Medicare ‘blended’ funding model raises temperatures

The allied heath sector is pushing to be funded independently of GP clinics under a reformed Medicare.

Australian Physiotherapy Association national president Scott Willis Picture: Jesse Spezza

The allied heath sector, including physiotherapists, podiatrists and dietitians, is pushing to be funded independently of GP clinics under a reformed Medicare, hitting out at doctors’ insistence they be the “gatekeepers” of team-based care and funding.

Nurses, exercise physiologists and even paramedics are set to be integrated into the primary care system with their services funded by Medicare for the first time under the biggest shake-up of the public health insurance scheme since its inception.

But some doctors say the reforms will undermine the role of general practitioners and result in even greater unsustainability of the sector amid plummeting numbers of medical graduates signing up to specialise as GPs. They want an immediate injection of funding to shore up general practice. However, federal health minister Mark Butler has indicated any rebate increase will not be forthcoming.

The Australian Medical Association and the Royal Australian College of GPs have broadly backed a shift to a “blended” funding model, which would be a mix of fee-for-service funding to GPs for episodic care and a separate pool of funds to provide for complex team-based care to combat the rising tide of chronic illness.

But the RACGP is insisting all funding be delivered directly to GP clinics, with primary care doctors acting as the “stewards” of multidisciplinary care.

In contrast, the allied health sector wants block funding for multidisciplinary health to be delivered via the federal government’s Primary Health Networks, which would then employ or contract allied health practitioners to deliver services to patients.

“I think we need to put the patient at the middle of this to look at true health reform and not just pump more money into what we’re doing at the moment,” Australian Physiotherapy Association national president Scott Willis said. “We need to look at different models of care.”

Almost one in six GP visits are related to musculoskeletal concerns. Physiotherapists say if they could provide expert diagnosis and treatments for patients directly without the GP having to provide the referral it would mean a more efficient system, and millions of Australians would gain access to physiotherapy services who currently could not afford it.

The APA wants a UK-style funded First Contact Physiotherapy model in Australia alongside the introduction of Urgent Care Clinics, which it says would shift the health system towards a preventative approach. Currently GPs are offered incentive payments to employ nurses and other allied health staff, but peak body Allied Health Professions Australia says the model has amounted to “tinkering around the edges”. “We can’t let the vested interests of the past dictate the future of our health system,” AHPA chair Antony Nicholas said.

Mr Nicholas said the Workforce Incentive Program had become “just another GP business subsidy”. “The point of the WIP was to increase multidisciplinary care and we haven’t seen any data to show that that has actually ­occurred,” he said.