Nov 19, 2012

Happier days for doctors: is it because of health reforms?

The Labor Government’s health reforms may have failed to make much impact on the public at large, but maybe they did assuage the doctors. That’s one possible interpretation of t

The Labor Government’s health reforms may have failed to make much impact on the public at large, but maybe they did assuage the doctors.

That’s one possible interpretation of the startling improvement in GPs’ views about the health system, revealed in the latest Commonwealth Fund survey.

Headlines trumpeting the stressed state of Australia’s health system have subsided in the past year.

One explanation maybe that the attention given to health “reforms” has mollified many doctors’ concerns

Philip Davies, Professor of Health Systems & Policy, School of Population Health, at the University of Queensland, looks at the Commonwealth Fund survey results and finds while there has been a remarkable turnaround in GPs’ satisfaction with their jobs,  still fewer than half believe the health system works well.


GPs’ view of health system improves but worries remain about time with patient

Philip Davies writes:

The latest annual survey from the US-based Commonwealth Fund offers some interesting insights into how Australian GPs view our health system.

The survey, which was carried out between March and July this year, involved almost 10,000 ‘primary care physicians’ across 11 countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, UK, and USA).

Overall the 500 Australian GPs who were surveyed seem to be pretty happy with their lot; and getting happier! Eighty per cent reported they were either satisfied or very satisfied with practising medicine.

That’s a marked improvement on the figure of fewer than half (48%) of Australian GPs surveyed in 2009 who reported similar levels of satisfaction at that time.

Our current rating puts us on a par with New Zealand and Canada (both of which reported an equivalent figure of 82%), and the UK and Switzerland (both 84%).  To find the most contented GPs we need to look towards the Netherlands and Norway where satisfaction rates were 88% and 87% respectively.

Just one in four of the GPs surveyed in Australia claimed they were somewhat or very dissatisfied with the money they earned from their practice. On that measure we’re in the middle of the pack (ranking 6th alongside New Zealand).  Norway appears to have the most financially fulfilled GPs with only one in six reporting dissatisfaction.

Constraints on time with patients a concern to many GPs

More disturbing, perhaps, is the fact that 40% of our GPs indicated they were somewhat or very dissatisfied with the time they were able to spend with their patients.  That seems to be a general area of concern though with only two countries’ GPs reporting lower levels of dissatisfaction (Norway with 37% and Switzerland with 31%).

Looking at our health system as a whole, the proportion of Australian GPs who reported that they considered it ‘works well’ with ‘only minor changes needed’ was 45%, which is almost exactly double the equivalent figure in the Commonwealth Fund’s previous GP survey carried out in 2009.  That’s the largest turnaround in GPs’ opinions among all the countries surveyed.

The best performing systems, according to the GPs who work in them, are to be found in Norway, the Netherlands and New Zealand where more than half of those surveyed felt that only minor changes were needed.  But in the USA only 15% had such a positive view.

As far as Australian GPs’ use of e-health is concerned the survey paints a mixed picture;   92% of Australian GPs reported that they used electronic medical records in their practice (a drop from 95% in the 2009 survey is probably statistically insignificant).  On that score we’re beaten only by the UK, Norway, the Netherlands and New Zealand.

Our GPs seem also to be putting their IT systems to good use when it comes to prescribing with 88% indicating they routinely receive electronic prompts about potential problems with medications.

But we still seem to be struggling to capture the real benefits of e-enabled networking and communication.  Just 27% of our GPs can electronically exchange patient summaries and test results with doctors outside their practice (that’s half the rate in New Zealand and only Germany and Canada do worse than us); a mere 8% of practices allow patients to request a referral or appointment online (only Canada at 7% reports a lower percentage); and only one in five allows patients to e-mail about a medical question (again, Canada is the only country with a lower rate of 11%).  In Sweden fully ⅔ of practices offer on-line appointments or referral requests, while the same proportion of Swiss practices cater for e-mail medical questions.

The survey also focuses on ‘Access and barriers to care’. A quarter of Australian GP respondents considered their patients often reported they faced difficulty in paying out of pocket costs (placing us in sixth, median, position among the countries surveyed) while one in six saw patients facing similar difficulties in respect of access to diagnostic tests (where we again ranked sixth).

Interestingly, while New Zealand GPs saw roughly the same level of difficulty posed by out of pocket costs their views on diagnostic tests were significantly bleaker with 59% of respondents suggesting their patients often faced access difficulties – the highest rate among all eleven countries.

Things seem less encouraging when it comes to timeliness of access though with 60% of GPs saying their patients often faced long waits to see a specialist.  That puts us in fourth place alongside Norway but is a significant deterioration from the equivalent figure of 34% in the Commonwealth Fund’s 2009 survey. Again, though, it was New Zealand that had the biggest reported problem with three-quarters of GPs considering their patients had long waits to see a specialist.  Of course, such views might themselves be shaped by expectations of what constitutes a ‘long’ wait in the context of a country’s health system.

In the same vein we appear to have little to boast about when it comes to timely access to GP services.

Only 38% of Australian GPs reported that more than 80% of patients can get a same-day or next-day appointment when requested.  That’s the third lowest figure among the countries surveyed with equivalent rates of 55% in the UK, 59% in New Zealand and an astonishing 86% in France.

Delays and disorganisation point to challenges for Medicare Locals

The survey provides a wealth of additional data, including illuminating material on care coordination and service quality.  Those data, together with commentaries and various graphical presentations can be accessed here but what conclusions, if any, can be drawn from the findings outlined above?

First we need to note that this is a survey of GPs’ views that may not align fully with those of the wider population.  Second, the sample size (500 GPs) is relatively small and so all results should be treated with a degree of caution. And third, we need to recognise that views on health services can be influenced by goings-on in the broader political environment and comparisons with other countries, in particular, may be influenced by contextual factors.

Notwithstanding those caveats, a headline from the survey, at least as far as Australia is concerned, is the remarkable improvement in GPs’ views on the overall wellbeing of the system.  At the time the previous survey was collecting data we were eagerly awaiting the publication of the National Health and Hospital Reform Commission’s final report.

It’s possible that the many new initiatives launched since the winter of 2009 have succeeded in building GPs confidence in the system from previously low levels.  On the other hand it could simply be that that the very existence of the Commission (and other bodies looking at primary care and prevention) together with the publicity and high expectations surrounding its work created a view among GPs back in 2009 that
change was needed.

There are few surprises in the survey’s findings as far as IT is concerned.  We’ve known for some
considerable time that levels of computerisation in our GP practices are high.  What the survey confirms, however, is that we’re still not making the most of the opportunities that come from linking up
stand-alone systems and enabling patients to interact electronically with care providers.

In terms of affordability, GPs seem to place us very much in the middle of the road relative to our peers.

However, it is hard to reconcile their view that one in six patients faces difficulties in accessing diagnostic tests with the fact that bulk-billing rates for pathology and radiology services at the time of the survey were around 87% and 74% respectively.

The findings also point to delays at the key interfaces in primary care: when patients first approach a GP to book an appointment; and when they need a specialist referral. Coupled with the observations above about IT they point to a need for continued efforts to improve the ‘connectedness’ of primary care; to facilitate communications and planned patient journeys; and to enhance the ‘systemness’ of what is currently all too often experienced as a disorganised sector.

Those are areas where the new Medicare Locals are expected to deliver.  The Commonwealth Fund survey makes clear the scale and scope of the challenges they face.

But if all else fails, moving to Norway looks like a smart option.

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