Archives
Policy and empirical evidence: The case of general practice changes
DP Doessel
Department of Economics, University of Queensland, QLD
Abstract
Financial support from The University of Queensland Foundation for the research reported in this paper is gratefully acknowledged. The assistance of Ms Rukmani Gounder and Mr R Lenton is also acknowledged. Needless to say the usual caveat applies.
It can be argued that the general practice part of the health sector is very important, as it is typically the first 'port of call' when illness strikes members of the Australin community. Yet very little is known about general practice: However, general practice has been subject to heightened interest in recent years. This increased interest is, in part, explained by an agreement between the Commonwealth Government and the Royal Australian College of General Practitioners (RACGP) to introduce new items (and fees), the so-called 'content-based descriptors', in the Medicare Benefits Schedule Book for general practitioner (GP) services provided by GPs who are 'vocationally registered'. To be vocationally registered involves various commitments (with the customary 'grandperson clauses') to continued medical education and quality assessment. These arrangements were not acceptable to the Australian Medical Association (AMA) and necessary legislation for the changes was blocked in the Senate of the Commonwealth Parliament. Subsequently a Senate Select Committee reported on the changes (Senate Select Committee on Health Legislation and Health Insurance 1989) and the legislation was passed. For an account of this background see Doessel (1990a).
As part of the 'settlement' to this dispute the Commonwealth Government established a research program in the area of general practice, which is providing a means by which the accumulated ignorance about general practice in Australia is being reduced (See Department of Community Services and Health 1989). As yet, no political scientist or sociologist has analysed the 'blood on the carpet' that occurred during the conflict between the RACGP and the AMA on this issue.
References
Australian Bureau of Statistics (1986) The 1986 Census Dictionary, Canberra: ABS.
Australian Bureau of Statistics (various) Australian Demographic Statistics. Canberra ABS.
Australian Institute of Health (1989) Medical Workforce 1986. Health Workforce Information Bulletin No 14, Canberra: AGPS.
Committee of Inquiry into Medical Education and Medical Workforce (1988) Australian Medical Education and Workforce into the 21st Century. Canberra: AGPS.
Commonwealth Department of Health and Australian Institute of Health (1987) 'Submission to the Medical Education and Medical Workforce Inquiry Committee, Part Two', mimeo, Canberra.
Commonwealth of Australia (1991) Health Care in Australia - Directions for Reform in the 1991-92 Budget. Budget Related Paper No 9, Canberra: AGPS.
Commonwealth of Australia (1992) Health Care for All Australians: 1992-93 Reforms. Budget Related Paper No 8, Canberra: AGPS.
Deeble J (1991) Medical Services Through Medicare. National Health Strategy, Background Paper No 2, Melbourne: National Health Strategy.
Deeble JS (1989) Health Care under universal insurance: The first three years of Medicare. In Butler JRG and Doessel DP (eds) Health Economics: Australian readings. Sydney: Australian Professional Publications, pp.189-211.
Department of Community Services and Health (1989) Government Response to the Report of the Senate Select Committee on Health Legislation and Health Insurance: Part I Vocational Registration 30 August 1989. Canberra: Department of Community Services and Health.
Department of Health, Housing and Community Services (1991)
The Changes to
Medicare. Canberra: DHHCS.
Doessel DP (1983) A Note on Medical Workforce Data in Australia, Economic Analysis and Policy 13: 94-112.
Doessel DP (1990a) Editor's Introduction. In Doessel DP (ed) Towards Evaluation in General Practice: A Workshop on Vocational Registration. Canberra: Department of Community Services and Health, pp.ix-xx.
Doessel DP (1990b) Australian health expenditure, private medical practice and the relative size of general practice. In Doessel DP (ed) Towards Evaluation in General Practice: A Workshop on Vocational Registration. Canberra, Department of Community Services and Health, pp.21-44.
Douglas RM (ed) (1991) General Practice Financing Think Tank - What Are You Going to Do about Australian General Practice, Canberra: National Centre for Epidemiology and Population Health.
Douglas RM, Dickinson J, Rosenman S and Milne H (1991) Too Many or Too Few? Medical Workforce and General Practice in Australia, NCEPH Discussion Paper No 5, Canberra: National Centre for Epidemiology and Population Health.
Fuchs VR and Kramer MJ (1973) Determinants of Expenditure for Physicians' Services in the United States, reprinted in Fuchs VR (ed) (1986) The Health Economy. Cambridge: Harvard University Press, pp.67-107.
Fuchs VR (1978) The Supply of Surgeons and the Demand for Operations, Journal of Human Resources 13(Supplement): 34-56.
General Practice Consultative Committee (1992) The Future of General Practice: A
Strategy for the Nineties and Beyond. Canberra: General Practice
Consultative
Committee.
Howe B (1991) Changes to Medicare, Healthcover 1: 12-4.
Macklin J (1990) The National Health Strategy: Setting the agenda for change. National Health Strategy Background Paper No 1, Melbourne: National Health Strategy.
Mendenhall W (1982) Statistics for Management and Economics 4th edn, Boston: Duxbury Press.
National Health Strategy (1992) The Future of General Practice. Issues Paper No 3, Melbourne: National Health Strategy.
Pindyck RS and Rubinfeld DL (1991) Econometric Models and Economic Forecasts 3rd edn, New York: McGraw Hill.
Ramsey JB and Wasow B (1986) Supplier induced demand for physician services: Theoretical anomaly or statistical artifact? In Basman RL and Rhodes GF (eds) Advances of Econometrics 5, Greenwich: JAI Press, pp.49-77.
Richardson J (1981) The inducement hypothesis - that doctors generate demand for their own services. In van de Gaag J and Perlman M (eds) Health. Economics and Health Economics. Amsterdam: North Holland, pp.189-214.
Senate Select Committee on Health Legislation and Health Insurance (1989) Vocational Registration of General Practitioners. Canberra: AGPS.
Veale BM and Douglas RM (1992) 'Money matters in general practice: Financing options and restructuring', NCEPH Discussion Paper No 6. Canberra: National Centre for Epidemiology and Population Health.
eContent Home
