New system to pay doctors on performance


Wednesday Nov 15 20:47 AEDT

Bad doctors would lose pay and good doctors would be rewarded under a controversial new proposal intended to improve the health system.

The Australian Centre for Health Research discussion paper proposes rating individual doctors and hospitals and making information about their performance publicly available.

Health funds would be allowed to refuse the 25 per cent scheduled fee rebate to doctors whose performance was consistently below average, while high performers would be rewarded.

For private medical treatment in hospitals, Medicare provides 75 per cent of the scheduled fee, while private health funds must pay the remaining 25 per cent and may cover any "gap payment".

The paper's author, former Australian Health Insurance Association head Russell Schneider, said the Medicare rebate "gravy train" paid health care providers regardless of whether they provided adequate patient care.

"What we need to do, I think, is make sure the legislative and regulatory framework and community attitude changes so it's expected that the good performers will be rewarded and the bad ones won't," Mr Schneider told journalists in Canberra.

"If we can get more competition - and the only way to do that is let the providers know how they stand - I believe that it will lead to an improvement in standards."

He said he hoped the medical profession would work to set the appropriate benchmarks, which could include length of hospital stay, readmissions, infection rates and even death rates adjusted for demographics.

At the launch of the Making Medicare Better paper in Canberra, former health minister Michael Wooldridge lamented his failure to channel more Medicare funding into rewarding positive outcomes.

Dr Wooldridge, who is now retired, said Health Insurance Commission figures he requested as minister in 2000 showed only 13 per cent of diabetes patients were getting best practice treatment.

The figure rose to 30 per cent in one NSW region because of a few conscientious doctors, but they were receiving no reward, while those doing poorly were not penalised, he said.

Dr Wooldridge said he knew of one doctor who earned up to $800,000 annually because he treated about 600 patients a week - but fewer than 40 per cent of the children he treated had been properly immunised.

AMA President Mukesh Haikerwal said doctors welcomed feedback but linking it to pay would create an expensive US-style managed system.
Dr Haikerwal said good doctors were rewarded with return patients, while doctors working dangerously or inappropriately were picked up by Medicare or the medical board.



?AAP 2006


I think this could be a very bad idea. I can see Dr's refusing to threat some people how desperately need even though their prognosis isn't good, just to keep their figures looking good.