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Comment on D.P. Doessel's paper
John Deeble
National Centre for Epidemiology and Population Health Canberra
Abstract
Darrel Doessel's paper addresses an important issue in health policy. It is a pity, however, that it has done so by creating a straw man. Essentially, he contends that:
- the Commonwealth Government's policy on general practice and the medical workforce depends very much on my 1991 National Health Strategy paper Medical Services Through Medicare.
- my conclusion was that 'medical services are being over-utilised and that this over-utilisation is best controlled by restricting the medical workforce'. In addition, I asserted that 'there is a causal link between medical service utilisation and medical practitioner supply' and that 'the increased per capita utilisation of medial services was associated with the increased supply of medical practitioners'.
- my analysis of these issues was flawed because of the data sources used and because I ignored the different service structures in each state and the possibility of public/private sector substitution.
- regression analysis of medical service use per capita by electoral divisions failed to confirm 'the relationship between the utilisation of medical services and the number of medical practitioners which Deeble has asserted, but not shown'.
- in any case, limitation of doctor numbers is not in the public interest because 'it is quite likely that the prices of medical services will rise' and because the 'diffuse interests' of the consumers of medical services 'will not be served by the supply restriction'.
There are thus three streams to his argument.
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