How Medicare Rebate cuts may impact the patient, other than cost
Previously I looked at the financial aspects of the proposed cuts to the Medicare Rebate. This article assumes knowledge of the previous article. There are non-financial impacts we seriously need to consider. In this article I look at Continuing Professional Development (a doctor impact) and treatment delay (a patient and community impact).
Policies, based only on financial
considerations, that discourage people from seeking treatment at the
earliest (and therefore cheapest) opportunity are knee-jerk reactions
at a momentary point in time with no thought for the future or the
non-financial impact of those policies. Research shows such short-term
“savings” actually result in higher costs and sicker people in the
long-term.
considerations, that discourage people from seeking treatment at the
earliest (and therefore cheapest) opportunity are knee-jerk reactions
at a momentary point in time with no thought for the future or the
non-financial impact of those policies. Research shows such short-term
“savings” actually result in higher costs and sicker people in the
long-term.
Mother and newborn
Medical Knowledge/Continuing Professional Development
Doctors hold our health in the palm of
their hands. Yes, we, the patients, certainly have a major part to play
in caring for our own health, but the reality is the doctors decide what
tests to run, what medications to prescribe and whether we need to see a
specialist or a surgeon.
their hands. Yes, we, the patients, certainly have a major part to play
in caring for our own health, but the reality is the doctors decide what
tests to run, what medications to prescribe and whether we need to see a
specialist or a surgeon.
In order for doctors to care for us in
the best way possible, they can’t be consulting all the time. We expect
the medical profession to keep up-to-date with advances in the field.
Again I will use my own case as an example. The RF (Rheumatoid Factor)
test had been the stock standard test for Rheumatoid Arthritis (RA) for
many years, well over half a century. Unfortunately, specificity is not
very good: IgM RF, the isotype most typically detected, is seen not only
in RA but also in various other conditions. Also, some RA patients
never test RF positive. There is a new (relatively speaking in research
to commercially available terms) blood test, the anti-CCP with
much higher specificity and in many cases earlier detection of RA.
Earlier detection leads to earlier treatment resulting in better
outcomes.
the best way possible, they can’t be consulting all the time. We expect
the medical profession to keep up-to-date with advances in the field.
Again I will use my own case as an example. The RF (Rheumatoid Factor)
test had been the stock standard test for Rheumatoid Arthritis (RA) for
many years, well over half a century. Unfortunately, specificity is not
very good: IgM RF, the isotype most typically detected, is seen not only
in RA but also in various other conditions. Also, some RA patients
never test RF positive. There is a new (relatively speaking in research
to commercially available terms) blood test, the anti-CCP with
much higher specificity and in many cases earlier detection of RA.
Earlier detection leads to earlier treatment resulting in better
outcomes.
As a patient, you expect your doctor to
know about new tests. Continuing Professional Development (CPD) takes
time (up to 50 hours a year is specified in some cases) and effort and
can be costly. Certainly my general practitioner may be able to learn
about a new blood test from a medical journal or a medical association
newsletter, but these cost. Journal subscriptions and association
memberships don’t come free. There is the time required to read the
information, absorb it, understand it. This is all non-revenue
generating time.
know about new tests. Continuing Professional Development (CPD) takes
time (up to 50 hours a year is specified in some cases) and effort and
can be costly. Certainly my general practitioner may be able to learn
about a new blood test from a medical journal or a medical association
newsletter, but these cost. Journal subscriptions and association
memberships don’t come free. There is the time required to read the
information, absorb it, understand it. This is all non-revenue
generating time.
What of our surgeons? New surgical
techniques are constantly being developed. We can have laparoscopic
hysterectomies these days, a far cry from the full abdominal cut. We
want our surgeons to know the least invasive techniques, don’t we?
Learning these may be a bit more time-consuming and/or expensive than
reading a journal article about a new blood test.
techniques are constantly being developed. We can have laparoscopic
hysterectomies these days, a far cry from the full abdominal cut. We
want our surgeons to know the least invasive techniques, don’t we?
Learning these may be a bit more time-consuming and/or expensive than
reading a journal article about a new blood test.
Remember the days of “exploratory
surgery”? My mother had some of that. Now with modern imaging
techniques, one rarely hears the term. Yet without knowledge of these
advances, our doctors would still be recommending exploratory surgery.
surgery”? My mother had some of that. Now with modern imaging
techniques, one rarely hears the term. Yet without knowledge of these
advances, our doctors would still be recommending exploratory surgery.
Doctors are no different to the rest of
us. They have families, mortgages and household bills. They like to go
to their children’s sports events and school concerts. Date nights with
their spouse are important, just as for all of us. Doctors are normal
people with normal lives. They are entitled to time off.
us. They have families, mortgages and household bills. They like to go
to their children’s sports events and school concerts. Date nights with
their spouse are important, just as for all of us. Doctors are normal
people with normal lives. They are entitled to time off.
Yes, there are some doctors who are very
rich. So are some plumbers and electricians. Most are not. Many have the
added responsibility of running a business: it isn’t just the medical
knowledge.
rich. So are some plumbers and electricians. Most are not. Many have the
added responsibility of running a business: it isn’t just the medical
knowledge.
If we arbitrarily cut the gross revenue
of our doctors, yet the running costs of their businesses and their
family lives continue to increase in line with the overall economy, what
might suffer? I suggest it might be the extra CPD most doctors do to
stay abreast and that impacts on all of us. Or the study diligence will
suffer, perhaps, without them even realising. My profession also
requires CPD but I can tell you right now if the kids need help with
homework, or the dinner needs cooking or the pantry needs restocking, my
professional journal can sit untouched. They’ll do the legal
requirement, of course, but is that enough to be the best when medical
advances are frequent and across the breadth of medical knowledge. Will
they be forced to attend cheaper courses or conferences for a lesser
value learning experience?
of our doctors, yet the running costs of their businesses and their
family lives continue to increase in line with the overall economy, what
might suffer? I suggest it might be the extra CPD most doctors do to
stay abreast and that impacts on all of us. Or the study diligence will
suffer, perhaps, without them even realising. My profession also
requires CPD but I can tell you right now if the kids need help with
homework, or the dinner needs cooking or the pantry needs restocking, my
professional journal can sit untouched. They’ll do the legal
requirement, of course, but is that enough to be the best when medical
advances are frequent and across the breadth of medical knowledge. Will
they be forced to attend cheaper courses or conferences for a lesser
value learning experience?
NB: There is no intention to imply doctors would deliberately compromise their CPD.
Apart from CPD, cost pressures may force
staff reductions in a practice. One nurse instead of two, or one less
receptionist. How will this impact on you? Will medical practices close
and the doctors change professions?
staff reductions in a practice. One nurse instead of two, or one less
receptionist. How will this impact on you? Will medical practices close
and the doctors change professions?
If the doctors do, as they have said they
will have no option but to do, pass the cost of the lost revenue on to
the patients, then we have the potential for the second consideration.
will have no option but to do, pass the cost of the lost revenue on to
the patients, then we have the potential for the second consideration.
Treatment Delay versus Early Intervention
I think we all know these days that the
earlier a medical condition is detected and treatment begun the better
the prognosis for the patient. Breast cancer, colon cancer, rheumatoid
arthritis – the list goes on. In every case you will find the words
“early detection”. When the costs of a medical consultation or tests or
prescriptions become a barrier to seeking medical advice, the condition
worsens. Once the patient is forced through deteriorating health to
finally seek treatment they may be unable to continue to work, they may
die much earlier, they may need much longer and more expensive
treatment. All of this is an unnecessary financial burden to the health
system and consequently to the community. Not to mention the cost to
children who lose parents too early or the spouse who loses a partner.
earlier a medical condition is detected and treatment begun the better
the prognosis for the patient. Breast cancer, colon cancer, rheumatoid
arthritis – the list goes on. In every case you will find the words
“early detection”. When the costs of a medical consultation or tests or
prescriptions become a barrier to seeking medical advice, the condition
worsens. Once the patient is forced through deteriorating health to
finally seek treatment they may be unable to continue to work, they may
die much earlier, they may need much longer and more expensive
treatment. All of this is an unnecessary financial burden to the health
system and consequently to the community. Not to mention the cost to
children who lose parents too early or the spouse who loses a partner.
The following is about the USA experience. Is this really what we want for Australia?
The National Council on Aging found that
25 percent of people with chronic diseases delay or skip medical
treatment because of costs. Families U.S.A. has also studied the effect
of high deductibles and copayments on utilization. According to Kathleen
Stoll, director of health policy, the danger lies in “small medical
problems becoming large medical problems, one of the many
high-deductible pitfalls that consumers need to watch out for.”
Here is a similar study involving children in the Philippines.
In relation to maternal health, the United Nations says:
It is often said that maternal mortality
is overwhelmingly due to a number of interrelated delays
which ultimately prevent a pregnant women accessing the health care she
needs. Each delay is closely related to services, goods, facilities and
conditions which are important elements of the right to health (see Box
4).
Is this what we want for Australia? The word cost is up there in the top left-hand square.
What other non-financial impacts can you contribute to the discussion? I am sure there are many, many more.
Have you, or anyone you know, already ever delayed seeing a doctor
due to the cost or fear of the cost of any treatment? Please share your
experience.
No comments:
Post a Comment