Year: 2024
Type: article
Abstract: BackgroundAustralia is undergoing general practice funding reform, with recent changes to Medicare and the introduction of MyMedicare voluntary patient registration. ObjectiveWithin this context, we provide general practitioners (GPs) with an explainer on health economic concepts relevant to current funding reform debates.This article outlines different funding model types, discusses the theoretical advantages and disadvantages of each funding model, and reflects on past experiences of reform. DiscussionCommon GP funding models across the world include fee for service, capitation, pay for performance and bundled payments.Each funding model has its potential advantages and disadvantages.Blended funding models can minimise undesired consequences of individual funding models but can introduce additional complexity.The challenge remains to design funding models that enable access to quality care, adequately pay providers and are sustainable into the future.GENERAL PRACTITIONERS (GPs) are often the first point of contact in the Australian healthcare system, with nearly nine out of 10 Australians visiting a GP at least once a year. 1 First established in 1984, Medicare is Australia's public health insurer.Patient attendances at general practices are subsidised by Medicare patient reimbursements, according to the Medicare Benefits Schedule (MBS).2,3 The MBS provides fee-for-service (FFS) payments to healthcare providers for agreed services.MBS payments might constitute the full payment for a service ('bulk billing'), or providers might charge fees greater than the MBS rebate, in which case the patient bears additional out-of-pocket costs.Medicare turns 40 this year.This milestone has brought into sharp focus discussions and debates around the financial viability of practices, increasing out-of-pocket costs for patients, a gap in remuneration for GPs versus other specialists (contributing to workforce shortages) and other related funding concerns.General practices currently receive approximately 6.5% of the total health expenditure.4 Over several decades, the MBS has been criticised for not reflecting contemporary clinical practice and for insufficient rebates that have not kept pace with inflation.3,[5][6][7] Although the Medicare FFS system incentivises a high volume of care, the funding model does not encourage integrated care, continuity or preventative health.[8][9][10][11] Thus, there is interest from funders and policymakers to explore alternative funding models to both improve quality of care and manage increasing healthcare costs.3,8,[12][13][14] To achieve the aims of implementing effective primary healthcare in Australia, 15 the 2022 Strengthening Medicare Taskforce Report highlighted a need to review and reform current funding models.8 Within this context, we aim to equip Australian GPs with health economic concepts relevant for participating in current funding reform debates.We begin with an overview of funding model types, discuss the theoretical advantages and disadvantages of each funding model, reflect on past experiences of reform, and conclude with a discussion on recent changes to Medicare.
Authors: Winnie Chen, Kees van Gool, Michael Wright
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405028942