Health beyond the horizon

A tax on disease will hit us all.

Flickr / Brenden Ashton

Sad irony last week as the Australian federal government announced their renewed intention to introduce a financial co-payment for primary care (albeit now re-presented in a cunning new form) in the same week we were celebrating University Health Coverage Day.

The former, a polls-inspired reformulation of the $7 planned GP fee that instead is now planned to be pinned on doctors - providing them the “choice” to pass it on to those they care for, or take a personal pay cut. A co-payment that by definition is intended to make people rethink a visit to the doctor through a financial barrier to care. In essence, a tax on disease.

The latter, a day that celebrates the basic concept that health is a right, not a privilege - an investment, not just a cost.

Struggling to bridge the gap between the progressive global rhetoric and bold statements of needing to close gaps in healthcare within and between populations - and our very own policy announcements that threaten to do the opposite - I turned to procrastination.

Facebook, to be precise.

Much to my bewilderment, I came across an insightful post from a colleague of mine, on this very topic. A former medical school classmate and a global thinker, she wrote a passionate, caring reflection on her viewpoint as a GP-in-training, a public health graduate and a concerned Australian citizen.

I wanted to share it with you.

Reflection from a young GP

Dr Mariam Tokhi

“This year I started General Practice training. My last two medical jobs were as a Medical Registrar at the Alfred Hospital in Melbourne, and as an Obstetrics Registrar at Alice Springs Hospital: both jobs with intense workloads and hours. But family medicine is the toughest gig I’ve ever had. I get 15 minutes to work through the presenting complaint, plus the five other issues that the patient has stored up in anticipation of this appointment. And I’m expected to be compassionate, efficient and a good diagnostician. (Try running on time when 50% of your patients cry during their appointments!)

I see people at their most fragile, and help them to work out an encouraging, realistic plan for their health - and I’m in it for the long haul. GPs are Australia’s first responders to most acute and chronic medical problems. We also manage the bulk of mental health issues, help with social stresses, coordinate patients’ interactions with specialists and allied health, and are strong advocates for preventative health care. We are expected to practice up-to-date & evidence-based medicine, use resources judiciously and have a breadth of medical knowledge unknown to any other specialty. Done well, its good stuff.

Co-payments (whether mandated by law, or coerced by regulatory funding cuts) damage general practice and the care we want to provide. Cutting GP rebates undermines the value of general practice, and is unsound health policy. If the point of co-payments is to deter people from going to their GP, then the government is missing the point. Using co-payments as barriers to access will lead to: less attendances, later (sicker) presentations, costly hospitalisations, and ultimately worse health for my community. Primary care is the only clinical specialty that consistently saves money, and protects health. I chose to work in it because I loved it, and I was proud of the Australian primary care model that once looked after ALL Australians.

As a health practitioner, it is easiest to engage with people who are motivated and interested in their own health. But, this rebate reduction will hurt those of my patients who struggle the most to engage with the healthcare system (and who often need care the most): people with mental health issues, parents whose kids have disabilities, older people with chronic illnesses and families with financial difficulties.

Australia has a world-class healthcare system (which costs Aussie taxpayers roughly half as much as American taxpayers - for better, universal healthcare). This policy is a backwards step in the development of our healthcare. We’ve all heard that prevention is better than cure: another truth is that prevention is cheaper than cure. I see patients every day for what at first glance appears to be a simple cold, or a sprained ankle— but who (if encouraged) will engage in a discussion about quitting smoking, limiting their alcohol or reducing their risks of diabetes, heart disease and sexually-related illness. GPs should be supported to provide this comprehensive care, taking the time to help patients proactively live healthy lives.

A visionary government would be investing in this: recognising that GPs don’t just care for the sick, but also help build healthier societies by protecting health and preventing illness.

Good quality, affordable primary care saves money and lives. Co-payments will compromise this, and ultimately cost our health system much more than it can save. I hope that Australians will protest Abbott’s cost-shifting strategy, and stand up for the health of our communities”.

A sound reflection from the frontline.

A tax on disease?

We live in testing political times. A time when many nations around the world are having to make decisions on how best to spend increasingly tightening budgets. As Universal Health Coverage Day passes, let’s not forget a few things.

First, that healthcare is not just a cost. Good primary care is an investment, and prevention actually saves us money.

Second, that saving dollars cannot come at the cost of suffering, exclusion or through policies that increase the already growing divide between the ‘have’ and ‘have not’.

Finally, that ultimately we all have a choice in how we choose to treat those most vulnerable members of our society. But that society prospers when everyone prospers. Health is a right, and we should be demanding that our governments respect and uphold that right - not only for ourselves, but particularly for those most at risk.

This is not just about Mariam, or ideology, or a tax of illness - this is about our health.


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