A Canadian family medicine specialist believes it is a mistake for patients to have to pay for their GP visits and argues that their fees should be footed by the government.
Helen Batty, a family doctor and professor at the University of Toronto, strongly believes retaining the present system, whereby patients pay out of pocket for GP visits, will weaken the revolutionary reform of primary healthcare being pushed by the government.
"People who need to go to the doctor are usually the poorest and the sickest. I think you will lose some of the strength of the system if they have to pay to see their family doctor," she said during a short visit to oversee medical students' exams.
When questioned about this, Health Parliamentary Secretary Joe Cassar said doctors did not want to become government employees.
"They do not want to be paid by the government for the service. They shot it down in 1987 and they will shoot it down now," he said.
Last month, the government launched a consultation on the much-awaited reform that gives more powers to family doctors and pivots around a system in which patients will register with a GP. Registration will be free but patients will continue to pay for visits, although there will be a means-tested mechanism to identify those who cannot afford to pay.
Moreover, the 49-page reform document proposed that people with chronic diseases, who go to health centres for follow-up care and repeat prescriptions, would be able to obtain this service from their family doctor, with the visit subsidised by the government.
Prof. Batty believes the government should pay for everyone's GP visits, a system that has been in place in Canada for four decades.
Her reasoning is based on international research, which found that a strong primary health system reduces the need for hospital admissions and cuts healthcare costs.
In fact, the local consultation document pointed out that studies have shown primary care improves the health outcomes of a population and contributes towards the long-term sustainability of healthcare provision.
Prof. Batty believes results will start being seen after five years. "If you put more money in primary care, the hospital expenditure will go down because people will not go unnecessarily and won't stay longer than they need to," she said, adding that a strong community care system was also important.
The physician highlighted the importance of building a strong doctor-patient relationship, which is possible through the registration system that exists in Canada.
"We know the healthcare outcomes are much better when there is a strong relationship between the patient and the doctor," she said, adding that family doctors see patients as a whole person.
She explained that in patients with multiple conditions, the treatment for one disease might exacerbate another.
But a family doctor could find a tailor-made programme for the patients, leading to a better outcome.
She emphasised the importance of round-the-clock coverage by family doctors, a system that operates in Canada and is included in the local reform.
"A lot of small things can be solved through a five-minute phone call in the middle of the night, which avoids a visit to the emergency room," she said.
Prof. Batty believes healthcare protocols should not be set by bureaucrats but by the doctors themselves.
"As a professional, I feel the government should trust me. If I say that a patient needs a particular test, it is because I believe it is necessary and am willing to defend the decision," she said.
In Canada, the government foots the bill of such investigations, although patients pay for medications, mostly through insurance.
The local reform recommends that part-time doctors or those working reduced hours will only be able to work within the system as part of a group practice.
Prof. Batty believes part-time doctors should not be discouraged from being part of the registration system, even because they might want to have reduced hours temporarily. She stressed that family doctors were highly specialised and it would be a pity to have a number not included in the system because they could not work full-time.