A national funding overhaul has cross-review consensus, says Professor Mark Cormack. Now it’s a matter of implementation, starting in the regions.
Professor Mark Cormack is calling for a single national strategy with regional application to overhaul Australia’s preventative health funding model.
Speaking at the University of Canberra’s Building the Future Health and Care Workforce seminar last night, Professor Cormack, from Australian National University’s National Centre for Health Workforce Studies, was asked how funding models could realistically tackle access and scope of practice barriers.
Professor Cormack said several major reviews – Strengthening Medicare, the GP incentive payment review, and his own scope-of-practice review – had reached a policy agreement on the need to modify the payment model.
He said the reimbursement rate needed to shift away from 90% fee-for-service to a 60/40 model that enables greater multidisciplinary healthcare.
This would see about 60% of a practice’s income from fee-for-service (FFS) payments, with the additional 40% operating as a blended payment that is less prescriptive and more outcomes-based.
“We’ve reached the threshold of there being agreement on that needing to be done. The next step, of course, is making it happen,” he said.
The best way to progress the model, he said, would be in rural and regional areas, where the FFS model “doesn’t work anyway, or doesn’t work well enough”.
He said there was also less resistance in these areas to allied health professionals and nurses working to their scope of practice than in highly competitive metropolitan areas.
As recommended in both his own report and Emeritus Professor Stephen Duckett’s Strengthening Medicare review, he prescribed a 10-year horizon for the shift.
“I think that’s completely reasonable to essentially redesign the workforce,” Professor Cormack said.
He said Aboriginal Community Controlled Health Organisations had already modelled the system well due to their local governance and payment model that supported prevention.
“Start with areas where there’s already in a prospect for growth, in areas where there’s likely to be less political resistance, and I think that’s the way to progress those things,” he said.
He was also scathing about the workforce shortage and stressed that fixing demand wasn’t simply a matter of training more doctors.
“The horse has bolted on training our way out of this problem,” he said.
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“The demand side of the equation is largely driven by a complete incapacity of governments to be able to identify the levers at their disposal and to pull them appropriately,” he said.
He said this called for moving away from professional silos toward a skill-mix approach, and for removing scope restrictions embedded across laws and payment systems that prevent flexibility.
The seminar was based on Professor Duckett’s paper, ‘Getting planning for the health and social care workforce right’, published by the University of Canberra Vice-Chancellor’s Centre of Public Ideas.
