Reflections on the NHHRC Interim Report

Like the very best sort of underwear, the Interim Report from the NHHRC Commission is important as much for what it conceals as what it reveals.

What is revealed in the report is the support of the Commission for a strong primary care sector, with many of the features recommended in the CPD’s occasional paper A New Approach to Primary Care for Australia.  These include the expansion of the Government’s ‘GP Superclinics’ policy so that more Australians have access to coordinated and integrated primary care services from a range of health care professionals.

The report emphasises the benefits of primary care in preventing and managing chronic disease, reducing unnecessary hospital admissions and increasing equity of access to health care. It also makes a strong case for better coordination of care, both within the primary care sector and between it and other areas of the health system.  These recommendations reflect the views of many health interest groups and experts and will have strong support within the sector.  They are the most likely to be accepted by the Government, at least in principle.

More controversially, the report also recommends patient registration for specific groups of consumers within primary care, in particular those with chronic illnesses and young families.  The aim of this is to improve the quality and coordination of care provided by tying payments to outcomes and (over time) replacing fee-for-service funding with “bundled” payments for a course of care or over a period of time.  Both doctor and consumer groups are likely to be concerned about how patient registration may impact on their members and addressing these concerns will be a major challenge for the implementation of the recommendation, should it be accepted by Government.

The recommendation to replace the current Divisions of General Practice with Divisions of Primary Care with increased population health responsibilities will also attract opposition from some elements of the medical profession nervous that this will reduce GP control over primary care.  This could result in an interesting scenario within medical politics as the AMA, which has never been a champion of Divisions, will be forced to either advocate for their continuation or support a policy which will direct Divisions’ program funding away from doctors towards other health professionals.  Without a united opposition to the recommendation from the medical sector, it will be much easier for the Government to go ahead with this recommendation.

What is concealed in this report is, unfortunately, a reluctance by the Commission to address some of the more fundamental issues facing both primary care and the health sector more generally.  The report makes unsubstantiated statements supporting the current balance between the public and private provision of care and fee-for-service payment systems without considering whether there might be better alternatives.  This omission means that major reforms in health financing are unlikely to result from the Commission’s final recommendations to Government.  For such an eminent group with such wide-ranging terms of reference this is a disappointment and represents a missed opportunity to improve some of the structural problems that undermine the quality and efficiency of our health system.