One of the problems of Labor’s strategy of running with a small target is that there isn’t much to talk about during the course of a campaign. While attacking the character of the Prime Minister takes up some time, there is still a need to produce ‘announceables’ lest the voters begin to wonder what they will get from a change of government.
Having seriously fluffed his lines on the rate of unemployment and the cash rate, opposition leader Anthony Albanese quickly turned his attention to the area of health, announcing the trial of 50 urgent care clinics at a cost of $135 million. Evidently, we are expected to believe that these Medicare-funded clinics will ‘take the pressure off emergency departments, so they can concentrate on saving lives’. When announcing these clinics, Albo declared that the proposal had been fully costed by the Parliamentary Budget Office. But it turned out that the PBO hadn’t provided a full costing – only that it had been consulted – and this correction was subsequently made by shadow finance minister, Katy Gallagher. Oops.
Note here that Labor’s health minister spokesman is Mark Butler – a member of the Left and once president of the party. During his inordinately long time as climate change spokesman, he was not known for his command of detail or for providing the political ammunition needed to defend policy positions.
When the then leader of the opposition, Bill Shorten, was unable to provide any costing of the Labor’s emissions reduction policies in the 2019 election campaign, the fault really lay with Butler. Instead of commissioning some modelling, no matter how dodgy, Shorten was left to simply utter platitudes about the cost of inaction. Arguably, it was a turning point in that campaign.
Now Butler has been handed health and has demonstrated the same level of energy and attention to detail – low/none – he applied to his previous shadow portfolio. He is telling us that these clinics are trials, which begs the question why there would be 50 of them. Surely 5 or 6 would be plenty to figure out whether or not they will work?
He has also stated that all 50 will be up and running by the middle of next year, in part because health care workers will be so keen to work at the clinics. That’s a big call.
On the face it, having a phalanx of urgent care clinics providing bulk-billed services sounds like a political winner. Evidently, if you have a sprained ankle, a suspected broken wrist, a minor burn or an ear problem, you will be able to head down to the urgent care clinic and be seen promptly by a doctor or nurse – all free of charge.
We are being told that the clinics will be set up on the basis of need using a non-political process yet a number of electorates have already been promised one during the campaign.
The costing of $135 million for the clinics is for four years. That’s a tad less than $34 million per year. There are going to be 50 clinics, so that works out at $680,000 on average per clinic per year.
Now the clinics are expected to operate seven days per week from 8 am to 10 pm. At the very least, there will need to be several receptionists/nurses as well as doctors to cover these hours. There will also be the cost of consumables and if people with broken bones are presenting, there may also need to be basic X-ray machines. Add in other diagnostic equipment.
And where will these urgent care clinics be housed, assuming that there isn’t a whole lot of spare capacity within GP practices and community health clinics just hanging around? Labor is surely not assuming that capital is free here, so these costs will need to be factored in.
Presumably, the Medicare rebates for the bulk-billed services will be retained by these clinics but given the requirements, it’s hard to see how the revenue would come close to covering the costs even taking into account the subsidies in the program.
And where will these additional nurses and doctors come from given that there are already acute worker shortages, particularly in some areas? It’s hard to see how the economics of these clinics would allow above market rates of pay to be offered to attract staff. In any case, this could easily end up as a case of robbing Peter to pay Paul – staff being taken from other areas of need such as public hospital emergency departments or nursing homes.
There is also the issue of the staff skills needed to undertake these minor but urgent tasks. Given that many GPs do not have these sorts of procedural skills, it will be a sub-set of the profession that will be able to fill the urgent care clinic positions. The medical indemnity insurance companies may also have a close look at these operations if staff members are performing tasks which are regarded as outside the normal range of their competence.
The bottom line of these urgent care clinics is that they are really nothing more than a thought bubble designed for their political appeal rather than a practical proposal designed to relieve the pressures on emergency departments.
There is also no point referring to supposedly successful clinics in New Zealand. After all, different countries’ health care arrangements have their own details – there is very little private health care in NZ, for example, and co-payments are common – and what may work in one place won’t necessarily work here.
This is particularly so given the network of private GP businesses, some of which could be adversely affected by these clinics, to say nothing of the emergency departments of some private hospitals.
Don’t get me wrong – it might be interesting to pilot a small number of these clinics to establish the advantages and disadvantages. What happens, for instance, when someone with a serious condition presents at these urgent care clinics that are designed only for minor ailments?
But to claim that they will ‘provide help for families, less pressure on hospitals’ is to jump the gun. They have the same bad smell as the supposed one-stop GP super clinics that the Rudd Labor government championed, only for this program to face major cost overruns with only two-thirds (39) of the clinics ever opening. It took a Coalition government to unceremoniously ditch this $650 million program.
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