Thursday, January 15, 2015

The abandoned copayment idea was stupid anyway

The assumption that distorted the government's frankly stupid and now abandoned position on copayment is that GP visits are (a) discretionary and (b) about poor people.

So I'll present a standing, constant and continuing inefficiency in the health system that demands “six minute medicine” and could be solved quite easily.

I won't reiterate Ms T's entire medical history: it's a chronic immune-system disorder that demands lots of specialists, lots of drugs (some nasty), and – pertinent to the GP copayment debate – lots of repetitive prescriptions.

It's the prescriptions that are relevant, because if your only reason to visit the GP is to knock off this week's list of new prescriptions, the visit will fall under the “six minute medicine” heading.

A typical exchange might be:

GP: “Hi, what do you need?”

Ms T: “Prednisone 5 mg and 1 mg. Ursofalc. Atenolol.”

GP: “I've read the letters from the specialists. Everything seems to be going well.” (While he's typing the prescription details and, if necessary, calling the PBS people for authority prescriptions like Ursofalc.)

And she's out the door.

Some of her medications can't be prescribed for more than a month, which means a minimum of 12 “six minute” appointments each year.

There's no point in him turning it into a long appointment to do “preventative medicine” things. She has seven specialists looking after her, three of them professors, and the GP is just a prescription-machine.

Oh, yes. With seven specialists, there's the other six-minute medicine thing that happens.

GP: “Hi, what do you need?”

Ms T: “My referral to X expired.”

GP: (writes new referral)

None of this actually needs the GP: all of these “six minute medicine” appointments are systematic. The rules demand a GP appointment, regardless of whether the GP has any agency in the outcome of the appointment.

Also: there are certain drugs whose rules limit their prescription duration to one month. For example, the pain patches that are replacing Ms T's former addiction to Endone.

There's a necessary 12 appointments per month. I don't disagree with the rules, but those 12 appointments aren't created by the patient, they're created by regulation.

If the regulations don't change, chronic patients and GPs live in a Venn diagram of routine drug prescription, controlled drug prescription, and specialist referrals.

Over to the government proposal: the idea of reducing GPs' rebate for all of these routine visits was plainly stupid or worse, deliberately malicious.

In either case it was inefficient, because it would encourage turning a routine brief “sign this” visit into something longer that would get a better rebate.

PS. A grand a year on GP copayments would pinch us, but not cripple us. But an awful lot of chronic patients are seriously poor, and I don't see why they should be punished for needing a new prescription. 

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