AMA’s aged care budget requests

In this story:

• AMA federal budget submission
• ANF response
• Health workforce report 2011

By Natasha Egan

Aged care homes must have adequate medical treatment facilities including private clinical areas and technology that allows access to medical records and improves medication management, the peak body for Australian doctors has called for in its budget submission paper.

In its 2013-14 federal budget submission concerning aged care, the Australian Medical Association (AMA) is also calling on the government to provide adequate nursing, funding to improve arrangements between providers and doctors, and increases to a number of Medicare rebates to improve services for older people.

The Australian Nursing Federation said today that any changes to the Medicare rebate system would need to go through stringent processes. 

On releasing the submission, AMA President Dr Steve Hambleton said health spending should be prioritised to go toward programs and services with strong evidence of direct benefit to patients. 

“The Government has announced major policies in the areas of aged care and mental health. Where there is evidence that things can be done better, the government must take the advice of clinicians at the front line and shift or re-prioritise funding accordingly,” Dr Hambleton said.

Key areas concerning aged care in the AMA submission:

• Aged care to make appropriate facilities available for visiting doctors 

• Adequate nursing care in the aged care sector 

• Additional funding to support arrangements between aged care providers and medical practitioners 

• Doubling of the Medicare rebate for medical and dementia care services 

• An extension of Medicare items for video consultations with aged care residents and patients who are immobile

• Dedicated Medicare rebates for end-of-life medical care

• Community aged care services, including home visits, linked to the recipient’s medical services 

More detail and ANF response

The submission highlights that while the demand and complexity of health care services for older Australians is growing rapidly, so is the difficulty for medical practitioners to provide the required care in the context of their day-to-day surgical practice.

“An AMA survey of medical practitioners working in the aged care sector shows that the medical workforce is ageing and individuals are starting to cut back their visits, and that younger doctors are not moving in to fill the gap,” it says.

To meet the needs of residents, the residential aged care sector must be able to provide an adequate level and quality of medical and nursing services, it says.

The submission calls aged care to make appropriate facilities available “including adequately equipped clinical treatment areas that afford patient privacy, and information technology to enable access to medical records and improve medication management” and nursing care that meets “the needs of residents and support the ongoing medical care of residents”.

The ANF agrees with both of these measures, Assistant Federal Secretary Yvonne Chaperon said.

“As aged care requires qualified registered nurses, enrolled nurses and assistants in nursing who are regulated to deliver safe quality care. The skill mix of RN EN and AIN needs to meet the clinical and care needs of the residents,” she said.

“The heavy workloads in aged care also need to be mandated.”

To ensure ongoing access to medical care in residential aged care, the AMA says funding should be given to encourage and subsidise arrangements between facilities and medical practitioners.

Medicare rebates

As Medicare rebates for ongoing medical and dementia care should reflect the time and complexity provided by medical practitioners and practice nurses, the rebate to be doubled for such services, the AMA submission says.

The submission makes the case that efficiency gains in medical provision could be achieved if the Medicare rebate is extended to include items for general practitioner video consultations with aged care residents and housebound patients.

Likewise, in order to improve palliative care in residential and community aged care the AMA is calling for the introduction of dedicated Medicare rebates specific to end-of-life medical care.

Regarding community aged care, the AMA submission says services, including home visits, should be comprehensive, individualised and linked to the recipient’s medical services, which are coordinated at the practice level.

Ms Chaperon said Australia’s aged care sector was undergoing wide-ranging reform as part of the Federal Government’s Living Longer Living Better package and funding for this sector was being closely examined by government, consumers, unions, and health care professionals.

“Accordingly, any changes to the Medicare rebate system must pass through stringent processes,” Ms Chaperon said.

“Telehealth funding is currently available for patients and residents who are unable to get to visit a specialist consultant usually because they live regionally, rural or are in an aged care facility,” she said.

“This could possibly be extended to general practitioners within certain guidelines but a lot of consultation with the health care sector would need occur before this is realised.”

For more, see the AMA’s 2013-14 federal budget submission for aged care.

Elsewhere in the submission the AMA is calling for the government to use the May Budget to take action to minimise the red tape for health professionals.

It further asks that the commonwealth and state governments work together, make every dollar count and put patients’ interests first.

See here for the complete AMA Federal Budget Submission 2013-14

Health workforce report

Elsewhere this week, Dr Hambleton (pictured) said the real decline in general practitioners raises serious concern about patient access to quality primary care.

He made the comments in response to the Medical Workforce 2011 report which found growth in Australia’s overall medical workforce, but a relative decline in GPs.

In 2011 there were 78,833 medical practitioners employed in medicine compared to 67,208 in 2007, an increase of 17.3 per cent the Australian Institute of Health and Welfare report found.

Of those, 93.8 per pent of doctors were working as clinicians – 33.1 per cent as specialists and 33.9 per cent as general practitioners.

However, in 2007 for the 93.2 per cent of doctors who were working as clinicians, 38.5 per cent were general practitioners and 34.6 per cent specialists.

“The good news is that there was a 17 per cent increase in the number of doctors between 2007 and 2011,” Dr Hambleton said.

“On the downside, the report shows that general practice is still not getting its fair share of the growth in workforce numbers.”

Elsewhere Dr Hambleton noted that while there was also an increase in the supply of doctors working in rural and remote areas, the rural medical workforce was still lagging well behind the metropolitan workforce.

The uneven distribution of Australia’s medical workforce highlights decreases in the supply of some key specialty areas, he said.

“The supply of specialists-in-training, specialists, hospital non-specialists and other clinicians all increased, but the supply of GPs fell from 111.9 to 109.7 full time equivalent per 100,000 population between 2007 and 2011,” Dr Hambleton said.

The AMA is calling for further investment in general practice to help build the GP workforce to sufficient numbers to meet community need, he said.

For more, see the Medical workforce 2011 report.