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Reflection and reformation
Marcus Dripps

The recent federal budget gives us cause to reflect on many aspects of health funding and policy. The Abbott government may have provided much to criticise, and the first response of many physiotherapists that I have had discussions with has been negative. Removing Health Workforce Australia and the Australian National Preventative Health Agency, as well as the restructuring of funding for the primary care sector, are significant changes. The fact that they appear to have occurred with minimal consultation indicates the start of a challenging time for us in the health setting

The unexpected announcement of a reduction in state health and education funding, to the magnitude of $80 billion over 10 years, appears to be a measure designed to bring the states to the table to discuss macro-level tax reform.

When these measures are combined with substantial changes to welfare and other community supports, it is natural for the Australian public to get nervous.

It is the right thing for governments to create efficiencies in the regulatory environment, and to ensure they are getting value for the money they invest in government programs, but it is critical that the focus of reform is on the outcomes that matter. I respectfully suggest that the suite of recent announcements risks being interpreted as a return to a 'doctors-only' model of funding and public policy that does not serve the interests of the Australian public.

I acknowledge the difficult and unsustainable position that the health budget is in. We need to find ways to take pressure off the acute sector, and deliver a contemporary range of services closer to home for patients. The Medicare Locals were not perfect, but there were some who appeared to work incredibly well in meeting local needs through building partnerships and engagement with GPs, private allied health providers and local hospital networks.

I am concerned about the suggestion that future primary health care organisations will be governed by 'GP councils'. There is no doubt that GP care will always play a pivotal role in Australian's primary care sector, but the Australian community is not served well by a return to the 'doctor knows best' days of years past, when the prevailing view was: 'If the doctor needs to bring in some of those allied health folks to help out, he’ll let us know.'

I encourage Minister Dutton and his team to reconsider the role that physiotherapy and allied health can play in the Australian health system. I encourage a focus on reforms that improve the efficiency of primary healthcare in Australia. We need to acknowledge that many Australians choose to fund a large number of health services that government does not. Industry surveys have indicated that 60 per cent of visits to a physiotherapist are patient-initiated, rather than based on medical referral. I would have thought that government policy around primary health care would want to help develop industries that take the burden off government-funded services, not the other way around.

Reforms that strengthen the role of physiotherapy services in primary care do four important things: allow the Australian community to choose to self-fund healthcare that they value, rather than encouraging them to chase care with less out-of-pocket costs; utilise the natural focus of physiotherapists on prevention and self-management; decrease the burden on publically funded GP and emergency department services; and support the more than 4500 small businesses that contribute to the $1 billion physiotherapy industry.

Many of the changes in the budget may be unpopular, but they do provide an opportunity to trigger reform to make health funding more sustainable at a macro level. Let’s work together to ensure that the Australian public have access to the right care, by the right clinician, in the right place, at the right time.

MARCUS DRIPPS, APAM
APA National President

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