So what does the Productivity Commisioner Report say ?


We woke this morning to the headlines screaming out:

“Aussies making ‘avoidable’ hospital visits due to poor GP access”

 

It makes for seemingly depressing reading in regards to how poorly GPs are looking after their patients:

  • GPs are hard to access
  • GPs cost a fortune
  • People are putting off seeing their GPs / purchasing their medicine due to costs
  • Chronic conditions are poorly managed

It is however always advisable in such cases to always seek out the source documents and see what it states without the political bias that the media on either side of the divide attach to it.

So this is what the Report states (with my bias as a GP tainting the interpretation):

Money

  • The Australian Government spends $0.98 a day on GP care for every Australian
    • In the ACT they only spend $0.74 a day per person on GP care

2019-01-30 (2)

Note that the ABC article linked above incorrectly states that this cost ($357 per year) is the out of pocket cost for patients which is factually incorrect

(Add. They fixed their error – 03/02/19)

The Medicare Statistics does give the actual out of pocket costs which in Australia is $36.50 per GP visit and in the ACT $43.72 – hopefully the ABC journalist read this blog and do their homework correctly next time

  • 86.5% of “non-referred attendances” were bulkbilled across Australia
    • In the ACT this is 63.5%
      • 75.8% of children under 15 years were bulkbilled
      • 70.6% of those older than 65 years were bulkbilled

                    I would urge caution on this stat as the report is referring to Medicare  attendances when they are clearly referencing Item numbers and not attendances – the actual bulkbilling attendances would be lower

  • The daily cost spent per person in hospitals is $7.14 across Australia
    • In the ACT it is $10.14 a day

It therefore costs the Government 14 times more to treat a patient in an ACT hospital than to fund a GP so one would consider it a no-brainer that GP services should be supported and expanded

Instead we find Federal Government increasing GP rebates by a mere few cents each year and ACT Government finding much more expensive alternatives to compete with GPs

Workforce & Accessibility

  • In the ACT there are 76 FSE GPs / 100, 000 people.
    • Nationwide there are 101.5 FSE GPs/100, 000 people
  • There are 309 Female GPs in the ACT adding up to 145 FSE positions
  • There are 252 Male GPs in the ACT adding up to 172 FSE positions
  • Across Australia 63.3% of people could get to see a GP within 4 hours
    • The corresponding ACT statistic looks less ideal (39.4%) but this datapoint has a very large margin of error and is thus unreliable
    • 22.4% of ACT residents could however get to see a GP within 24h

This statistic is however flawed unless it is very clearly identified if a patient had chosen access to ANY GP at ANY time. 

Any experienced GP will recognise that this specific issue is hugely influenced by

  1. Patients insisting on seeing a specific GP and not the one(s) that was available
  2. Patients insisting on being seen at a time that suits them and not when the GP is actually available
  • Keeping the preceding caveat in mind it is re-assuring to note that 81.8% of patients in Australia did not feel that they had an unacceptable wait to see a GP in the preceding 12 months
    • In the ACT 77.5% of patients felt this way

Patient behaviour

  • 6.5 GP-type services are used annually per person across Australia
    • In the ACT this is only 5.0 services

2019-01-30

  • 96% of Australians do NOT defer going to a GP across Australia due to cost
    • In the ACT 92% of people did not defer going due to cost.
  • 93% of patients across Australia did not defer picking medication from their pharmacy due to the costs
    • In the ACT this was 92.9 %

This is much more a reflection of attitude than true financial hardship given that the ACT has the highest median wage in the country

This figure has also been relatively static in the ACT over the last six years.

  • The report lists 2,850 013 “potentially avoidable GP-Type presentations” to Emergency Departments in 2017-18
    • In the ACT this was 53, 041

This is most definitely the single most flawed section of this report.

These presentations are defined by them as:

  1. The type of visit was reported as an emergency presentation
  2. Did not arrive by ambulance, police or other correctional vehicle
  3. Was triaged as a semi-urgent (cat 4) or non-urgent (cat 5)
  4. Was not referred to another hospital, admitted or died

To define these presentations as GP-type attendances is simply wrong and as far back as 2013 Researchers have been pointing out that the AIHW methodology seriously overestimates the actual proportion of GP – type presentations.

More rigorous methodologies estimate that true GP-type presentations make out less than 5% of the total ED length of stay 

This HUGE flaw in the report has been totally overlooked by the media who just ran with the populist headlines

GP Behaviour

  • 89.5% of Australians felt that their GPs always/often listened carefully to them
  • 92.8% felt that their GP always/often showed respect towards them
  • 88.4% felt that their GP always/often spent enough time with them
  • GPs performed 2, 765, 321 GP Management Plans for patients in 2017-18
  • 2, 348, 046 Team Care Arrangements were performed during the corresponding period
  • These items were reviewed 3, 696, 322 in this time

2019-01-30 (1)

Chronic Disease

  • The report states that 50.5% of diabetics had a blood test showing that their diabetes was perfectly controlled.

The media jumped on this as an example of how poorly chronic disease is managed – conveniently leaving out the fact that this particular dataset

dates back to 2011-12.

It is hard to fathom what it is even doing in the 2017-18 report.

  • 80.3% of all vaccinations to Children under the age of seven were provided by GPs

 

My overall summation of the Productivity Report is that GPs are doing an amazing job and that they cost the Government, and patients, less than what most Canberrans spend on their hairdressers or on takeaways each year.

 

Ironically the Pharmacy Guild saw this debate as an opportunity to once again campaign for changes within Community Pharmacies.

One would have though that their focus would be on how to do something to assist the 7% of the population who cannot afford their medication – unfortunately they instead saw it as an opportunity to argue for a broadened scope for clinical services for community pharmacies.

I would considered this a home goal and a missed opportunity

This entry was posted in Medical workforce issues, Medicare, walk in clinics and tagged , , , , , . Bookmark the permalink.

1 Response to So what does the Productivity Commisioner Report say ?

  1. Ewen McPhee says:

    Reblogged this on Rural General Practice and commented:
    To quote an infamous millionaire “Wake up Australia” fake news, politicians looking for simple sound bites, and the guild an opportunity to expand its business. Another political report be people without expertise in the field & flawed data. We’ve one of the best health systems there is, it could be better, but improvement will only happen through sound analysis, rationally applied principles and rebalancing the system to prevention, early intervention & addressing social issues in community. Well done Thinus, another great blog

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