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The first
sign of this comes in an Australian Health Care Agreement (AHCA)
Reference Group Report on the next Health Care Agreement ("Medicare
Agreement") due to commence for five years from 1st July
2003. In a discussion on the shortage of allied health professional
in rural areas the Report states:
"Work with the Pharmacy Guild to develop and fund models
of community pharmacy that substantially raise the quality use
of medicines in rural Australia".
From where the Guild sits these "models" will have to
be owned by a pharmacist.
They could not be owned by a regional health authority, private
health maintenance organisation, community controlled health organisation
or a private hospital.
Even medical centers or "multi purpose health services"
would not be considered by the Guild hierarchy.
Okay - that is all right if there are enough pharmacists to take
up the challenge, but at a time when there is an alleged shortage,
these challenging jobs may not be appealing to an entrepreneurial
professional.
Industry watchers who thought this subject was dead and buried
after the "Wilkinson Report" of February 2000 should
think again, especially if they give any credence to reports by
the influential "think tank", the Centre for Independent
Studies.
An article titled Nostrums or Cures? (29 Apr 2002) by Steven Schwartz
, when discussing the need for competition within the health industry
has this to say:
"There are also restrictive retail practices
that serve to protect providers. For example, rules that require
pharmacies to be owned by chemists or that require spectacles
to be sold in shops owned by optometrists do nothing for consumers;
they just protect these guilds by keeping prices high."
Those pharmacists who were upset when the Guild took a stand against
"Consultant Pharmacists" having their own practice outside
the realms of a retail pharmacy will know why the following quote
is close to the mark:
Work practices, which on the waterfront would be called rorts,
are prevalent in health. Patients are required to visit GPs to
pick up repeat prescriptions. Surgeons invite referring GPs to
"assist" in surgery. Psychologists and other health
professionals are not permitted to prescribe drugs. All of these
practices keep costs high.
"Encourage fair competition", according to Steven Schwartz.
"We need to eliminate the restrictions on practitioner numbers
and all the other anti-competitive practices that have grown up
over the years. Anyone should be allowed to own a chemist provided
that qualified pharmacists do the dispensing".
The cries
will come that "pharmaceuticals are not ordinary items of
commerce", but at the same time support will be given to
a multi layered supermarket operation that (just by the way) has
the pharmacy department owned by a pharmacist.
The AHCA reference Group Report also makes mention of the need
for support with "population health" measures as opposed
to more acute interventions. It says that:
"Strong
and established professional and industry groups are very effective
advocates for the medical and pharmaceutical parts of the health
sector while population health does not have such powerful support".
A further
aspect of population health is the gathering of data which is
vital for planning and evaluation. The fact that the PBS statistics
only cover items which have been subsidised by the Commonwealth
shows the need for close collaboration across sectors if a true
picture is able to be analysed.
Again the AHCA report urges the obtaining of data in all sectors
and points to the paucity of information obtained on individual
patients because of inadequate ID information.
This should be rectified now that the full effect of the Medicare
numbers is known, but that episode in itself shows the difficulty
a Government has in obtaining information from a private sector
industry with no competition.
The "Union" type approach the Government ran into is
reason enough for it to wonder whether a non-competitive market
place is where the health industry should be.
The report says:
"Poor information flows between programs
result in patients being subjected to multiple assessments, repeat
investigations, and potentially dangerous polypharmacy."
The next AHCA is expected to strengthen the pharmacy reforms given
in the current agreement where public hospitals had access to
the PBS.
This time it is likely to be stronger:
"All eligible persons must be given
free access to public hospital services and affordable access
to medical and pharmaceutical services, in an appropriate setting,
regardless of place of residence and ability to pay".
Who can best
represent pharmacists?
Watch this space.
Comments welcomed
Ends
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