Yes, the national reform agreement should do a lot more to reduce specialist wait times.
One part you mentioned is how public specialist care is funded. I agree that public specialist care should be funded through hospital funding, not the Medicare Benefit Schedule (MBS). The MBS is the wrong way to pay for this care.
The MBS is too rigid, requiring care by a named medical specialist. But that doctor might not be working when the patient comes in, or the care might be best delivered by a team member who isn’t a medical specialist.
The funding model also creates opportunities for cost-shifting between governments, and in some cases there has been inappropriate MBS billing.
Another area where the national reform deal could help is productivity. It’s a big problem if the skills of an experienced specialist like you are going to waste!
Our research found a lot of differences in how public clinics work, even in the same city, ranging from what kind of patients they see, to how they schedule care, to the roles that different health workers play. There is a lot of room to spread best practices and improve efficiency
So, while there should be more funding for public specialist care, it should come with more accountability for productivity. That means the prices governments pay should reflect efficient practices, and there should be public reporting on both wait times and how much care each dollar buys.
The new National Health Reform Agreement, which governments struck earlier this year, creates opportunities for some of these changes. It didn’t have the big expansion of public specialist care we proposed. But it does commit to a new national reporting framework, and significant funding to spread new models of care.
Both could be used to help improve the productivity of public specialist clinics.