of benefit for out-of-hospital medical services, such as visits to a doctor in his/her rooms, is at least 85 per cent of the Medicare Benefits Schedule fee. For the more costly services, the benefit is raised to ensure that the difference between the benefit and the Schedule fee (the ‘gap’) is limited.

 

Private specialist doctors’ services under Medicare

 

For some kinds of medical services, Medicare requires that a doctor who has been formally recognized as a specialist provide the service, and that another doctor has referred the patient to the specialist. If these requirements are not met, either no benefit is payable or the benefit is lower.

 

For most pathology and diagnostic imaging services, Medicare benefits are paid only when another doctor has referred the patient to the doctor providing the pathology or imaging service. These requirements are in place in order to constrain costs by removing financial incentives to obtain unnecessary specialist services. As a consequence, most access to specialist medical services is on referral from general practitioners.

 

Billing arrangements for private medical services under Medicare

 

Patients may claim Medicare benefits in the following ways:

  • Pay the doctor’s account and then claim the benefit from Medicare; or
  • Obtain from Medicare a cheque for the benefit, payable to the doctor, and then give the cheque, and any balance, to the doctor.

 

Claims may be made either by post or over the counter at Medicare offices or agencies. Alternatively, doctors can send accounts directly to Medicare, accepting the Medicare rebate as full payment for the service. This arrangement is known as direct billing or ‘bulk billing’. Since the doctor, or any other person, may not make any additional charge relating to a bulk-billed service, there is no out of pocket cost to the patient. Unless a service is bulk billed, Commonwealth law does not restrict the level of the fee charged.

 

Medicines/pharmaceuticals

 

The Pharmaceutical Benefits Scheme (PBS) aims to provide all Medicare-eligible persons with access to effective and necessary prescription medications at a reasonable cost to the patients and to the government.

 

Pharmaceutical benefits are paid as cash transfers direct to around 4800 approved community pharmacies that dispense PBS medications on a claims reimbursement basis. The PBS also provides other forms of assistance to improve affordable access to medicines, for example specific funding for public hospitals for certain high cost drugs, such as immunosuppressants used in transplantation.

 

It is estimated that around 75 per cent of all prescriptions dispensed in Australia are

subsidized under the PBS. The other major source of subsidized medicines is public hospitals, where medicines are provided free to in-patients. The Commonwealth pays around 83% of total PBS costs. The remainder is funded by patient co-payments.

 

Under the PBS all eligible persons fall into one of two categories, which determines the amount the patient contributes and the amount of subsidy paid:

• Concessional category - People who receive certain pensions, benefits or cards administered by the Departments of Family and Children’s Services (FACS) or Veterans’ Affairs (DVA), or who meet certain criteria for being declared to be disadvantaged; or

• General category - General patients pay the cost of dispensed medicines up to a maximum amount per item.

 

Where the dispensed price of a drug is above that maximum, the general patient pays that amount and the PBS pays the balance up to the listed price. If the prescription involves a more costly but equivalent brand, the subsidy may be limited to the lower cost brand (the minimum pricing policy).

 

Concessional patients pay a smaller amount per item than general patients do, and the

PBS pays the balance up to the listed price. This is also subject to the minimum pricing policy. Pharmacists must check patients’ entitlement cards before providing medicines at the concessional rates. Concessional patient prescriptions comprise 80% of the total Government Expenditure on the PBS.

 

A safety net arrangement applies when the total amount of co-payments paid by a patient (or immediate family) in a calendar year reaches a certain threshold. From that time until the end of the calendar year, the co-payment reduces to a smaller amount, with the benefit paid to the pharmacist increasing. In the case of concessional patients the safety net threshold is lower; and when it is reached no co-payment is required for the rest of the calendar year.

 

Specific federal government grants for health care services

 

Under Medicare, the Commonwealth government provides a range of grants to government and non-government bodies in order to achieve specific health care objectives. These include:

·        The provision of services to special needs groups such as people in rural and remote areas, Aboriginal and Torres Strait Islander peoples, and people with mental illness;

·        Funding of medical services that involve the use of expensive equipment, for example the capital component of radiotherapy services performed on specific approved equipment; and

·        Improving general medical practitioner and associated services.

 

The Medicare levy

 

When Medicare began in 1984, the Medicare levy was introduced as a supplement to other taxation revenue to enable the Commonwealth Government to meet the additional costs of providing the same level of care for the whole population, over the previous system. Medicare levy revenue provides the equivalent of only around 27 per cent of Commonwealth funding for Medicare. The rest of Medicare is funded by a range of taxes such as income tax, taxes on sales of goods and services, and non-tax revenue which together form consolidated revenue. Parliament appropriates funds for most government programs from consolidated revenue.

 

The Medicare levy is paid by individuals at a basic rate of 1.5 per cent of taxable income above certain income thresholds. Taxpayers on high incomes who do not have private health insurance pay an additional 1 per cent of taxable income as part of the levy.

 

Private Health Insurance

 

Private health insurance is an important component of funding of heath care in Australia, providing about 11 per cent of total national health care funding. For insured people it provides added benefits such as choice of doctor, choice of hospital and choice of timing of procedure. Private insurance can also assist with meeting the costs of private sector services that are not covered by Medicare, such as dental, optical, physiotherapy and podiatry services.

 

The Commonwealth regulates insurance offered by registered health insurance organizations to ensure that the principle of community rating is maintained.

Community rating means that health funds must charge everyone the same premium regardless of the health status or claims history. This ensures that private health insurance is open to a wide range of people in the community and that the aged and chronically ill are not priced out of private health insurance.

 

In order to support community rating there is a system of ‘reinsurance’ in place that redistributes the costs of claims for the elderly and those in hospital for an extended period across all private health insurance funds. This ensures that health funds with a high proportion of these higher cost members are not disadvantaged.

 

There are over forty private health insurance funds registered by the Commonwealth.

Most of these are open to everyone, but some only offer cover to restricted groups such as employees of a particular firm. In order to ensure that there is a balance between the public and private health sectors in Australia the Commonwealth Government has introduced a number of measures to address the affordability, stability and attractiveness of private health insurance.

 

Issues to Consider:

 

a)      The RACGP has formally acknowledged that GPs play a pivotal role in identifying and addressing inequalities in health care. Health inequalities are unjust, unfair and avoidable differences in health status or health care based on social position or economic circumstances. How might Hazel’s management differ if she had private health insurance or a DVA Gold Card? Is this a health inequality?

 

 

 

 


Summary:

 

This case illustrates many concepts central to population health. As a GP you are in an important position to apply population health strategies to your patient groups. This implies a shift in focus from the individual to the population. This case demonstrates the link between the individual and population approaches. In practice, this shift of focus is not always easy to make as we often feel that our obligations are to the individual patient rather than to the population.

 

As a result of completing this case you should have a better understanding of the Australian health care system (including funding mechanisms and policies), be more aware of the sources of population health data in Australia, understand the concepts underpinning good clinical practice guidelines, and be conscious of the need for practice systems that allow you to integrate population health strategies such as screening, recall and the use of clinical practice guidelines into healthcare delivery.
References and Further Reading:

 

Economics of hospital care. In G. Mooney & R. Scotton (eds), Economics and Australian Health Policy.

 

Swerissen, H., & Duckett, S. (2002). “Health Policy and Financing”, in H. Gardner & S. Barraclough (eds) Health Policy in Australia (second edition).

 

Arthritis and other musculo-skeletal disorders. In: Australian Institute of Health and

Welfare. Australia’s Health 2000. Canberra. AIHW. Chapter section 2.4.2: pp97-102.

 

Wright J, Williams R, Wilkinson JR. Development and importance of health needs

assessment BMJ 1998;316:1310-3.

 

Wilkinson JR, Murray SA. Assessment in primary care BMJ 1998;316:1524-8.

 

Department of Health and Ageing. The Australian Health System – An Outline. September 2000.