Health Care Homes – Blog 4 of 4 part series
Most general practices we work in these days are struggling to remain viable whilst continuing to offer a high standard of healthcare. If they are still bulk billing it is not uncommon for doctors to see 50 patients per day and patients to wait over an hour to be seen. I am finding if practices are not already charging patients a gap fee they are talking about introducing one. Practice owners are thinking creatively about how to generate more income. Every second practice we visit seems to be offering cosmetic services to supplement their income stream. There has also been a significant increase in allied health professionals joining general practices and consumables for sale.
However in other areas of Australia patients simply cannot afford to pay and will not seek healthcare for themselves or their children if there is a fee. In private billing practices receptionists have mentioned an increase in patients cancelling their appointments and stating the reason they are postponing is because the appointment is “before payday”.
Healthcare for the wealthy
At the other end of the spectrum are healthcare providers in the more affluent areas of our capital cities. I have seen what I call ‘concierge’ medicine models emerge. By this I mean small numbers of regular patients who pay over $300 per consultation. There is no waiting time, most consultations last an hour and many patients do not seem concerned about claiming a Medicare rebate at all. Patients pretty much have ’24/7 access’ to their doctor as well as flexible care delivery options. Much easier of course when not restricted by Medicare rules and limited income. I have seen this model with ‘holistic’ general practice medicine and also with pain specialists. This patient-centred approach has the benefits of both continuity and co-ordination of complex care needs.
And then there are of course the Emergency After Hours Private Centres who charge $485 for a standard consultation with a very minimal Medicare rebate. Again, in affluent suburbs some patients do not hesitate to pay for benefits such as immediate access to care by fully qualified and highly experienced doctors.
New models
Our two previous blogs discussed Australia’s ‘Health Care Home’ official trial sites. With this model patients ‘register’ with a Health Care Home practice and the practice is paid a fee (by the government) according to the complexity of the patient’s needs. Other models exist where patients register with a particular practice and pay the practice an annual ‘membership fee’. I have heard of practices (especially in Canberra) operating with this business model for many years. The fee may be in exchange for reduced fees at consultation or bulk-billing at consultation.
Osana Care in Sydney have also decided on a ‘registration’ model. Osana Care is currently setting up in affluent areas of Sydney and I understand is funded by wealthy investors. With worthy goals and an innovative approach, it will be interesting to watch and learn. I believe the model is being studied by Australian researchers. You can hear Dr Kevin Cheng discuss this new model here.
Summary
Health Care Homes, ‘consumer-centred’ care, registration and capitation – I know these new models and funding uncertainty is worrying healthcare providers. Let’s study the successes and challenges faced by New Zealand, United States, United Kingdom and other countries as they have implemented large-scale change with varying levels of success. Let’s encourage our own innovators and work together to ensure we don’t go backwards and can continue to provide affordable, high quality healthcare for all Australians.
Over the next 3 weeks I will be undertaking my own independent ‘person-centred’ US study tour. You can follow via this blog, Facebook, Twitter or Linked In.
With best wishes, Katrina Otto
Free Resources: We will continue to update our ‘Health Care Homes’ free resources page with links and relevant blogs. Start here: Health Care Homes & The Person Centred Health System and the Medical Home