Patient vouchers for care
Australian Doctor
9-Mar-2009
By Paul Smith (
http://www.australiandoctor.com.au/articles/31/0c05f031.asp)
PATIENTS with chronic conditions would be given “credit cards” to buy allied health services under ideas being discussed by the National Health and Hospitals Reform Com mission.
The system would bundle together the money currently being spent through enhanced primary care items. While the funding available would be limited, the services bought by the patient would be determined in consultation with the patient’s medical team.
The idea, discussed by the com mission’s chair Dr Christine Bennett, comes amid growing tensions within the commission about its blueprint for primary care.
The tensions have been caused by a lack of clarity surrounding one of the key recommendations in the com mission’s interim report, which wants to pool the total costs of caring for enrolled patients.
The recommendation states: “Over the longer term, payments will be developed that bundle the total cost of care of enrolled individuals over a course of care or period of time, in preference to existing fee-based pay ments.”
That has been read as signalling the end of fee-for-GP-service pay ments for enrolled patients.
Last week, Dr Bennett admitted the wording of the recommendation was “open to interpretation”.
Asked what the intention of the recommendation was, she said: “Bundled packages of care would be available and would follow the patient, not the practice. You could roll up the money being used to fund enhanced primary care items, [and] add a bit more. This could be used to give you access to a broader range of services.
“The bundled package could be like a credit card but it’s for the indi vidual patient. It’s not fundholding for the practice. It’s not pooled fund ing. Patients make decisions [on how to spend the money] with the doctor. The doctor is still the gatekeeper ... but patients would work out with their clinical team how to draw on it.”
She insisted that fee-for-GP-serv ices should remain but added that pooled funding for enrolled patients could “roll in fee-for-service over the longer term”.
One of the 10 reform commission ers — former AMA president Dr Mukesh Haikerwal — has said he would not put his name to a report that resulted in a significant scaling back of fee-for-service for doctors.
An insider for the commission admitted there was ongoing disagree ment about how to fund primary care services, including the precise role of fee-for-service payments.
She said: “The commissioners are focusing on [how to fund GP services for chronic disease patients] at the moment. There is a disagreement within the commission as to whether medical services are in or out of [the bundled] payment.”
Click to expand...