Owen Harris

Medicare and the Bulk-Billing barnacle

medicare

With the Medicare co-payment barnacle apparently scraped from the hull of the not-so-good ship HMAS Abbott Government,  GP Owen Harris fears that quality healthcare and the future of good GP’s might go with it.

Like most doctors and much of the general public, I welcomed the news that the GP Medicare co-payment would be scrapped.

It was a policy entirely at odds with the notion of universal access to healthcare, and on a practical level it was a clumsy and complicated plan that would have been a huge headache to administer. I thought common sense and human decency had prevailed.

Yet now as I read the details of the government’s amended plans and think about the broader implications, I realise that it is determined to dismantle Medicare and that our nation’s health can only suffer as a consequence.

The government seems fixated on the need to provide a “price signal” to the public. At first glance, it seems they are treating patients as greedy consumers drunk on frequent visits to their GP, the logic being that if they visited less often, the Medicare bill would fall. This view ignores the significant cost of actually being unwell and visiting a doctor; it ignores the cost of the medicare levy; and it also ignores the huge mountain of research that shows strong primary health care with an emphasis on preventative health is far cheaper for the system in the long run. On closer inspection though, it’s clear that the government is actually ideologically opposed to universal access and wants to shift costs entirely to the patient.

By freezing the medicare rebate for consultations (a plan actually devised by the former Labor government) the government is effectively giving each and every GP a pay cut this year and every single year until 2018. In addition, the government proposes to reduce each rebate by a further $5 (though rebates for healthcare card holders are exempt). A practice has only two choices – see more patients by reducing the time spent with each,  or charge the patient a co-payment (gap payment).

A standard (Level B) consult attracts a rebate of $37.05 . A $5 cut is 13.5 percent. Imagine telling a state school that their funding is being cut by 13.5% immediately then frozen for the next six years. Imagine telling the school that it’s now optional for them to ask the parents to make up the shortfall, or ask all teachers to take a pay cut!

I work in a “mixed-billing” practice. Those who can’t afford the gap are bulk-billed. Those who can, are charged. The problem is that the medicare rebates have failed to keep up with the costs of inflation and of providing a quality service – a bulk-billed consult earns me approximately half of a full fee consult. Practices like ours rely on the full-fee paying patients to subsidise the bulk-billed services. But this is becoming increasingly unsustainable and I fear that soon we will create a two-tier system. Those with money will attend privately billing practices, and hose without will receive sub-standard care, or worse, no care at all, as bulk-billing clinics disappear entirely and patients become sicker and sicker, and rely more on hospital emergency departments.

Being a GP is rewarding, but it is hard work. A good GP is one who knows the patient well after many years of consistent care and who has the time to explore the patient’s concerns but also has their radar constantly on alert for other serious but rare conditions. A good GP is one who can avoid expensive tests because they can assess the patient thoroughly and rely on their clinical judgment. A good GP can review a patient often and can educate them on their condition. A good GP can detect illness early and start treatment before the patient becomes unwell and needs hospital care. Being a good GP clearly takes time and this time needs to be remunerated accordingly. While I am certainly not crying poor, it’s also true that I could be earning a lot more if I chose to work in other areas of medicine or in another profession. It is a choice that I made because I enjoy my work and because I believe that all people deserve high quality and accessible health care. If the government continues to force a pay cut on GPs then it is a choice that will be harder for the future generation of young doctors and our entire community will suffer.

I applaud the government for raising the issue of “six minute medicine”, however, their approach is entirely flawed. If GPs were treated with respect and Medicare rebates lifted accordingly then six-minute consultations would not be necessary. If more money is needed then raise the Medicare levy. Other reforms like changing the fee-for service model should also be considered.

But the government is blind to any sensible suggestion because they have become fixated on a user pays mentality. That people should pay for healthcare just like they should pay for university. And that those who can’t afford it are simply “leaners”, though I fear there will soon be many without a leg to stand on in terms of quality healthcare, let alone lean.

Owen Harris

Dr Owen Harris is a GP and one of the partners at St Kilda Medical Group. He has worked in private practice, community health, aboriginal health and rural and remote emergency departments.

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2 Comments

  1. Edward Egg said:

    In many cities in Australia bulk-billing already is already extremely rare. Increase in the Medicare levy not the cost of visiting the GP.

  2. Rainer the cabbie said:

    Hey Owen
    Thanks for a great article.
    Keep up the good work, I appreciate your dedication.

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