Nice building that GP Super Clinic on the front page of the Aus today, but no GPs it would seem. Having denied local GPs access to overseas trained doctors (the local GPs opposed the Super Clinic claiming adequate local services), the recruitment plans of the GP Super Clinic have had to be changed - a couple of Malaysian doctors had been recruited – but no luck so far. In the meantime, the Clinic is advising standard working hours – what, but I thought the whole idea was to provide accessible, one-stop, multi-disciplinary services for the locals, including out-of-hours services.
More generally, now that Ted is in power, things are turning further south on the prospects for the HHR (Health and Hospitals Reforms, repeat the last word many times and you might believe it). He has said that he will have a look with the arrangement that the Victorian government had agreed to; everyone knows that it is not legally binding.
Yesterday, Nicola sought some reassurance from her diminishing group of friends with a press release from the Queensland government, declaring additional money was flowing (it sounded pretty modest) and there were more elective surgical procedures, shorter waiting times, etc.etc. No doubt she is hoping Ted will notice the good news.
Jeremy Sammutt had a very good piece at The Drum outlining why the blame game in health is not about to end, now or in the future. But more to the point, the whole construct of the Health and Hospital Reform is faulty and without returning to first principles, all the “Reform” will achieve is another centrally planned patch-up job. Who ever thought that by the Commonwealth taking up 60 per cent of the hospital funding (and at the efficient price only, for larger hospitals) would make any difference, apart from the number of bureaucrats. (It would be interesting to see the extent to which DOHA has geared up for the REFORMS in terms of new staff.)
Jeremy has a very interesting analysis of the centrality of the supplier-induced demand theory driving faulty health policy. Based on contempt for the ethics of doctors and the common sense of patients, the theory drove years of faulty advice doled out by the Department to ministers; the number of medical graduates was cut, then only slowly increased, until recently. Many of the problems we currently experience – including no GPs for the Super-clinics, although we don’t need them – stem from this dodgy advice.
I remember talking to some sort of policy clerk at the department many years ago. She excitedly told me that every additional doctor with a provider number cost the Commonwealth $200,000 per year. ”And what about the benefits?”, I asked her. Oh, she declared, she had not thought about that.
It is actually impossible to follow the jigsaw that is the HHR, but I did get a laugh when the boundaries of the new Medicare Locals were released. (What these Medicare Locals will do is unclear, there is reference to “local health planning” – probably not extending the location of GP Super-clinics, would be my guess.) Tasmania is the boundary for one Medicare Local. New meaning to LOCAL.
speaking as a customer of medicare GPs – it seems the government will settle for any warm body regardless of if they speak english or know what they are doing.
john malpas
3 Dec 10 at 10:49 am
There’s a shortage of GPs in many places, but it has little to do with Medicare. It’s frightfully expensive to set up a new medical centre, so they tend to be over-run with
corporate scumbagscapitalist entrepreneurs who take 50% of the GP’s Medicare earnings. This necessitates that the medical centre turn into something of a production line, with the end result being a crap experience for both GP and patient.As a consequence, if a GP can find a half-decent employer, they’re likely to stick with them, and the newer medical centres tend to attract either locums or cynics. The problems faced by the Superclinics are shared by all the corporate medical centres, and have more to do with the corporate running of the place than Medicare. The reason why the Superclinics are necessary is that a 24-hour GP clinic can save people the need to clog up emergency departments in hospitals.
THR
3 Dec 10 at 11:03 am
“corporate scumbags capitalist entrepreneurs who take 50% of the GP’s Medicare earnings.”
For that risk and financial burden, they should give it away? Okay. A locum I know goes skiing O/S once a month. Clearly he’s being exploited.
.
3 Dec 10 at 11:23 am
For that risk and financial burden, they should give it away?
What ‘risk’? You’ve got a bunch of parasitical middle-men soaking up government payments that were intended for GP’s treating patients.
THR
3 Dec 10 at 11:43 am
“It’s frightfully expensive to set up a new medical centre”
…
“The reason why the Superclinics are necessary is that a 24-hour GP clinic can save people the need to clog up emergency departments in hospitals.”
They sound like parasites when their operation effectively creates a positive externality…no?
.
3 Dec 10 at 11:46 am
They don’t sound like parasites. They are parasites. Moreover, their skimming off the top of government payments reduces the quality of service for the patient. If they want exorbitant commissions, they should be entirely private, and we ought to think of ways to allow GPs to self-manage clinics.
THR
3 Dec 10 at 11:53 am
Fund the patient.
.
3 Dec 10 at 11:56 am
Fund the patient.
We’ve discussed this before, and you know full well it’s a ridiculous pipedream, unless you think a voucher system is going to provide mobile specialists to service rural and impoverished regions.
THR
3 Dec 10 at 11:59 am
“We’ve discussed this before, and you know full well it’s a ridiculous pipedream, unless you think a voucher system is going to
.”
Hoist by own pretard.
.
3 Dec 10 at 12:03 pm
Not really, dot. Your system would produce massive gaps in service delivery. As it stands, the govt already ‘funds the patient’ to a large extent, since medicos are paid per consult by Medicare. Marketising the system further would simply make medical treatment a luxury for the well-off.
THR
3 Dec 10 at 12:14 pm
“Your system would produce massive gaps in service delivery.”
Like super clinics with NO gneeral practitioners?
“Marketising the system further would simply make medical treatment a luxury for the well-off.”
Rubbish, going to the doc to get a chest infection cleared up all up is less than basic pay TV for a month plus a good, sensibly priced meal for one person.
This is with a massive regulatory burden and no subsidisation.
.
3 Dec 10 at 12:17 pm
If these clinics are such sure-fire money spinners, why don’t you become a capitalist exploiter and open a few yourself?
boy on a bike
3 Dec 10 at 12:34 pm
“If these clinics are such sure-fire money spinners, why don’t you become a capitalist exploiter and open a few yourself?”
Allow me… a lack of brains, lack of balls and lack of drive.
DavidJ
3 Dec 10 at 1:10 pm
I can’t believe THR s blaming ‘capitalism’ for a lack of GPs for super-clinics opened by the government; alright, yes I can.
dover_beach
3 Dec 10 at 1:36 pm
There are no shortages under communism, just slow moving queues.
Infidel Tiger
3 Dec 10 at 1:42 pm
It’s no surprise to see libertarians championing ‘private’ operators who live exclusively off government funds, and who impede health service delivery. Can anybody find for me the chapter and verse in Rand that justifies this sort of idiocy?
THR
3 Dec 10 at 1:49 pm
Flagrant misrepresentation and calumny.
.
3 Dec 10 at 1:54 pm
One can always recognise that a socialist has lost the argument when the name of Rand is raised, but will THR acknowledge this?
dover_beach
3 Dec 10 at 2:08 pm
THR, dude.
The government has opened a medical clinic with no medicos.
This is literally the stuff of Humphrey Appleby.
C.L.
3 Dec 10 at 2:31 pm
THR.
So doctors are smart enough to get through years of uni, specialise, (in many cases) but not bright enough to try and maximise their earnings afterwards?
riiight…
thefrollickingmole
3 Dec 10 at 2:35 pm
C.L – the Government not being able to provide a public service in a socilaistic manner is an internal contradiction of capitalism.
Didn’cha know?
???
Makes Ronnie’s “speaking out against SOCIALISED MEDICINE” seem very reasonable and centre grounded.
.
3 Dec 10 at 2:35 pm
BTW would THR like to speculate on what % of medicos costs are related to insurance, record keeping and complying with regulations… Heres a hint, aim over 30% of earnings…
thefrollickingmole
3 Dec 10 at 2:36 pm
mole – like my jetsetting friend, they are exploited by the parasitic capitalistic class…and no DOCTORS have ever been the capitalists behind a 24 hour medical centre – no siree bob.
.
3 Dec 10 at 2:37 pm
_
Because they see more money to be made “farming” the thickets of regulation and crap on behalf of other practitioners who studied to be doctors and not beuraucratic navigators.
The doctors and businessmen running clinics make money because it is unreasonable to expect a mid sized practice to run without a full time manager to handle regulatory hurdles.
To throw that back as a failure of unfettered free markets is more than a little rich.
thefrollickingmole
3 Dec 10 at 2:47 pm
Gillard describes a medical clinic with no doctors:
“It’s the absolutely standard way…”
C.L.
3 Dec 10 at 2:59 pm
if not for medicare payments, governments wouldn’t have to worry about ‘supplier induced demand’ and entry could be liberalised.
There is no reason to subsidise GP visits. There is perhaps only a case for subsidising medical expenses of people below some given income and subsidising catastrophic health insurance
jtfsoon
3 Dec 10 at 3:06 pm
Gilard’s motto:
If we build it, they will come.
Not the patients, of course, the doctors.
thefrollickingmole, whatever happened to your great avatar?
dover_beach
3 Dec 10 at 3:20 pm
THR
WTF? WHERE do you get this shit?
Peter Patton
3 Dec 10 at 4:15 pm
lulz…good work Patton.
.
3 Dec 10 at 4:18 pm
Too right. It is because those places are fetid toilets where no sentient being would want to live.
Peter Patton
3 Dec 10 at 4:29 pm
Melbourne is short of GPs?
C.L.
3 Dec 10 at 4:44 pm
Flagrant misrepresentation and calumny.
No, I haven’t misrepresented you. You and several others have decided to defend not the GPs, or their patients, but the middlemen who grow fat by diverting govt funds away from both of the former. By your silly reasoning, we might as well champion ‘private’ third-parties to act as middle men between Centrelink and dole recipients.
So doctors are smart enough to get through years of uni, specialise, (in many cases) but not bright enough to try and maximise their earnings afterwards?
I made perfectly clear earlier that there are significant costs when it comes to entering and starting up a clinic. It has nothing to do with education or intelligence. Under your corporate system, rich people get to set up clinics and get richer, whilst diverting taxpayer funds from actual medical services.
BTW would THR like to speculate on what % of medicos costs are related to insurance, record keeping and complying with regulations… Heres a hint, aim over 30% of earnings…
Bullshit. It’s nothing like that figure for most medicos, and, in any case, insurance costs do not justify corporate ownership and management of clinics, which is the real issue here. In the case of the ‘superclinic’, the government appears to have replicated the many bad features of pre-existing ‘private’ clinics, which is why they are having trouble getting staff.
To throw that back as a failure of unfettered free markets is more than a little rich.
You (and others) are straw manning. I haven’t mentioned ‘free markets’. They don’t exist, except in the fantasies of right libertarians.
THR
3 Dec 10 at 4:57 pm
Melbourne is short of GPs?
Yes, in some areas.
THR
3 Dec 10 at 4:57 pm
“You and several others have decided to defend not the GPs, or their patients, but the middlemen who grow fat by diverting govt funds away from both of the former.”
When the Government tried to do the same, they had no doctors at their clinics.
“By your silly reasoning, we might as well champion ‘private’ third-parties to act as middle men between Centrelink and dole recipients.”
Please stop projecting.
“Under your corporate system, rich people get to set up clinics and get richer, whilst diverting taxpayer funds from actual medical services.”
Seeing a GP isn’t a medical service? What is it? Is seeing a GP the same as applying for a boat licence? Maybe you’d like them to operate in the open…not possible, they need accreditation from the AGPAL racket.
Rich people get richer…as society has generally for the last 300 years. Ho hum.
“I made perfectly clear earlier that there are significant costs when it comes to entering and starting up a clinic. It has nothing to do with education or intelligence.”
Investing, construction – nothing to do with education or intelligence!
“Bullshit. It’s nothing like that figure for most medicos, and, in any case, insurance costs do not justify corporate ownership and management of clinics, which is the real issue here.”
A Nobel is up for grabs here.
Coase, Ronald H. (1937). “The Nature of the Firm”. Economica 4 (16): 386–405.
“You (and others) are straw manning. I haven’t mentioned ‘free markets’. They don’t exist, except in the fantasies of right libertarians.”
Did you mention Rand because you’ve got an unusual devotion to her or…because you were implying something about free enterprise when you kept on mentioning…*CAPITALISM*…?
.
3 Dec 10 at 5:05 pm
THR
Are you EVER going to provide any data for your garbage? WTF would you know about being a doctor?
Peter Patton
3 Dec 10 at 5:07 pm
When the Government tried to do the same, they had no doctors at their clinics.
Where’s the data? The govt hospitals I know of are better-staffed than many private clinics, who are turning patients away for lack of doctors.
Please stop projecting.
There’s no projection. I specifically attacked the system of corporate management of clinics, and said that this particular private-public partnership was both harmful (as evidenced by a lack of doctors) and inefficient (as evidenced by the 50% commissions they usually take per patient). Now, if you have a fetish for this particular brand of cronyism, then explain yourself. If not, you’ll see that my Centrelink analogy was perfectly reasonable.
Maybe you’d like them to operate in the open…not possible, they need accreditation from the AGPAL racket.
This has nothing to do with the issue at hand.
Investing, construction – nothing to do with education or intelligence!
Are you saying that intellect has some clear correlation with wealth? By your own standards, you’re impoverished in both.
Did you mention Rand because you’ve got an unusual devotion to her or…because you were implying something about free enterprise when you kept on mentioning…*CAPITALISM*…?
I mentioned the gospel of St Rand as I’m trying, sincerely, to figure out WTF avowed libertarians are doing defending ‘private’ clinics that are entirely parasitic in their funding and operations.
THR
3 Dec 10 at 5:11 pm
“Where’s the data?”
This bang your head and hope you blackout stuff…
FROM THE TOP OF THIS VERY ARTICLE:
” Nice building that GP Super Clinic on the front page of the Aus today, but no GPs it would seem. Having denied local GPs access to overseas trained doctors (the local GPs opposed the Super Clinic claiming adequate local services), the recruitment plans of the GP Super Clinic have had to be changed – a couple of Malaysian doctors had been recruited – but no luck so far. In the meantime, the Clinic is advising standard working hours – what, but I thought the whole idea was to provide accessible, one-stop, multi-disciplinary services for the locals, including out-of-hours services.”
“There’s no projecting, I built a strawman and attack it as YOUR logic…”
“Maybe you’d like them to operate in the open…not possible, they need accreditation from the AGPAL racket.
This has nothing to do with the issue at hand.”
…previously you said:
“It’s frightfully expensive to set up a new medical centre”
“Are you saying that intellect has some clear correlation with wealth? By your own standards, you’re impoverished in both.”
To say that being competent as an investor or construction contractor is a function of inheritance is truly belonging to the drooling, mouth breathing faction of the Marxists.
“I mentioned the gospel of St Rand as I’m trying, sincerely, to figure out WTF avowed libertarians are doing defending ‘private’ clinics that are entirely parasitic in their funding and operations.”
We said *fund the patient* but you think this is unworkable as it does not begat a superclinic at Cunnamulla.
.
3 Dec 10 at 5:17 pm
“It’s frightfully expensive to set up a new medical centre”
What a stubborn and persistent idiot. The expenses that corporate practice managers fork out have nothing whatsoever to do with GP’s training expenses. GP’s fund these entirely on their own, and function more or less as sub-contractors at the clinics I’m describing. The expenses involve getting rooms, which cost a small fortune in many metro areas.
THR
3 Dec 10 at 5:21 pm
The story of the market for GP services is a complicated one and distorted by the major subvention of Medicare (including the convoluted fee schedule that drives patterns of practice), scope for co-payment and major regulatory intrusion – some justified, a lot not (red tape everywhere) – on the part of governments.
Traditionally, GP land was really something of cottage industry with quite a few one person or two person practices. This is now very uncommon. The fixed costs of running a GP practice – including for the reasons mentioned above – have meant fewer, larger practices generally with the service of a practice manager.
Many practices are essentially non-procedural because undertaking procedures (removing skin lesions etc.) requires higher insurance as well accreditation of the GP rooms. The way to maximize incomes is still largely the 6-minute visit – prescription and out the door. But it is not entirely unsurprising that the GPs become bored witless.
So when the corporation comes knocking, offering a large cash payment plus a relatively easy to fulfil earn-out arrangement, it is hardly surprising that many GPs just accept the offer. And then all the conerns of running the practice, as opposed to consulting patients, are someone else’s concern.
But if you look at the stockmarket outcomes for those corporations that have bought GP practices – Primary Health, for instance – the results have actually been very poor for their shareholders. Buying out any type of professional service firm is a very dangerous thing to do as the ‘capital’ is so tied up with the professionals. Contractual disputes have been rife.
Maybe the Modbury GP Super-clinic should be renamed the Nurse Practitioner Super-clinic and see how it goes.
Judith Sloan
3 Dec 10 at 5:48 pm
Are you saying that intellect has some clear correlation with wealth? By your own standards, you’re impoverished in both.
Title [The Future of Capitalism: How today’s economic forces will shape
tomorrow’s world
Author [Lester Thurow, Prof of Economics MIT
Publisher [Allen & Unwin
Place Pub [St. Leonards, NSW, New York
Date [1996
243
“One of the mysteries of economic analysis is why market economies produce distributions of income that are so much wider than the distributions of any known human characteristic or talent that can be measured.”
John H.
3 Dec 10 at 5:55 pm
A long paper, but its general thrust appears to be GP (in paticular) would like to run their own practices but the overheads are too high. Either they bulk bill and go broke, or chrge and drive away a lot of customers.
The larger corporate clinics being derided as profiteering scum are (so the paper states) often the major provider of bulk billing services.
Damn their greedy corporate hearts eh?
thefrollickingmole
3 Dec 10 at 6:11 pm
It’s amazing that you call me an idiot when I didn’t mention training costs.
.
3 Dec 10 at 7:01 pm
Dot at 7.01
It’s amazing that you call me an idiot when I didn’t mention training costs.
Dot at 5.17:
“Maybe you’d like them to operate in the open…not possible, they need accreditation from the AGPAL racket.
Since AGPAL’s accreditation is directly linked to education and training, you were talking about training costs.
THR
3 Dec 10 at 7:26 pm
I go to a very good clinic that is owned and managed by the doctors. They now have about 15 GPs and a couple of nurses, and whilst they aren’t open 24 hours, they do provide good coverage. Not all the doctors are shareholders – only the half dozen that founded it have equity. The rest are employees.
Does that make those risk taking GPs that founded the practice “capitalist parasites”?
boy on a bike
3 Dec 10 at 10:41 pm
You don’t sound like a big fan of Super GP clinics, but I reckon they’re a great idea, and I’m willing to give some slack during the bedding in period. It’s early days yet.
Chris Grealy
4 Dec 10 at 9:45 am