Monday, October 11, 2010

CORPORATISED MEDICINE – A BLESSING OR A BURDEN FOR CONSUMERS?

The Sydney Morning Herald has been running a few articles about corporatised medicine this week.  HCCA has had concerns about this development as it has applied in the ACT, especially after the closure of corporate practices in Wanniassa and North Canberra a couple of years ago, and the forced re-location of their doctors to corporate medical centres in the town centres.

Corporatisation of General Practice is becoming increasingly commonplace in Australia.  In 2006-7, only 8.2% of general practitioners were working solo, while 56.1% worked in practices with five or more doctors, although not all of these could be classed as fully corporate practices in the way this is generally understood.  The attraction of corporate medical clinics, such as those run by Primary Health Care, Sonic Health and Healthscope, seems obvious if you are a GP.  Joining a corporate clinic means that the administrative costs and procedures are dealt with by the company and not the doctor, alleviating an area of concern for many general practitioners.  In addition, generous “sign-on” fees are often offered to entice GPs into selling practices.  However, GPs who “sign-on” with a corporate clinic agree to work a certain number of hours and to sacrifice as much as a half of their billings to the corporation.

As a result of this system, insiders claim that GPs working in corporate clinics are pressured into cramming more patients into consultation hours, reducing time spent with each patient and increasing profits.  The “all-in-one” service approach of many corporate clinics has drawn criticism as well.  Many clinics house various diagnostic services such as pathology and x-ray, meaning that it is financially desirable to have patients take advantage of such services “in-house”. 

For consumers, there are both benefits and disadvantages to this arrangement.  For example, most corporate clinics bulk-bill patients as in a large practice this is financially viable.  In house diagnostic services are also a positive, when they are employed appropriately.  However, these gains may come at the loss of continuity of care for patients, as in a corporate clinic patients do not usually have a regular doctor, but see whichever GP is available at the time.  Also, there has been a disturbing recent trend in some corporate clinics to demand an upfront payment from those presenting for services at a clinic, and this is not refunded even if a disgruntled consumer leaves to seek treatment elsewhere because of long wait times.

The unfair treatment of GPs in this environment where profit is the biggest motivator has garnered media attention in NSW in recent days.  Primary Health Care has been accused of demanding that doctors complete more hours on the end of their contracted time in order to make up their quota.  GPs claim they have been threatened with litigation by the health care giant. 

HCCA stands against this type of corporatised medicine which does little to embrace the new paradigm of patient-centred care being promoted by the Australian Commission on Safety and Quality in Health Care.  In 2008, HCCA supported a rally to try to keep the GP clinic at Wanniassa open, and later appeared at a Legislative Assembly inquiry into GP shortages, noting that centralisation of GP resources into town centre locations did little to make access to GPs any easier.

Details of past HCCA positions on GP clinics and more information about people centred care can be obtained from the HCCA office.   Remember, GPs are people too.  Please let HCCA know if you have had any recent positive or negative experiences with corporatised medicine in Canberra or NSW, and we will feed this back to the Commission in response to its consultation paper on patient-centred care.  There are other potential solutions to the problems that have led to the development of corporate GP clinics.  Better public primary healthcare services through enhanced community health centres incorporating nurse practitioner led walk-in clinics and collective practices such as Super Clinics supported by Commonwealth Government funded infrastructure are two new models we would support in Canberra.  Let’s hope the current reforms in health policy settings will give more support to these options.

Russell McGowan

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