Published on the 18/03/2020 | Written by Heather Wright

Is it time to stop putting all our eggs in the Healthline basket?…

The head of New Zealand’s Health IT body NZHIT is calling on the government to push some of any future Covid-19 relief funding into encouraging GPs to deliver virtual healthcare services to patients.

Scott Arrol, NZHIT chief executive, says the current funding model in New Zealand doesn’t encourage the use of technology to deliver care, instead focusing on getting patients coming through the door. He says urgency needs to be given to changing funding models and incentives to enable GPs to change their business models to accommodate virtual healthcare.

“GP practices need to be incentivised and supported to make the change – and to make it fast.”

“The current Covid-19 outbreak highlights the need [for virtual healthcare services] to be given a high priority, not only for outbreaks of this nature but as a means to provide healthcare services as a part of our daily lives, which is already happening in other parts of the world,” Arrol says.

This week’s Covid response package from the New Zealand government included a $20 million funding boost for Healthline – a move Arrol applauds, saying it’s appropriate that the service, which as a phone service is technically a virtual healthcare service, gets more money to ramp up.

But he told iStart ‘All our eggs are in the Healthline basket and it’s a good basket to have at a time like this. The Healthline system is fantastic. But that’s all we’ve got as a main way of dealing with this, other than in person.

“New Zealand GP practices need to be incentivised and supported to make the change – and to make it fast.”

A funding model which bulk funds for enrolled patients, with co-payments for attending is a key part of the issue.

Of what is holding virtual healthcare in New Zealand back, Arrol says. GP business models have been built around that funding model, and pivoting to a new model of hybrid healthcare is challenging – particularly when around 50 percent of GPs are currently within 10 years of retirement and reluctant to invest in changing their business model when they plan to sell out before long.

“We have younger GPs coming through who are adopting technology in a much quicker and different way and can adapt to a different business model if they are incentivised to do so – but not enough of them.”

Arrol says many GP practices have the ability to offer video consults through patient portal platforms, but aren’t doing so.

“This is where the govt could step in to incentivise that behaviour and say if a doctor offers one and you choose a video consult, it will be free to the patient and, to incentivise the GP, we will pay a premium [government subsidy].”

In Australia, the Covid-19 package announced by Scott Morrison included specific funding for an increase in the telehealth response. The AU$100 million offering, which is being bulk billed, is available for medical, nursing and mental health staff to deliver services over the phone or via videoconferencing, including FaceTime, Skype and WhatsApp.

As well as providing services to those self-isolating and the elderly and vulnerable, the new telehealth funding will enable medical practitioners who are themselves in isolation to continue providing health services.

Arrol says Canada has also done similar.

“It’s a cliché, but virtual healthcare has to become quite quickly one of the tools in our toolbox.”

Arrol says we haven’t got the time to debate the outliers – those who for reasons such as connectivity issues, won’t be able to use videoconferencing.

“It’s the bell curve model – you get as many of the population into the centre of the bell curve and deal with them accordingly and then the outliers you have to have specific responses or targeted services for them.

“We tend to spend a lot of time talking about the outliers and tend to blur the conversation because of that,” he says.

With the push on for people to call Healthline – or potentially their own GPs – for Covid assistance, rather than going in to see doctors, Arrol says there’s potential for GP practices to suffer financially.

“Putting a business lens over this, I could see small GP practices really struggling as numbers ramp up of Covid cases. They’re defaulting back to their bulk funding but they’re not getting the walk-in co-payments they used to get so it’s going to put pressure on their cashflow and bank balance.”