Dial a doctor: pandemic pressures healthcare system

The healthcare system in Australia has not been overwhelmed by the COVID-19 pandemic as initially expected - although the full extent of the second wave of the virus is yet to be seen.

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Nevertheless, there have been significant changes in the use of healthcare from the suspension of non-urgent elective surgery, social distancing restrictions that have discouraged people from leaving home, public fear of contracting or spreading the virus in health facilities, and increased household financial pressure reducing the affordability of out-of-pocket payments.

"The changing mix of face-to-face and telehealth consultations is significant, with 36 per cent of all consultation items provided by telehealth, compared to 1.3 per cent before the pandemic.”

Workload variation

In the latest ANZ-Melbourne Institute Health Sector report, general practitioners (GPs) reported evidence of significant variation in workload as a result of the pandemic. The increase in the number of newly funded Medicare telehealth consultations in April 2020 was accompanied by a reduction in the number of face-to-face consultations, with an overall increase in the total volume of services provided.

For non-GP specialists, new telehealth items and increases in the use of pre-existing telehealth items only partly substituted for a fall in face-to-face consultations, with an overall decrease in the volume of consultations provided.

These changes in workload and working patterns are substantial and uncertainty remains as to the permanence of the rapid shift to telehealth and how fast a potential recovery will take place.

Telehealth increases

Use of telehealth is high, with almost all GPs reporting use of telehealth compared with 76 per cent of non-GP specialists. Use of telehealth was lower among solo GPs and those in the most disadvantaged or rural areas. There were no differences by GP age or practice size.

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The changing mix of face-to-face and telehealth consultations is significant, with 36 per cent of all consultation items provided by telehealth, compared to 1.3 per cent before the pandemic when government funding for telehealth was mainly for non-GP specialists seeing patients in rural areas.

Most telehealth consultations are by telephone (96 per cent for GPs and 81 per cent for non-GP specialists). The use of video is still relatively low, presumably reflecting practitioner choice, patient preference or issues with access to technology. 

GPs bulk billed 96 per cent of telehealth consultations, reflecting initial restrictions as well as higher bulk billing incentives. Non-GP specialists bulk billed 76 per cent of telehealth consultations.

Most respondents (84 per cent) thought telehealth should be permanently funded by Medicare with stronger support from non-GP specialists and female doctors. GPs are more likely to support the funding of telephone consultations compared with video consultations.

New opportunities for the increased use of telehealth and digital health technologies now exist as policy has quickly developed and there is widespread support from doctors and patients. 

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Though this will improve patient convenience and may increase utilisation for some patients (and potentially lead to new business models in private practice) further research on the effects of telephone and video consultations on the quality and continuity of care is required.

Stress and mental ill-health

The significant changes in the mix of care being provided, increased risk to doctors’ own health and high levels of uncertainty about revenue flows caused by the COVID-19 pandemic are having an impact on doctors’ levels of stress and mental health.

Around 60 per cent of doctors reported feeling more stressed than usual, similar for both GPs and non-GP specialists. This was associated with a fall in income.

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Those who were financially stressed or who had applied for JobKeeper payments for their practice staff were more likely to report probable serious mental illness.

As some increased funding is being provided to support mental health treatment services for doctors, continuing effort and research into preventing and treating mental ill-health among doctors is urgently required.

The future

There remains much uncertainty about if and when conditions will return to as they were pre-pandemic. GPs seem to be more pessimistic about the future compared with non-GP specialists.

The pandemic and its consequences have accelerated a number of pre-existing trends in the healthcare sector and among the medical workforce. These include increased use of telehealth and lower growth in the use of private medical care together with the creation of new opportunities for improving the delivery of medical care in Australia.

How these changes influence the quality, costs and access to healthcare in the future is a key issue going forward.

Professor Anthony Scott leads the Health and Healthcare theme at The Melbourne Institute: Applied Economic & Social Research at the University of Melbourne

Click here to read the full ANZ-Melbourne Institute Health Sector report

The views and opinions expressed in this communication are those of the author and may not necessarily state or reflect those of ANZ.

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