When is a co-payment a tax?

Cut & Paste had a bit of fun this morning:

Is it a co-payment to a doctor or a tax? ABC1’s Q & A, Monday:

TONY Jones: This co-payment, you’ve agreed, is effectively a tax on people going to the doctor. …

Joe Hockey: Well, I don’t accept … it’s … it’s a payment. Well, you can call it a tax. You can call it whatever you want.

Jones: You called it a tax. You admitted it was a tax.

Hockey: No, I didn’t. … Given of the $7, $2 goes to the doctor, I didn’t know doctors, in that situation were receiving taxes, but your call. You want to call it a tax, you can call it anything you want. You can call it a ­rabbit.

Tax or rabbit? Annabel Crabb, ABC online, The Drum, Thursday:

THE Medicare co-payment might be a tax, but on the other hand it might be a rabbit.

So is a train ticket a tax? Chris Kenny tweets Tuesday:

THIS morning the Treasurer and I shall call my train ticket a tax.

The bad news is that $5 of the $7 co-payment is a tax. The definition of a tax is (emphasis added):

… a compulsory exaction of money by a public authority for public purposes, enforceable by law, and … not a payment for services rendered.

What the government have done is introduce a transactions tax on going to the doctor. Think of it like a Tobin tax – except for health services and not financial services. The express objective is to ration people out of the health system – and it seems to be working.

Update: Based on the comments in the thread I just want to clarify that I’m not opposed to the idea of “co-payments” for medical services or, indeed, any other service.Ideally health would be entirely private. I am opposed to the medical research fund. I’m also pointing out that the co-payment is a tax.

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223 Responses to When is a co-payment a tax?

  1. not a payment for services rendered

    But it is, Sinc…

    You presently get a GP visit fully funded by the government (or at at least up to the scheduled fee for those who don’t bulk bill). You now pay $7 for a service which costs more.

    Yes, the government has been too clever by half, by trying to link the visits with the silly $20b fund, but spending elsewhere doesn’t suddenly make it a tax.

  2. Sinclair Davidson

    No. It is a tax on the transaction. There is no relationship at all between the value of the transaction or the spending that underpins the transaction. If either of these conditions were met it would be a co-payment. Playing silly-buggers with the research fund turns a co-payment into a tax.

  3. Notafan

    Someone I know was arguing that it was a stealth GST on health. It should never have been linked to a research fund, and just made it clear that health costs were increasing at an unsustainable rate due to overservicing.

  4. Gab

    When is a co-payment a tax?

    When the revenue from the “co-payment” collected goes into the ledger marked “tax receipts”.

  5. candy

    No-one going to the doctor thinks they’re paying a tax, you know. It’s called paying the doctor, not paying a :) hope that helps!

  6. candy

    Sorry – it’s called paying the doctor, not paying a tax, is what I meant.

  7. Sinclair Davidson

    Candy – when I go to Coles, it’s called paying the supermarket, yet 10% of the price of most goods goes to the government. A little something called the GST.

    Hope that helps.

  8. candy

    Everyone knows the GST is a tax, Prof. D. It’s called goods and services tax. A bit of a giveaway!

    I’m sure that helps. Don’t be cross! :)

  9. Aristogeiton

    Can someone explain to me what the $2 component is? Can’t the practice set their own prices?

  10. val majkus

    don’t doctors have a discretion as to whether or not to charge it?

  11. Michael

    GST is technically a tax on the supplier, not on the consumer. When you go to Coles and pay for goods, the GST liability falls on Coles as the entity making the supply. It is, of course, invariably absorbed into the price paid for the goods and that way the consumer bears the economic burden of the tax.

  12. Aristogeiton

    So what is it, a suggestion to raise prices by $2?

  13. val majkus

    The Australian Medical Association has been critical of the co-payment plan. The AMA says it would mean that some people who should seek early intervention would be discouraged – although, in an apparent contradiction, it also predicts that after an initial period there would not be much of a fall in visits.

    The AMA is especially concerned about the implications for four groups: Indigenous people, low-income earners, those with severe mental problems and the aged.

    The government would reap its savings by cutting the rebate by some $5, leaving the doctor with part of the co-payment as a sweetener. Doctors would have discretion in waiving the co-payment – putting them in a rather invidious position – and to protect the chronically ill, it would not apply after a certain number of visits. The Commonwealth would negotiate with the states for a co-payment in the emergency departments of hospitals for non-emergency cases.

    However, I’m a bit like Hockey; call it what you like

  14. Mk50 of Brisbane, Henchman to the VRWC

    I have been hunting high and low for a downside to this idea.

    Still can’t find one.

    Either we control health spending and waste on moochers to keep the decent system we have (which means making damned sure as many people as posisble are privately insured), or the system will spiral into a wasteful inefficient hugely expensive deadly and useless heap of steaming crap like the British NHS. What does the NHS call murdering old people in their hospital system (starvation and death by thirst) so they don’t have to spend money on them? The ‘Liverpool Pathway’, I do believe.

  15. Aristogeiton

    So they are doing it by cutting the rebate by $5. The extta is just a a suggestion to gouge by the Government. Got it.

  16. The AMA is especially concerned about the implications for four groups: Indigenous people, low-income earners, those with severe mental problems and the aged.

    What about the children? Any list of policy victims is incomplete without them. Won’t somebody think of the children?

  17. Aristogeiton

    Wait, so the money is not collected but is just shuffled from health spending into this silly fund, yes? To cure cancer. Because research money funds.

  18. Bert

    I don’t agree Sinc. It is a copayment, not a tax. A tax is payable irrespective of whether you consume a service. In the case of the copayment, it is only payable when consuming a service- ie: visiting a doctor. How it is collect, or whether it is hypothecated, is irrelevant. If the full cost of that visit to the doctor is $80 and you only pay $7 that is not a tax. It is like buying a stamp from Australia Post or a train ticket from NSW State Rail. The latter is more comparable since the cost of the train ticket is much much lower than the cost of the service – it is highly subsidised.

    There is no way that the copayment is a tax. It fails the very first part of your definition “compulsory exaction of money by a public authority for public purposes” – it is not compulsory since one doesn’t pay it if one doesn’t go to the doctor. That’s different to a tax which is payable irrespective of whether you consume a service (such as the Medicare Levy which is a tax).

    If you follow your argument, you would say that any charge by any Government-owned instrumentality is a tax. That’s ridiculous.

  19. Bert

    And what’s a Tobin Tax got to do with it? It is not a transactions tax. A Tobin Tax is levied whenever one is making a financial transaction. But the Government isn’t paying financial institutions to provide their services. This is quite different – government is paying doctors to provide their services.

  20. Aristogeiton

    I suppose that it was sold this way to avoid an argument with the AMA over bulk billing? As usual, sucking up to socialists has worked a treat for the Government, since the AMA realise that this is less money for members.

  21. Infidel Tiger

    It’s one of the few decent parts of the budget. Except it should have been $50.

  22. Infidel Tiger

    It’s not a tax. It’s a subsidy reduction.

  23. Aristogeiton

    Infidel Tiger
    #1318083, posted on May 24, 2014 at 4:06 pm
    It’s not a tax. It’s a subsidy reduction.

    If it’s just a reduction in the rebate with window dressing then it is *not* a tax.

  24. Anita

    “… a compulsory exaction of money by a public authority for public purposes, enforceable by law, and … not a payment for services rendered.

    What the government have done is introduce a transactions tax on going to the doctor. Think of it like a Tobin tax – except for health services and not financial services. The express objective is to ration people out of the health system – and it seems to be working.”

    A tax is paid by the community whether they use the service or otherwise. I may never visit a doctor but I pay 1.5 % of my income as tax so that the wider community could have general health services.

    However, if I pay $7.00 for each visit, I am paying a fee for services rendered. Simple as that!

  25. Aristogeiton

    Bill is not before Parliament so far as I can see. Any better information out there about this?

  26. Leo G

    Surely train fares, in most instances, are co-payments.
    A train fare is not a tax, even if it is government revenue, but a direct payment for which the farepayer expects a specific service.
    It could be considered a tax under certain circumstances- if train services were provided as a universal entitlement by one level of government, but a tax was imposed by another and collected as the fare.

  27. Gab

    It’s not a tax. It’s a subsidy reduction.

    So no-one forks over $7 to the doctor?

  28. Aristogeiton

    What is the mechanism by which it is collected? Is it collected? Can we establish that first?

  29. tomix

    Making a dent in the gargantuan incomes of GPs in private practice? Quelle horreur.

  30. Gab

    Well, Hockey’s explained this one rather well. Clear as mud.

  31. Andrew

    What the government have done is introduce a transactions tax on going to the doctor. Think of it like a Tobin tax – except for health services and not financial services.

    Sinc, are you high? It’s a Tobin tax if you’re paying the doc bill yourself and THEN the govt clips the ticket. Here, you’re consuming a $70 service, asking the doc to accept $40, of which the govt used to pay $40. Now the govt pays $35, you pay $7. The doc gets an extra $2 for his effort, and in addition to the $35 the govt’s also making a $5 donation to medical research acceleration. In agreeing to the “it’s a tax” lie you’ve forgotten who is actually paying here.

  32. H B Bear

    Another own goal by the Liberals. And another bullshit hypothecated tax.

    Why bother taking all this political pain for some half-arsed future fund that “may cure cancer”. If you want to engage in feel good gestures buy a yellow ribbon and go for a run.

  33. Alfonso

    F*****g Hockey.

    These fabian Liberals need some media training from Mark Steyn.

  34. Aristogeiton

    Andrew
    #1318112, posted on May 24, 2014 at 4:31 pm
    What the government have done is introduce a transactions tax on going to the doctor. Think of it like a Tobin tax – except for health services and not financial services.

    Sinc, are you high? It’s a Tobin tax if you’re paying the doc bill yourself and THEN the govt clips the ticket. Here, you’re consuming a $70 service, asking the doc to accept $40, of which the govt used to pay $40. Now the govt pays $35, you pay $7. The doc gets an extra $2 for his effort, and in addition to the $35 the govt’s also making a $5 donation to medical research acceleration. In agreeing to the “it’s a tax” lie you’ve forgotten who is actually paying here.

    What he said. Have to duck out, but as I read the tripe I posted above it’s just a reduction in the Medicare benefit by $5 and an encouragement by the Government to gouge the customer for $2, no doubt done to sweeten the deal for the AMA.

  35. Aristogeiton

    GPs lose the “bulk-billing incentive items” if they don’t charge the copayment; this is either $5.15 or $7.85. These apply for under 16′s and concession card holders:

    http://www.medicareaustralia.gov.au/provider/incentives/files/incentive_payments_to_GPs_who_bulk_bill_concessional_patients_under_16.pdf

  36. Linda

    It is clearly not a tax as the doctor does not have to charge the extra 7 dollars. Therefore it is not compulsory nor enforceable. The payment also does not go to the government .

  37. Aristogeiton

    This incentive payment is made to increase the occurrence of bulk billing to concession card holders and da yoof; some practices will bulk bill regardless.

  38. stackja

    The express objective is to ration people out of the health system – and it seems to be working.

    ALP public health system – you join a queue.

  39. not a payment for services rendered.

    It’s Tribute to the poor taxpayer subsidising the pensioner’s visit.

  40. Dan

    No no no.
    Medicare rebates go down in real terms every year. The indexation is about 2% at best. Such that as I mentioned on another thread the absolute quickest consultation for a non VR GP grosses $11 total from medicare

    There is currently a freeze for six months on indexation (effectively a loss of half this year’s indexation) which will now last for 2.5 years. Private health funds have mostly followed Medicare (cheeky when they are charging their members a compounding 7% annual increase).

    This isnt a copayment at all. That would have been an extra fee going to the government. This is simply a further erosion in real value of Medicare rebates, which to cut all the crap GPs are expected to mainly waive.

    I would estimate that developing a new computer system across GPs, pathology, radiology and Medicare to calculate the caps will cost more than this measure will save. In fact i doubt it will ever be achieved.

  41. Petros

    Doesn’t the copayment on medications go to the pharmacist? Doesn’t most of this doctor visit tax/levy/copayment go to the government? If so, it’s a tax like the GST.

  42. Aristogeiton

    Source on indexation Dan?

    If I turn up and say I’ve made my ten at ten different practices, what happens?

  43. lem

    Look. It’s not a tax. it’s the end result of the government buying into an unsustainable chimera of health insurance. Thanks Gough. Now we everyone is finding out the truth. It cannot be paid for by the fairy godmother.

  44. Dr.Sir Fred Lenin

    If you want to fund medical research just cut out indiginous spending,refugee intake. Foreign aid and the government will be flush with money liberating indigents from welfare will enhance Democracy instead of bringing “refugees”here ,let them stay at home and liberate thier own countries,and with no foreign aid third rate countries will have to work to improve living standards.Bludgers always hate and despise the people who give them charity,the racist indigents will tell you that ,and the bludging “refugees”So we give them nothing and gain grudging respect and fear.mand be better off.

  45. Aristogeiton

    Off your meds Fred?

  46. lem

    So, Sinclair, with all due respect darling, give up the tax talk.

    What happened (and I am perfectly aware that you know this) is that the government years ago decided to buy into the health insurance business thereby bribing doctors to exit the direct monetary relationship they (doctors) had previously with their patients, and which I might add led to many patients who couldn’t afford it, being treated for free.

    This new government intrusion on the monetray doctor-patient relationship meant that suddenly medicine could be freed from this responsibility to its’ patients. And could bill and receive payments without the direct scrutiny that immediate payment by the patient brings.

    And with this has come the lack of responsibility the immediate parties feel to expenditure when they expect a third party is picking up the bill.

    The government now are doing what they should,introducing what the other health insurers call a gap payment. Which I don’t think you would call a tax.

  47. egg_

    Well, Hockey’s explained this one rather well. Clear as mud.

    Thinks he’s pulled a “rabbit” out of a hat, but more likely a hare out of his ass.

  48. stackja

    Liberty Quotes
    If you think health care is expensive now, wait until you see what it costs when it’s free.
    — P.J. O’Rourke

    The Liberty Manifesto (1993)
    Health care is too expensive, so the Clinton administration is putting Hillary in charge of making it cheaper. (This is what I always do when I want to spend less money — hire a lawyer from Yale.) If you think health care is expensive now, wait until you see what it costs when it’s free.
    linky

  49. 2dogs

    The patient is paying for a service rendered, at a discounted price.

    The doctor is receiving a net payment from the transaction.

    For each instance of the transaction, the government donates $5 to medical research.

    That sounds to me like a marketing promotion. Not a tax.

    It’s just that it’s a perverse one, because the government actually wants to reduce such “sales”.

  50. lem

    Liberty Quotes
    If you think health care is expensive now, wait until you see what it costs when it’s free.
    — P.J. O’Rourke

    You better believe it. Because I am at the pointy end of medicine, and if you think my colleagues haven’t dreamed up new ways to suck up money, which everyone will be clammering for as the latest must have in health care, then you’re dreaming.

    There’s only one way to stop this. And that’s for the government to exit the equation, except for the utterly impoverished.

  51. MemoryVault

    Can we cut all the pollie-spin, hide the pea under the shell crap about co-payments, how much, and whether it constitutes a tax or not?

    Thanks to Aristogeiton and the links (s)he has provided it is easy to ascertain what is really happening is that the Medicare rebate for a GP visit is being cut from $36.00 to $31.00, with similar cuts across the board on rebates for all medical services.

    Everything else is the usual well-mixed sludge of clap-trap and conjecture, designed to obfuscate the fact that it is, indeed, a cut in grubbermint expenditure that will hit everybody, and which will almost almost certainly kill off bulk-billing as a business model.

    Which would appear to have been the main aim in the first place.

  52. stackja

    lem
    #1318187, posted on May 24, 2014 at 6:10 pm There’s only one way to stop this. And that’s for the government to exit the equation, except for the utterly impoverished.

    Which as I remember was the case before ALP `improved’ the health system.

  53. lem

    Exactly memory vault and they are doing what they should, which is send a message to each party in the doctor- patient relationship that the party is over, and start making arrangements to enact different funding.

    Which includes doctors and patients honestly talking about cost effectiveness of investigations and treatments.

    By the way, there are plenty of us who have been doing this for years without allowing medicare to intrude in our practice anymore than BUPA or whoever. And I wager practicing better medicine.

  54. Notafan

    If bulk billing is dead that is a good thing.
    It was only a couple of years ago there were television adds for heart checks for everyone that the government stepped in and stopped.
    One of the new things I have noticed is skin cancer checks for everyone.
    I’m sure there are hundreds of other things doctors do to maximise their welfare checks.

  55. lem

    Notafan, trust me, the rorting is dreadful.

  56. Notafan

    Lem as lay person I only see the obvious stuff I am very sure once someone is in the system the sky is the limit.
    I might just be slack but all the screening I get told to do by the government (as an over 50 female)I ignore.
    I remember a colleague getting angry his 92 FIL was ‘refused’ a hernia op. I just tried to suggest it might be too dangerous at his age as he had a heart condition and was deteriorating pretty quickly.

  57. danzig_misfit

    All I know is if my 3 kids to different fathers get whooping cough at the same time, I am going without my Cruisers,

  58. dan

    Aristogeiton I dont have time to find original Medicare data but this link based on AMA info (I know…) summarises the issues.

    Notafan, minor surgery can be done at pretty much any age and in the presence of just about anything if it makes a difference to someone’s quality of life. While occasionally hernia surgery can be a massive undertaking, usually not and usually spinal or even local anaesthetic should make it a safe procedure. But the patients should usually pay for it themselves rather than look for govt rations.

  59. Sinclair Davidson

    lem – yes, I understand the whats and whys and even the history. Zero-price at point of sale government services create all sorts of perverse incentives. It does not change the fact that this co-payment is a tax.

  60. Notafan

    Thankyou Dan the gentleman in question died a few weeks later. It was a private hospital so I think possibly they genuinely believed it was not appropriate.

  61. JC

    Sinc

    If the service costs you nothing, because you’re glomming yourself or another taxpayer and then asked to chip in 7 bucks it’s not a tax.

    But yes, if the money is going to the government to fund the medical research crap it becomes a little problematic. The reason it’s problematic is because they’re ball-less twerps as they should have come straight out and said it was a co-payment to mitigate ruinous healthcare costs.

  62. Sinclair Davidson

    JC – whether or not you think health should be privatised or socialised doesn’t impact on whether the co-payment is a tax or not.

  63. kae

    Fleeced

    I don’t think it will affect the indigenous group.

    These people are bribed with t-shirts to attend the doctor for check ups now.

  64. lem

    Well, for once I’m with Hockey. Call it whatever you like.

    I call it the beginning of a strategic withdrawal from a business that the government should never have been in to start with.

    Thats Lemonomics :) )

  65. MemoryVault

    Lem, Notafan,

    I am not in any way opposed to killing bulk-billing. I think bulk-billing is a terrible idea that promotes over-servicing. I am however appalled at the sheer stupidity in the way the idea is being sold and implemented.

    Come July 1, 2015, most people, including our brain-dead journos, think that people currently being bulk-billed (IE actually paying nothing), are going to have to start paying $5.00 or $7.00 upfront.

    This is utter BS. From July 1, 2015, these people are going to have to pay upfront whatever the Doc chooses to charge, and then wait for their Medicare rebate. Even if a doc chooses to only charge the current bulk-bill rate of $36.00, the patient is going to have to fork over the whole $36.00 at the time of the visit, and wait for their rebate.

    I happen to think this is a good thing, but it is not what people are being spoon-fed at the moment with all this political clap-trap spin about $7.00 “co-payments”, further obfuscated by talk about “medical research funds” and the like.

    When it happens there will be political hell to pay, all sheeted home to the LNP because they are currently trying to hide what they are doing.

  66. Sinclair Davidson

    lem – see my update on the post.

  67. Notafan

    I’m not sure that is correct however I find EFTPOS machines work quite well and I hope by then the rebate can be claimed online, maybe even via an app on your phone.

  68. lem

    Memory Vault, in my practice we are linked up with medicare, so what happens is, if the patient has a current medicare card, we bill them as any business would our total fee, and then medicare automatically pays the rebate into their nominated account, so no need to submit a claim. So we are actually doing some of the work for medicare and the patient.

    Pretty easy.

  69. Di

    You know – I don’t really care. What I care about is why are we paying sooo much money for so little return.

    That is what I think this government is really trying to address with all of this. Yes their messages are all wrong, but you get that.

    The bigger question is – what is going to happen if the left win – how many more bullshit lefty programs are they going to ship in to Alice Springs to deal with Aboriginal Health? How many more carey sharey snout in the trough public servants can one town groan under?

    Canberra I imagine would be the same…

  70. Tintarella di Luna

    I pay $75 to my family GP when this co-payment commencement commences will it then cost me $7 on top of what I pay the doctor? I’m not going to call it a co-payment or a tax or a rabbit, I’m calling it ranunculus bulbosus

  71. Grigory M

    It’s not a tax. it’s the end result of the government buying into an unsustainable chimera of health insurance.

    Rubbish. If that was the case, then it would simply go into the Consolidated Fund to offset the “unsustainable chimera of health insurance”. Instead, it’s being funneled into a slush fund for so-called medical research.

  72. lem

    Sinclair, professor, sir, (although with some of the “professorial chairs” being awarded right now you might prefer a simple Monsieur) I never doubted your economic purity!

    But I still think they shouldn’t call it a tax. It’s just a different method of forking out the same amount of dough to the bulk billing doctors. I’d prefer “price signal”.

    Love ya work, going to the movies right now!

  73. wreckage

    I’m not sure that paying $7 to the government to get $36 back is something I’d call a “tax”. Processing fee, maybe…

  74. MemoryVault

    I pay $75 to my family GP when this co-payment commencement commences will it then cost me $7 on top of what I pay the doctor?

    No. At the moment you pay $75.00, and a couple of days later Medicare deposit $36.00 into your bank account as a rebate, assuming you have given your doc your bank account details. Otherwise you take the doctor’s receipt to a Medicare office and collect the rebate.

    After July 1, 2015 your doctor will still charge you $75.00 (or whatever he has put his fee up to by then), but Medicare will only pay a $31.00 rebate, instead of $36.00. So you will be a further $5.00 out of pocket overall.

  75. JohnMc

    It is a payment for services rendered. You’re paying the doctor for his services and, unlike a tax, people who don’t see the doctor don’t pay. This service is also substantially subsidised by taxpayers. So the payment is a reduction in the level of subsidy.

  76. Grigory M

    I pay $75 to my family GP

    If that’s for a standard consultation, your family GP is ripping you off to the tune of $38.70. He or she is charging you more than twice the schedule fee, which is the $36 “rebate” (actually $36.30) that Medicare will re-imburse you.

  77. Tintarella di Luna

    Thanks MemoryVault, so it will be business as usual and I’ll be light $5 – only problem now which of $5 vices to cut.

  78. Tintarella di Luna

    Thanks MemoryVault, so it will be business as usual and I’ll be light $5 – only problem now – which $5 vice to cut.

  79. Lochlinnie

    All this argument about a $7 co-payment when it’s been years since there were any bulk-billing doctors about, except for card holders. These rest of us have been paying full tarriff ($50+) for a consultation for years.

  80. MemoryVault

    which is the $36 “rebate” (actually $36.30) that Medicare will re-imburse you.

    My apologies for the slight inaccuracy, Grigory.
    I’ve been trying to employ the KISS principle.

  81. Tintarella di Luna

    …..your family GP is ripping you off to the tune of $38.70

    Grigory, I paid the frig man $135 to look at my frig and tell me what I already knew, that it was cactus. I figure $75 for a visit to my doctor who has my health and well-being at stake is a good investment. Besides and more importantly he’s ever so cute.

  82. MemoryVault

    All this argument about a $7 co-payment when it’s been years since there were any bulk-billing doctors about, except for card holders. These rest of us have been paying full tarriff ($50+) for a consultation for years.

    Spot on, Lochlinnie.
    It is all about removing bulk-billing for card-holders, nothing more, nothing less.
    Currently, I go to my doc, pay $55.00 and get a Medicare rebate of $36.00 ($36.30 to be pedantic).
    A card-holder goes to the same doc, pays nothing, and Medicare pays the doc the $36.00.

    I would imagine under the new system, I will go to my doc, pay $55.00, and get a Medicare rebate of $31.00. A current card-holder will go to my doc, pay (say) $40.00**, and get a Medicare rebate of $31.00. At no point does a $5.00 or $7.00 (or any figure) “co-payment” come into it. Yet that is what people are being led to expect. And Abbott and the LNP will act all surprised and hurt when there is an electoral backlash.

    ** My experience is, most GP’s are numerically challenged, and prefer to do accounting in multiples of fives or tens.

  83. Perpetual Motion

    Grigory, the Schedule Fee is not what the govt believes a consultation to be worth. It’s only the amount they are willing to subsidise. And then mostly at 85% of that figure.

    Doctors can charge whatever they want, and if they have any balls at all, they do, like any other service provider.

    The beta doctors bulk-bill.

  84. Notafan

    In Melbourne bulk bill for everyone is readily available east west north and south, there might be a few ‘affluent’ suburbs that don’t.
    The copayment is capped for health card holders at $70 and can be waived for the chronically ill. Doctors bulk bill to maximise market share, they don’t have to. I don’t see GP copayments as being significantly different to the current arrangements for PBS
    My ENT charges AMA rates, not the scheduled fee.

  85. Grigory M

    Doctors can charge whatever they want, and if they have any balls at all, they do, like any other service provider.

    Thanks for that insight, doc – not sure what the practitioner’s alleged manliness has to do with it, but. ;)

  86. Perpetual Motion

    Doctors can charge whatever they want, and if they have any balls at all, they do, like any other service provider.

    Thanks for that insight, doc – not sure what the practitioner’s alleged manliness has to do with it, but. ;)

    Actually Grigory, my own theory is that the decline of General Practice is due to the feminisation and corporatisation of the profession. Part-time females, working in corporates, and infesting medical organisations such as the RACGP , has led to the destruction of General Practice just as it has led to the destruction of teaching as an option for alpha males.

  87. MemoryVault

    Grigory, the Schedule Fee is not what the govt believes a consultation to be worth. It’s only the amount they are willing to subsidise. And then mostly at 85% of that figure.

    Absolutely true, Perpetual.
    If the grubbermint of the day feels that the country can no longer afford to subsidise a consultation at the current level, then they should simply say so, and reduce the subsidy to what they feel society can afford. And if they are hoping or planning that this change will kill off bulk-billing – as it must – then again, they should spell it out. Not bury the truth in spin and obfuscation and “co-payments” and “research foundations”, and hope the general populace won’t notice.

    They will. And with a start date of July 1, 2015, all the LNP have done is move the day of Reckoning a year closer to the next election. Brilliant strategy – NOT!

  88. Infidel Tiger

    Actually Grigory, my own theory is that the decline of General Practice is due to the feminisation and corporatisation of the profession

    Feminisation has seen the decline of everything except geriatric phone sex operators and mummy blogging.

  89. Grigory M

    And with a start date of July 1, 2015, all the LNP have done is move the day of Reckoning a year closer to the next election. Brilliant strategy – NOT!

    On that we are agreed.

  90. Perpetual Motion

    Too true MemoryVault. I find myself in frequent, furious agreement with you.

  91. Notafan

    I understand the co-payment is intended to change behaviour both of patients who go to the doctor for example to discuss their retirement plans or because there’s nothing on telly and doctors who overservice.
    Reducing the rebate won’t do that and would adversely affect non bulk bill doctors.

  92. Grigory M

    Feminisation has seen the decline of everything except geriatric phone sex operators and mummy blogging.

    Spoken like a true geriatric female, IT. Sadly, Dr Perpetual Motion sees your younger sisters who have chosen to practice medicine as unworthy rivals to men as the rightful owners of the God complex.

  93. Perpetual Motion

    I understand the co-payment is intended to change behaviour both of patients who go to the doctor for example to discuss their retirement plans or because there’s nothing on telly and doctors who overservice.
    Reducing the rebate won’t do that and would adversely affect non bulk bill doctors.

    The first thing to understand is that there is not a shortage of GPs in Australia.

    There is an oversupply of patients who attend their GP at the drop of a hat, and there is an abundance of greedy fucking GPs who rip-off Medicare every day of the week, simply because it’s “free”.

    The most egregious of the liars and thieves are imported, but there are plenty of home-grown GPs who are also taking advantage of the system.

    I absolutely support the “co-payment”, except that I would like to see it at a much higher level. The current system is making otherwise law-abiding citizens into criminals.

  94. Grigory M

    Reducing the rebate won’t do that

    Correct, Notafan – if the “co-payment/tax” is to work as a deterrent to either over-servicing by doctors or unnecessary visits by patients, then it has to be an inconvenience. That means that patients will have to pay it, and the GP’s practice (not the actual GP) will have to collect it, up front – in cash.

  95. queensland observer

    Small point, if we didn’t have the co payment we the taxpayers would pay tax to cover the service anyway. So whether it is a co payment or part of the medicare levy and part of my income tax to cover the medicare levy shortfall, doctors visits were always paid by my taxes.

    The only difference is I may pay less tax now on medicare. Aka say I rarely visit the doctor, I would be currently subsidising other citizens for their visits to the doctor with my tax. Meanwhile citizens who visit their gp regularly would probably get more value out of the service then the tax the contribute. The co payment changes this by forcing the user to contribute directly towards the cost of their care, as a consequence other taxpayers have to subsidize them less and face less tax burden as a result.

    shouldn’t libertarian support a uuser pays system of medicare?

  96. Tom

    Feminisation Feminism has seen the decline of everything except geriatric phone sex operators and mummy blogging.

    Oh, and be careful you don’t get clubbed with Grigory’s handbag, IT. Those passive-aggressive chicks can be real nasty bitches.

  97. Grigory M

    Get your hand off it Tom, you fuckwit.

  98. queensland observer

    One other thing, I see posts saying most gps don’t bulk bill. I suggest visiting any regional Centre. All the gps bulk bill, most bilk bill everyone not just card holders.

  99. MemoryVault

    shouldn’t libertarian support a uuser pays system of medicare?

    A “user pays” system of socialised medicine?
    Now there’s a brain-twister.
    As for a libertarian argument in support of such a “system” -
    The mind boggles.

  100. Perpetual Motion

    Spoken like a true geriatric female, IT. Sadly, Dr Perpetual Motion sees your younger sisters who have chosen to practice medicine as unworthy rivals to men as the rightful owners of the God complex.

    You have chosen to wilfully misunderstand me Grigory.

    When society moves from mostly males working 50 hours a week in general practice, to mostly females working 8 hours a week in general practice, then it becomes more of a hobby than a profession.

    Really, it’s nothing to do with a God-complex. I reckon that disappeared 50 years ago.

    I have a daughter who could have easily got into medicine, but it’s a dead-end nowadays. Socialised medicine will see doctors eventually reduced to wages barely above teachers.

  101. Notafan

    Medicare also spend a fortune on inducements for rural and locum services. If bulk billers see significant reductions in income some of them might actually have to provide services where there is a genuine need.

  102. Perpetual Motion

    Medicare also spend a fortune on inducements for rural and locum services. If bulk billers see significant reductions in income some of them might actually have to provide services where there is a genuine need.

    Quite right, Notafan.

    There are too many GPs in capital cities, and the end of bulk-billing will see many of them forced to move outwards to make a living.

  103. Perpetual Motion

    84% of GP consultations are bulk-billed.

  104. Aristogeiton

    Sinclair Davidson
    #1318223, posted on May 24, 2014 at 6:54 pm
    lem – yes, I understand the whats and whys and even the history. Zero-price at point of sale government services create all sorts of perverse incentives. It does not change the fact that this co-payment is a tax.

    With the greatest respect, Sinc, I don’t see how this could be a tax.

    None of the money collected goes to consolidated revenue. It is kept by the treating physician because they are charging it.

    Presently bulk-billing doctors cannot charge a fee:

    http://www.humanservices.gov.au/customer/services/medicare/medicare-bulk-billing

    By 1 July 2015, if the Government gets their way, they will be able to bulk-bill and charge in certain circumstances. Whether they charge the fee is completely up to them. GPs lose the “bulk-billing incentive items” where available (these apply for under 16′s and concession card holders) – which is an additional payment they get from the Government – if they don’t charge the copayment; this is either $5.15 or $7.85, so I suppose that it is their interests to charge (though many practices bulk-bill as a matter of course where the incentive item is unavailable). The charge is not mandated. The fund total moves from the relevant Medicare expenditure in the budget; pea and thimble.

    For the first time doctors that are part of the the bulk-billing arrangement are able to charge the customer a fee for service (albeit not more than $7). This is a good thing.

    Sources:

    http://www.humanservices.gov.au/corporate/publications-and-resources/budget/1415/measures/health-matters-and-health-professionals/34-90188

    https://ama.com.au/gpnn/7-co-payment-proposal-how-it-will-work

    http://www.medicareaustralia.gov.au/provider/incentives/files/incentive_payments_to_GPs_who_bulk_bill_concessional_patients_under_16.pdf

  105. Aristogeiton

    I should add that the only other thing going on here is that the rebate is reduced by $5. If a doctor tries to charge you one extra dollar for a standard consultation, he’s trying to rip you off. You have already paid, if you go to the trouble of recovering the Medicare benefit, with a higher effective cost. The $2 is just an extra gratuity for the doctor, and exists in theory only; the $7 you can charge while still bulk-billing, minus the $5 by which the rebate is cut yields a theoretical $2 (in a world without inflation).

  106. MemoryVault

    84% of GP consultations are bulk-billed.

    Until July 1, 2015, at which point all the old biddies who thought they were going to get hit with a $7.00 “co-payment”, will suddenly find themselves being charged $40.00 to $60.00 or more, upfront. And when they complain to their GPs – who they trust as much if not more than their local parish priest – they will be assured it is all the fault of that nasty Abbott666 and his cruel government who “forced” the doctors to charge more upfront.

    This totally negative feedback loop between a trusted source, and a hitherto solid LNP voter-bloc, will continue from July 1, 2015, duly repeated as “gospel truth” from mother to daughter and daughter-in-law, thence to son and son-in-law, and so on, until the next election, at which point Abbott666 and the LNP will be relegated back to the opposition benches, where they can spend the next three years contemplating the folly of attempting to outspin the spinmeisters on the Left.

  107. Milton Von Smith

    Whether it is a tax or a co-payment is somewhat beside the point. The Coalition is allegedly imposing this measure in order to make Medicare “sustainable”. But why on earth do they want to do that? Why are they dying in a political ditch in order to save socialised medicine? Surely, if the system is unsustainable, the optimal solution is to let it whither and die?

  108. Aristogeiton

    By “standard consultation” I mean to imply “non bulk-billed”.

  109. Simon

    With respect the co-payment is not a tax. The medical research fund has no impact whatsoever on the nature of the copayment. It’s no more relevant than the money allocated to PPL. By the logic presented here the increased university fees would also be a tax because they too come from a reduced subsidy.

    The copayment is paid by the patient to the doctor for the services rendered. At no stage does it go to the government. Instead, the doctor receives the current Medicare rebate less $5 (for bulk billed patients) or the patient receives $5 fewer back from the government. This is the mechanism by which the government saves $5 from every GP visit, pathology test and diagnostic imaging.

    Like all savings they are returned to general revenue. From the general revenue the government will allocate money to medical research fund. The amount allocated is calculated by reference to the copayment savings.

    It is not a transaction tax on seeing a doctor – that could only be the case if the government wasn’t paying for visits to the doctor now

  110. Notafan

    What has what an individual GP chooses to charge got to do with the co-payment?
    You think GPs who currently bulk bill their old dears will suddenly turn around and charge them whatever they feel?
    GPs will not act as one and all put their fees up to $75 at once. If some do people can vote with their feet.

  111. mareeS

    Numbers might be pleased to know that he will not be subject to the co-payment (assuming he is a DVA beneficiary; most veterans of his age are). One thing less for him to whinge about.

  112. Aristogeiton

    mareeS
    #1318374, posted on May 24, 2014 at 10:41 pm
    Numbers might be pleased to know that he will not be subject to the co-payment (assuming he is a DVA beneficiary; most veterans of his age are). One thing less for him to whinge about.

    Watch for the raft of people found by their consulting physician to have a “chronic medical condition” (CDM items are exempt). You could drive a truck through the criteria:

    http://www.health.gov.au/internet/main/publishing.nsf/Content/mbsprimarycare-chronicdiseasemanagement

  113. Notafan

    MareeS I’m sure he has mentioned several times that although he is eligible his income and assets are currently too high.

  114. MemoryVault

    You think GPs who currently bulk bill their old dears will suddenly turn around and charge them whatever they feel?

    No.
    I’m pretty sure a significant number of GPs who currently bulk-bill will not accept simply taking a $5.00 hit per consultation and continue bulk-billing, which is option 1.
    I see most of them simply scrapping bulk-billing per se, and introducing a two-tier up-front fee structure as described above, which is option 2 – especially when they can blame the nasty Abbott666 grubbermint – and be believed.
    I especially don’t see them scrapping their current accounting software and buying new systems which allow them to simultaneously charge the rebate fee to Medicare, and the “co-payment” fee to the client – that’s even assuming Medicare alters their system to accommodate it. That’s option 3.

  115. Aristogeiton

    Notafan
    #1318384, posted on May 24, 2014 at 10:53 pm
    MareeS I’m sure he has mentioned several times that although he is eligible his income and assets are currently too high.

  116. JohnA

    Tintarella di Luna #1318241, posted on May 24, 2014 at 7:26 pm

    I pay $75 to my family GP when this co-payment commencement commences will it then cost me $7 on top of what I pay the doctor? I’m not going to call it a co-payment or a tax or a rabbit, I’m calling it ranunculus bulbosus

    A good question, already answered. Minerva and the Lady Psyche would understand, I think.

    On the rare occasions I am forced (by near death experiences) to go to the doc, I pay the amount he charges me, and I await the credit to my bank account for the Medicare component. It looks like that will be $5 lighter in future, while the amount the doctor puts on the bill will increase by $2 (or more – how else is my doc going to afford that new investment property, eh?)

  117. Fisky

    What we really need is for the government to abolish licencing regs and allow people to buy pretty much anything over the counter that isn’t an anti-biotic. Painkillers in particular should never require a subscription.

  118. Monkey's Uncle

    A tax is when the government takes revenue generated from economic activity in order to finance the cost of government, but where the person paying the tax does not get anything in return. In other words, a tax is not a payment for the receipt of any service or good. It is simply a straightforward redistribution of resources from the private sector to the government.

    Income tax is clearly a tax, as income tax payers do not receive anything directly in return for their payment and the incidence of the tax is completely unrelated to any receipt of any service. Unlike (say) car registration or other government fees.

    In the case of the government’s co-payments for GP visits, this involves a small payment which is only incurred upon the receipt of a specific service which is heavily subsidised by the government. To label that a tax is quite a stretch.

  119. Aristogeiton

    JohnA
    #1318390, posted on May 24, 2014 at 10:55 pm
    [...]
    It looks like that will be $5 lighter in future, while the amount the doctor puts on the bill will increase by $2 (or more – how else is my doc going to afford that new investment property, eh?)

    I would not pay more; your transaction is unaffected. You get the Medicare benefit, not the physician. Nothing has changed.

  120. Simon

    Another way to demonstrate it’s not a tax is to think about the budget line items for the medical research fund.

    A reduction in expenditure (savings) is not the same as an increase in revenue (taxes). The money for the research fund comes from a reduction in expenditure on the MBS rebate, the amount is determined by reference to the copayment but that does not make the copayment a tax.

    There is a reduction in the MBS rebate expenditure line item ($5 less per GP visit) and an increase in the medical research fund expenditure line item. That’s it. Two changes on the spending side.

    There is no copayment revenue line item because at no point in time does the government receive any money from the copayment. It just saves money from paying a smaller subsidy.

  121. Gab

    Is the government going to be taking more money from my pocket? If so then it’s a tax.

  122. Aristogeiton

    Monkey’s Uncle
    #1318398, posted on May 24, 2014 at 10:59 pm
    [...]
    In the case of the government’s co-payments for GP visits

    This is not the the “government’s co-payment[...]“, this is a fee charged for a service: one which it was previously unlawful to charge; it is not mandated, and received to the use and benefit of the individual who charged it. What arrangements the GP has with the Government are matters for them for them.

  123. Aristogeiton

    Gab
    #1318406, posted on May 24, 2014 at 11:04 pm
    Is the government going to be taking more money from my pocket? If so then it’s a tax.

    No! They give you less back in a benefit for a voluntary transaction freely entered. It is a welfare cut. Come on peoples! I know Fairfax and the ABC can’t distinguish between a tax increase and a decrease in government benefit, but surely you can!

  124. Notafan

    If the correct effect occurs, in that large corporate bulk bill clinics are no longer viable as people either stop treating them as forms of entertainment or refuse to pay three times for what is really only one service, yes they might have to change what they do.
    Perpetual Motion has already indicated the process is quite straight forward and even bulk bill’s currently take payments for work cover patients and internationals. When I go to the dentist the assistant collects one part of the fee directly from the health insurers and I pay the balance.
    People will make better choices and shop around, like they do for everything else.

  125. Gab

    No! They give you less back in a benefit for a voluntary transaction freely entered. It is a welfare cut. Come on peoples! I know Fairfax and the ABC can’t distinguish between a tax increase and a decrease in government benefit, but surely you can!

    Then WTF are these morons going on about whinging and whining about not having the measley $70 per year that they think they’re going to have to hand over to the government via their doctor?

  126. mareeS

    Notafan, re income and assets for DVA, that’s true for the service pension, which is equivalent to the general aged pension in terms of the income and assets test. My husband is on the disability rating, or TPI, which doesn’t factor either income or assets, and is specifically excluded from the co-payment. Poor old numbers will just have to make do with his teacher’s super and still be able to have a whinge, then.

  127. Gab

    I know Fairfax and the ABC can’t distinguish between a tax increase and a decrease in government benefit, but surely you can!

    Hockey has not explained this well at all. No wonder people are confused.

  128. Aristogeiton

    Notafan
    #1318410, posted on May 24, 2014 at 11:08 pm
    [...]
    People will make better choices and shop around, like they do for everything else.

    The present system is in the “somebody else’s money on yourself” quadrant. A leftie I know personally boasts that he gets lots of blood tests and goes to many consults because he doesn’t have to pay. He also complains that the middle class are getting screwed and that this is bad for the economy because they have less discretionary income to waste. Where the money comes from for his excessive treatment never occurs to him. This is what we are up against.

  129. Notafan

    It’s a bit like free education, the government can never throw enough money at it but if people had to pay even a small tuition fee you’d be sure they would make sure they got good value for that.

  130. Aristogeiton

    Gab
    #1318415, posted on May 24, 2014 at 11:11 pm
    I know Fairfax and the ABC can’t distinguish between a tax increase and a decrease in government benefit, but surely you can!

    Hockey has not explained this well at all. No wonder people are confused.

    Agreed. I think it’s intentional, as otherwise people would find out that the $2 differential is really not necessary (though I would have to see the bill; it is not clear whether what were called the “bulk-billing incentive items” are recoverable at less than $7). Either way, as discussed earlier with inflation and changes to indexation, and by design, the GP that continues to bulk bill is getting screwed one way or another; but try selling a pudding that ain’t magic to the squealing electorate – they see: Government cut $5, I’m paying $7.

    So far as the design goes, however, at least this has a minimal administrative cost (although compliance with the limits is being offloaded onto the GP – and this will cost (you); I have NFI how this is going to work practically and the bill is not out yet so I don’t know what teeth are in it).

  131. Aristogeiton

    Notafan
    #1318421, posted on May 24, 2014 at 11:20 pm
    It’s a bit like free education, the government can never throw enough money at it but if people had to pay even a small tuition fee you’d be sure they would make sure they got good value for that.

    Yup. Milt was right as always.

  132. Gab

    So let me get this right. People are NOT actually going to be handing over an extra $7 to the GP? Just that for some they will get back a rebate less $7 for ten visits and after that they get back the full rebate?

    I still don’t understand what the pensioners are whingeing about.

  133. mareeS

    Whether it’s a tax or not, whether $7 is the end of Medicare or not, makes no difference to me. I still pay $65 up front to visit my doctor (once a year, on average), and claim whatever pittance there is to be had from Medicare, plus my health fund insurance, plus the Medicare levy, plus the out-of-pocket expenses for dental and optical not covered by private insurance. I’m way behind the game.

  134. Notafan

    It’s an extra $7 if you currently pay nothing.

  135. Aristogeiton

    Gab
    #1318431, posted on May 24, 2014 at 11:30 pm
    So let me get this right. People are NOT actually going to be handing over an extra $7 to the GP? Just that for some they will get back a rebate less $7 for ten visits and after that they get back the full rebate?

    I still don’t understand what the pensioners are whingeing about.

    No, for the first time GPs can charge up to $7 while bulk-billing; presently they are forbidden for charging. The government is reducing the Medicare benefit by $5. If you are a bulk-billing GP that means $5 less from the government, but for the first time you are able to charge up to $7 to the patient. For the non-bulk-billed patient this means you get $5 less in Medicare benefit.

  136. Aristogeiton

    forbidden from charging

    Too much wine.

  137. Gab

    Sounds awfully long-winded, Aristo. I guess it’s just not sinking in becuase it seems illogical to me and also I have always paid the doctor. Have never been bulk-billed so have no idea of the process.

    I appreciate your patience in answering my questions.

  138. Aristogeiton

    Gab
    #1318441, posted on May 24, 2014 at 11:37 pm
    Sounds awfully long-winded, Aristo. I guess it’s just not sinking in becuase it seems illogical to me and also I have always paid the doctor. Have never been bulk-billed so have no idea of the process.

    I appreciate your patience in answering my questions.

    Well, if you pay the doctor you Medicare benefit (rebate that you get from Medicare) goes down by $5, but nothing else changes.

    For the bulk-billed (read: don’t pay a cent), for the first time the GP can charge them a nominal fee, which they keep; it used to be that no money could be charged *at all*. The GP is getting screwed on the bulk-billing payment (which is decreased by $5), but can (if he likes) make up the difference and a bit more (at present value) by charging up to $7.

    It was confusing to me too, don’t worry.

  139. Aristogeiton

    “which they keep” = “which the GP keeps”; ambiguous otherwise.

  140. Monkey's Uncle

    I still don’t understand what the pensioners are whingeing about.

    They are whingeing because we have become a society that indulges whingers altogether too much. Like the feminists or the racial grievance industry, they have become another perpetual grievance/entitlement industry that will never be satisfied no matter what, and it is high time we stop trying to appease them.

  141. Notafan

    Dont worry, big Clive will be putting the pension up by $150 a week, so they won’t have to chose between going to the doctor or living on Pal.

  142. Elizabeth (Lizzie) B.

    Bulk-billing doctors will find it more administrative trouble than it’s worth and get fewer patients if they charge the seven dollars and thus have to collect a full payment from patients. Big clinics will take the $7 loss on bulk-billing and hope to make it up with maintaining or increasing custom. They’ll pick up patients who don’t have any ready cash to pay and wait for their refund – which includes just about anyone on pensions or other benefits. So the bulk billing system will survive and doctors will over-service the indigent even more than they do already in order to maintain their incomes, provided that patients can still sign off straight to Medicare at the new discounted rate offered by these clinics. If patients can’t do this, and have to pay upfront the whole Medicare component even if the extra seven dollars is not added by the doctor, then Abbott666 will be applied by everyone to this new system. There will also be some genuine cases of people not having the ready cash to see a doctor and wait for whatever the refund on their payment turns out to be. Given how hopeless many people, especially welfare recipients, are at keeping receipts and claiming payments the process will have to be automated somehow in order for it to work at all. If it can be done at the point of service then the discounting big clinics will survive and thrive.

    As lem has pointed out earlier, the medical profession will take care of its income somehow, either by over-servicing (one consultation for one minor issue, make another appointment for each new issue you wish to raise – which is what bulk billing practices already do) or finding new conditions and/or treatments which require a further health dollar (whether it’s the medicalization of emotional problems, or whiz-bang new robotic surgeries, or tailored monoclonal nanotherapies etc) .

    lem and Sinc want to break the nexus between government payment and treatment. A good idea, but that leaves the indigent at certain tender mercies and also doesn’t attack the issue of over-servicing, although it does make it a personal decision as to whether to pay at full cost rates for excessive over-treatment or not.

    Personally, I use doctors as sounding boards and treatment providers, but I research very thoroughly on the internet myself to ensure that I am getting good medical value.

  143. Notafan

    If bulk bill double down on overservicing they will eventually be caught out. Even full pensioners have EFTPOS cards, in any case as Perpetual pointed out 84% of GP consultations are bulk billed so it would appear a very large percentage of working people in larger cities also use bulk bill. Once they start paying the clinics will change their administrative procedures and unless every welfare recipient makes a fuss they will just hand over their cash or card like everyone else.

  144. Andrew

    Hypothetically, if the govt announced that Medicare was abolished tomorrow (which would STILL fall short of closing the Goose’s gigantic $50bn deficit), and we now had to pay the full $50 to see a doc, would that be a tax?

  145. Bert

    Sinc you have me confused. You support the copayment, but say it is really a tax.

    So that means you supports higher taxes. Fine.

    But you’ve spent best part of three weeks castigating Abbott for allegedly breaking a promise not to increase any taxes.

    So do you support higher taxes or not?

  146. Elizabeth (Lizzie) B.

    Many pensioners and welfare recipients have EFTPOS cards but there is often little or nothing in the account, so they will be drawn to a big clinic that discounts away the $7 and which manages to give the patient an immediate transfer of the Medicare component into the doctor’s account. Immediate return on payments is what would make it all work (although some would still have trouble finding the money), rather than people having to wait or front up to a Medicare office with receipts, with the $7 discount (the clinic’s loss) being the honey on the clinic’s table.

    I heard via a rellie of mine that one big bulk-billing Clinic in Darlinghurst (Sydney) has already sent a text message to all current patients assuring them that they will not be charging the extra seven dollars. This clinic did try to implement a co-payment of $30 a few years ago, and lost a lot of their customers; seems they are not willing to chance it this time. I wonder how they will get on. There still seems to be confusion about how it will all work.

  147. val majkus

    I suggest visiting any regional Centre. All the gps bulk bill, most bilk bill everyone

    not true in Tamworth, my GP doesn’t bulk bill; they take payment but they do kindly make my medicare claim for me

  148. Notafan

    Lizzie, even I got that bulk bill text message. I think there was a coordinated program by the bulk bill collective. It’s funny how all those welfare recipients have the mobile phone but can’t afford a copayment. I guess they will have to go to the doctors on pension day. They already have to find a little cash for their prescriptions. In any case a large part of the push to copayments is to discourage unnecessary visits. My GP is certainly well aware of those when he grumbles at the full waiting room saying ‘nothing on telly today’. The people most likely to make unnecessary visits are the people with too much idle time on their hands.
    As Mr Abbott said repeal the carbon tax and the savings in utilities will far outweigh the copayment.

  149. handjive

    Gillard:
    “No, it’s not a tax. It’s a price on carbon, which, in the future will be come an emissions trading scheme.”
    Hockey:
    “No, it’s not a tax. It’s a contribution to a medical fund that in the future will find a cure to cancer.

    Gillard: “Well, you can call it a tax. Ok, it’s a tax”
    Hockey: “Well, you can call it a tax. Ok, it’s a tax”

  150. tomix

    not true in Tamworth, my GP doesn’t bulk bill; they take payment but they do kindly make my medicare claim for me
    Not true in Rockhampton. Private practices aren’t even taking new clients.

  151. Notafan

    Yes, as discussed earlier in the thread stop the overservicing in places like Melbourne and Sydney and the bulk billers will have to do the same as other unemployed and move where the work is.

  152. Tel

    When the revenue from the “co-payment” collected goes into the ledger marked “tax receipts”.

    In that case it isn’t a tax, because Medicare costs the government, it never makes any revenue. The co-payment should (in theory) reduce that cost somewhat, unless more people go to the emergency instead.

  153. Alfonso

    “When is a co-payment a tax?”
    Hee, hee…..when Kylie and Shane in western Sydney say it is, theorists.

  154. egg_

    “Hee, hee…..when Kylie and Shane in western Sydney say it is, theorists.”

    Precisely – if a Professor of Economics has to debate it… it IS a tax.

  155. Bruce

    If the government is extracting money from you for specific goods or services, it is a payment.

    If the government is extracting money from you for non-specific goods and services, it is a tax.

    So, what are we to make of the “taxes” that aren’t “taxes”?

    “Duty” and “Excise” spring to mind.

    Import duty; a tax on importation of goods.

    Excise: a tax on the production of a product like alcohol or tobacco.

    Just remember that the excise on booze is calculated AND PAYABLE at the point of production. If a winemaker has a vat “assessed” as owing XX dollars, that is what he must cough up, before the stuff is even bottled or sold. If that same vat subsequently “goes off” and is unfit for sale or bottling, TOUGH. When you stagger through the vineyards quaffing “samples”, spare a thought that the vintner has already been taxed on your “FREE” booze.

    The alcohol excise is one thing, the sundry taxes on top are another. On a beer canning line, the amber fluid being pumped into the cans has already been “excised”. If a can is “misfilled”, a blast of air knocks the can off the line and the beer goes down the drain; the aluminium can is worth more than the post-excise cost of the beer plus the cost of stopping the line and adjusting that one can.

    Then the GST comes into play; every time the stuff is transferred from brewery, to distributor to retailer. Even with all the creative accounting of GST repayments, the government takes a cut EVERY time the product moves.

  156. It is obviously a tax because no one ever went to emergency with a headache or a sniffle. FFS.

  157. Notafan

    Egg is that an example of credentialism?

  158. Paridell

    Several years ago, the local 24-hour medical centre (actually only 8 a.m to 10 p.m) introduced a $50 co-payment off its own bat. To see a GP, you had to pay $50 up front, then claim a refund of $30 from Medicare and send the cheque to the centre. Overnight, the centre went from being a busy practice to almost deserted. Instead of waiting an hour, you could see a doctor straight away. It was great for the few remaining patients. But for the centre, having hardly any patients meant hardly any revenue coming in. Soon it was facing closure. Then it dropped the co-payment completely, and business went back to normal.

    This was in a fairly affluent area. What effect will a $7 co-payment have across the whole country? Maybe some other surgeries and medical centres will face closure too. But in the meantime, it could cut down waiting times no end!

  159. egg_

    Egg is that an example of credentialism?

    Certainly not – beware the “expert” at all costs.
    If ANYONE takes pains to explain something, axiomatically it likely IS, perception-wise.
    E.g. Hockey on Q&A on the very subject.
    (KISS principle).

  160. dan

    The (allegedly) liberal side of politics should actually have spent some time first explaining why having a government bureaucracy pay your doctor $16 for your doctors visit is inefficient and wasteful. If they would have frozen all expenditure at what we would call ‘Labor levels’ i.e. 2012-2013, and kept it frozen for five years while trying to explain the rationale for user-pays health systems and education we would
    - actually save hundreds of billions of dollars
    - be on the path to systemic savings and improvement.

  161. Sinclair Davidson

    Bert – I think you should read what I actually typed.

  162. Jessie

    Sinclair is opposed to a medical research fund and wrote an informative piece on Public Science.

    The proposed research fund may provide competition for medical research that is currently monopolised by NHMRC and ARC who deal with health AND medical research, inc CAGW related. This competition may provide incentive to apply more rigour in research projects, socialised health research may be scrutinised more rigorously.

    NHMRC Dec 2012 Submission to the review of the Freedom of Information Act 1982

    NHMRC administers significant numbers and sizes of grants to persons who perform important health and medical research for Australia (National Health and Medical Research Council Act 1992, s7 and s51). Due to competition for these grants, the majority of grant applicants are unsuccessful.
    In order to assess the quality of these complex research applications, NHMRC relies heavily on peer review system for their assessment. Eminent researchers for outside the agency yare asked to participate, at minimal remuneration, as external assessors and in NHMRC’s peer review panels across its range of granting schemes every year. Without a peer review system, NHMRC would not be able to administer its grant system.
    The scientific and medical research community is a small one, particularly when conflict of interest and expertise issues limit the pool of potential peer reviewers. There is potential significant detriment to this system should unsuccessful grant applicants learn the identities of peer reviewers who reviewed their grants. NHMRC does not make public, or provide to the individual grant applicants, the names of persons who assessed specific applications. If unsuccessful applicants were to become aware who reviewed their application, this would be likely to further impact on the frank and fearless advice provided by reviewers and the range and number of peer reviewers willing to participate in this system.
    NHMRC FOI decision-makers have generally not released the names of peer reviewers when documents containing this information are subject to an FOI request, relying on s47F and s47E(d).

    Unfortunately:

    All NHMRC websites, including RGMS, are offline from 5:00pm AEST Friday 23 May to 8:00am AEST Monday 26 May as part of a Government-wide initiative for NHMRC to transfer its entire IT infrastructure to a new data centre.

  163. Lem

    One thing is for sure, if a government is going to put public money into a medical research fund, it will be a gigantic failure, for all the reasons that Sinclair has said.

    It’s smart to exit health funding. It’s dumb to have apologised for it by saying “Look over here! Another giant pot of someone else’s money!” Did they learn nothing from the green schemes rorting?

  164. notafan

    I also opose the medical research fund, the doctors rorting medicare will just move over to rorting the research fund. It muddies the waters on the purpose of the co-payment and would be much better spent on paying down debt.
    If there is money to be made in medical research for new treatments and drugs let the private sector fund it and those that want it pay for it.

  165. Jessie

    Aristogeiton at 10.46

    Medicare has interactive stats.
    Provided that the selection of the MBS item and the entering of said item is correct………… the states/territories could compete for a % of the ‘new’ medical research fund.

    for eg
    Medicare Item 723 processed from July 2012 to June 2013
    Services per 100,000 – Age 75-84 years
    NSW 24,439/22,117 (Female/Male)
    Vic 22,562/20,424
    Qld 21,886/18,788
    SA 20,894/19,306
    WA 16,443/14,981
    Tas 20,399/16,603
    ACT 11,389/9,857
    NT 18,801/13,762

    then check again, count only………….
    NSW 47,370/35,858 (Female/Male)
    Vic 33,196/24,842
    Qld 21,731/16,114
    SA 10,185/7,741
    WA 8,383/6,448
    Tas 2,978/2,029
    ACT 806/578
    NT 298/225

    Yup, I need to check my input selection.

  166. MemoryVault

    Gaawd.
    Could you people get it through your bloody heads –

    There ISN’T going to be a “co-payment” of $5.00 or $7.00.

    I know that’s how the grubbermint is spruiking it, but it’s a load of tosh, designed to hide the fact that they are trying to kill off bulk-billing. A GP surgery is a business, like any other business. It is run to make a profit. Once the new rules come into force July 1, 2015, each GP surgery business will have the following business options:

    Option 1: Continue to bulk-bill and take a $5.00 profit hit on each consultation. This will only be an option at the mega-clinics found in the big metropolitan suburbs. It is not a commercially viable option for a small, outer-suburban, regional, or rural practice.

    Option 2: Scrap bulk-billing entirely. The client pays the full fee at the surgery (whatever the GP sets it as), and then gets a rebate from Medicare, paid into their bank account. This is the only commercially-viable option available to most GPs.

    Option 3: The patient pays the GP $5.00 (or whatever the doc chooses to charge as the “co-payment”), and the GP then bulk-bills Medicare for $31.00. This is the fantasy version being peddled by the grubbermint and it’s absolute tosh because:

    1) – It means the GP has to buy, install, and learn to use an entirely new accounting software package, which, incidentally, doesn’t even exist yet. Given that it would have to be integrated with the Medicare system, and we had internet banking for a decade before Medicare got its act together to produce the current integrated system, don’t hold your breath. Besides, why would the GP bother, when he can blame the whole thing on the nasty Abbott666.

    2) – Even if the GP decided to proceed the way the grubbermint is spruiking it, (assuming the integrated software appears from somewhere in time), to continue to charge at bulk-bill rates the GP has to get $5.00 from the patient, and process it. This means either EFTPOS or cash.

    There’s a very good reason why shops have signs saying “Minimum EFTPOS transaction $10.00″. Ditto for cash. Twenty people pay their $5.00 in cash – that’s a $100.00. It has to be accounted for – it can’t just be thrown in a drawer for lunch money. So now the receptionist spends an hour each day writing up a deposit book and driving to the bank to deposit the cash. Yeah, right.

    Most GPs will go with option 2. To all intent and purpose bulk-billing will die, and patients will have to cough up the full fee (whatever it is), and then wait for their (reduced) Medicare rebate. Personally I think this is a good thing. But it is not the lemon that is currently being palmed off to Joe Public.

    So, when the excrement of reality finally hits the oscillator of truth on July 1 next year, it will become yet another blow to Abbott’s credibility and yet another nail in the coffin of the LNP’s re-election hopes.

  167. stackja

    Patience is now taxed.

  168. Bert

    The way I read Sinc’s comments is that he supports a copayment on medical services (if indeed it is not privatised) but he does not support the proposed copayment because the revenue will be used for a medical research fund.

    But money is fungible. The fact that the money is being used for a medical research fund rather than paying down debt does not alter whether the copayment is desirable or not. I too am not enamored about the medical research fund. We already provide incentives with patents.

    But I think the copayment is a good policy – although I’m not sure what the best rate would be. And I don’t think it can be characterised as a tax.

    If the NSW government used all of the revenue from train fares for, say, sending politicians overseas on a holiday, that doesn’t make it a tax. The cost for running the train system is unchanged (just as the cost of the health system is unchanged), it just that the copayment isn’t being used to reduce government spending on health (or in the example train services).

  169. notafan

    There’s a very good reason why shops have signs saying “Minimum EFTPOS transaction $10.00″. Ditto for cash. Twenty people pay their $5.00 in cash – that’s a $100.00. It has to be accounted for – it can’t just be thrown in a drawer for lunch money. So now the receptionist spends an hour each day writing up a deposit book and driving to the bank to deposit the cash. Yeah, right.

    You know I have a shop and an EFTPOS machine and each shop keep gets their own deal with the bank. I pay 11c per non credit card transaction and .98% for CC transactions so I really don’t care about a minimim as long as I make a sale. I’,m pretty sure bulk billers can negotiate a better deal with a bank than me.
    You continue to ignore the behaviour changing intention of the legislation, in which patients make unnecessary visits and doctors do muptiple swipes for what should be a single service, see people going in for a blood test and being told it is $7 x 3 and not asking why. A fair percentage of bulk billed patients in the metro areas are not health care card holders. Bulk billers will need to do more than take a hit on the rebate to maintain their income. ,
    There is no evidence that bulk bill firms will need new software or if they do it will be monsterous expensive or that the government is beholden to provide it.
    Many doctors currently take a combination of payments and process rebates at the same time. If you go to the local bulk bill for a work cover consultation they take your payment, same with foreign nationals not covered by medicare. Not to mention the ones that house a dental service a physion and other ancillary services that are not covered by medicare. So they already have a cash book and someone taking money to the bank

  170. John Comnenus

    Does the copayment apply if I have health insurance and already pay the doctor?

  171. Bert

    MemoryVault, don’t exaggerate the difficulties of collecting a copayment. Small businesses do it all the time – you go and buy a coffee and there is no problems in collecting the $3.50 or whatever the price you pay.

  172. Wozzup

    I don’t believe it is a tax. In this case your analysis is faulty. By your definition a payment is not a tax if it is paid for services rendered. What is a doctors service – chopped liver? Of course the doctor delivers medical services. But in a sense he / she is just an agent for the real service deliverer in this case – the Government.

    Here is an analogy to help you see this better………………………………….

    I live in a city where public transport is delivered by Government (and subsidized by it). When I hop on a bus I must pay about $3.50 for a trip, give or take. Incidentally this by no means covers the real cost of most services on most routes which is at least double or triple that amount. The delivery of the service is via an agent – bus service delivery is contracted out to private sector providers – the “agents” for the government who is the real provider of the services (and until about a decade ago BTW government was the actual provider until contracting out came into effect). Part of the $3.50 goes to the service provider in payment for the service they deliver to me when I hop on a bus. (On the less profitable routes the real cost / payment to the service provider is higher but lets leave that aside for the sake of this analogy. The point is in each case I pay the same amount for a service).

    Does this make the fee for my bus trip a tax? No of course it does not. It is a fee for service just as it is with doctors services. Only the doctor is the agent in the case of medical services and the bus company in the case of transport services.

    And for the record I agree whole heartedly that the fee is needed for medical services. Labor is playing games and it has previously supported such fees in similar circumstances.

    I have family members who work in the health system and its obvious to them and to me based on the stories they tell that too many people visit their doctor far far too often and unnecessarily. For many it almost seems like a kind of social interaction thing. Nothing on TV, bored, feeling an odd twitch in my big toe. I think I should go to the doctor. It is a fundamental idea in economics that if you undervalue a good or service it will be grossly over used. And if there is no cost at all……………….work it out for yourself.

  173. notafan

    Doctors will also still be scrabbling for market share, so I very much doubt they will all start charging the schedule fee. Not just market share but to maintain a high volumn of visits. I can guarantee that if the local bulk bill charge the the schedule fee they will be struggling to pay the rent pretty quickly.

  174. Aristogeiton

    ‘a compulsory exaction of money by a public authority for public purposes, enforceable by law, and … not a payment for services rendered’

    Please explain to me how GPs being able to charge this fee, as a partial payment for services rendered (a private purpose), constitutes a tax? Anybody?

    Bert
    #1318837, posted on May 25, 2014 at 12:11 pm
    The way I read Sinc’s comments is that he supports a copayment on medical services (if indeed it is not privatised) but he does not support the proposed copayment because the revenue will be used for a medical research fund.

    But money is fungible. The fact that the money is being used for a medical research fund rather than paying down debt does not alter whether the copayment is desirable or not.

    Bingo, except there is no “the money”; the Government spends less on Medicare items in the budget, having made a saving, and moves that amount to a new line item. There is no money collected. It is all just money coming out of consolidated revenue.

    MemoryVault
    #1318827, posted on May 25, 2014 at 11:50 am
    Gaawd.
    Could you people get it through your bloody heads –

    There ISN’T going to be a “co-payment” of $5.00 or $7.00.

    +1

  175. MemoryVault

    Notafan

    You continue to ignore the behaviour changing intention of the legislation,

    How about reading what I wrote, instead of what you think I might write?
    I’m all in favour of it specifically because of its behaviour changing intent.
    So why bury a good idea in all this “co-payment” idiocy, which is only going to become unglued once it is implemented a year down the track? If there’s going to be opposition, let it be now, not 12 months (or less) out from an election.

    Bert

    MemoryVault, don’t exaggerate the difficulties of collecting a copayment. Small businesses do it all the time – you go and buy a coffee and there is no problems in collecting the $3.50 or whatever the price you pay.

    Apples and oranges, Bert. A better analogy would be your cup of coffee costs $3.50, the customer pays 50 cents cash or EFTPOS, the remaining $3.00 comes from the megalithic Department of Hot Drinks, and both payments have to be coordinated and accounted together so that the customer only pays the 50 cents on the first ten cups of coffee. After that the shop continues to charge $3.50 but the customer pays nothing and the Department of Hot Drinks pays the full amount.

    Just to complicate matters, the ten cups rule doesn’t just apply to one coffee shop, but to ALL coffee shops in Australia. So, if the customer buys his eleventh cup at a new coffee shop, the coffee shop, or the integrated software, has to know it is the eleventh cup, so that the shop owner can know who to charge and how to charge it.

    And people really believe this is actually going to happen?

  176. notafan

    Most GPs will go with option 2. To all intent and purpose bulk-billing will die, and patients will have to cough up the full fee (whatever it is), and then wait for their (reduced) Medicare rebate. Personally I think this is a good thing. But it is not the lemon that is currently being palmed off to Joe Public

    I’m sorry MV where have you said anything about the change in behaviour?

    A better analogy would be your cup of coffee costs $3.50, the customer pays 50 cents cash or EFTPOS, the remaining $3.00 comes from the megalithic Department of Hot Drinks, and both payments have to be coordinated and accounted together so that the customer only pays the 50 cents on the first ten cups of coffee

    This is already the case with the PBS ‘co-payment’ and the PBS safety net. That works and is fully supported by an existing computer system so why wouldn’t a GP visit co-payment also work? it even ‘knows’ as soon as someone no longer has a health care card and is required to pay a higher co-payment.

  177. Big_Nambas

    You may be interested in what has happened in Darwin. 3,4 and 5 years ago when I went to a GP I paid $70/75 and got $34 back from Medicare. Last year and this year ALL GP’s I have seen are bulk billing.
    Some clinics have big signs in front saying we bulk bill ALL. Must be too many GPs maybe.
    As for the copayment you only pay $7 if you are bulk billed.

  178. tomix

    There was a doctor at the Gabba fiveways for nearly 50 years who had a “No Appointment Necessary” sign next to his MBBS plaque..
    He had no receptionist, no filing system, no waiting time, he wasn’t in the AMA and he threw all letters from the Workers Compensation Board of Qld in the rubbish unopened and he bulk billed everyone. He had 3 pads ready to go on his desk: Workers Comp. Form 3s, Sickness certificates, and scrips, and the roller thing for the medicare card.

    Anyway, I went in to see him in 1985, when JWH was talking about axing Medibank if he won the 1987 election, which seemed a formality at the time. Dr. had a carby out of a European car on his desk and he asked “Have you got any idea how these things work?” Negative, and I asked him how the abolition of Medibank would affect him. He agreed that Medibank ought to be abolished and said he would only open 2 or 3 days a week instead of 6 days 8am- 8pm at 2 locations, and pursue other business interests.

    He said that in the previous year he had received more money from Medibank than any other GP in Qld.

  179. Aristogeiton

    notafan
    #1318866, posted on May 25, 2014 at 12:48 pm
    [...]
    This is already the case with the PBS ‘co-payment’ and the PBS safety net. That works and is fully supported by an existing computer system so why wouldn’t a GP visit co-payment also work? it even ‘knows’ as soon as someone no longer has a health care card and is required to pay a higher co-payment.

    So it tracks the number of visits, across any GP in Australia, for each patient? Billing procedures would change and the software would need to be upgraded to ensure compliance with the law. As somebody mentioned above, there are significant transaction costs, which may not be legally recoverable.

  180. notafan

    So it tracks the number of visits, across any GP in Australia, for each patient

    ?
    I just checked and it is up to your pharmacy if they keep a computer record for the safety net so there is an onus on the patient to record their prescriptions if they want to claim the safety threshold, in relation to the PBS ‘co-payment’ that system is in place. I think though if patients can keep a record of their own safety net for prescriptions they can do it for the associated GP visits which presuming they get more than one prescription and/or repeats would be less often anyhow.

    Safety net for PBS

  181. Aristogeiton

    notafan
    #1318879, posted on May 25, 2014 at 1:04 pm
    So it tracks the number of visits, across any GP in Australia, for each patient

    ?
    I just checked and it is up to your pharmacy if they keep a computer record for the safety net so there is an onus on the patient to record their prescriptions if they want to claim the safety threshold, in relation to the PBS ‘co-payment’ that system is in place. I think though if patients can keep a record of their own safety net for prescriptions they can do it for the associated GP visits which presuming they get more than one prescription and/or repeats would be less often anyhow.

    So the patient brings the bills from their last ten visits to the surgery? Remember that the doctor has to ensure compliance, not the patient, as the doctor is levying the charge at the point of sale. Also, a Pharmacy is not a General Practice.

  182. MemoryVault

    Notafan

    This is already the case with the PBS ‘co-payment’ and the PBS safety net. That works and is fully supported by an existing computer system so why wouldn’t a GP visit co-payment also work? it even ‘knows’ as soon as someone no longer has a health care card and is required to pay a higher co-payment.

    It works because all pharmacists tap into the same database using the same software, and it has been that way since the systems first became computerised.

    Conversely, the Medicare rebate system started out as a hard-copy paper-based system that has been through countless iterations with the advent of computerised systems. Consequently, the medical profession run a plethora of different commercial software packages, all of which have been written, or upgraded, to integrate with the Medicare system as it exists today.

    Any change in the PBS system is made at the server end, and that change is immediately reflected on the computer screen of every pharmacist in Australia. Conversely, any major billing change in Medicare would not only require changes at the server end, but would also require an upgrade and/or new software at the GP end.

    It is precisely for this reason – GP resistance to expensive software upgrade/replacement – that the KRudd-Gillard e-Health wet dream fell flat on its face.

  183. .

    The obfuscation is why I dislike the co-payment.

    All they really had to do was to increase the gap to $7 where it was less than $7 already.

    I think Hockey has botched it as a policy and as politics with the conflation and pie in the sky thinking about a cure for cancer.

  184. Aristogeiton

    MemoryVault
    #1318887, posted on May 25, 2014 at 1:14 pm

    I don’t think people understand that changing all the administrative procedures involved in running your business costs money. I expect as much from a leftists, but would expect better from regulars here.

  185. .

    I’m so glad e-health died up it’s own backside.

  186. MemoryVault

    So the patient brings the bills from their last ten visits to the surgery? Remember that the doctor has to ensure compliance, not the patient, as the doctor is levying the charge at the point of sale.

    Too true, Aristogeiton.
    Not that it would do much good. Currently the GP has no way of accessing information to even ascertain if the the bills are fakes, let alone what they were for and why were charged, all of which is relevant (not all visits qualify towards the magic “10″).

    Conversely, any pharmacist in Australia can confirm how much a customer has already spent on scripts on the PBS system, regardless of which pharmacist they have been dealing with, simply by accessing the database. True, there is no requirement for the pharmacist to keep track on behalf of their existing customers, but many of them do anyway. Where they don’t, and a customer thinks they have reached the limit, all they have to do is ask.

  187. notafan

    I’m reading that the patient keeps a card which is stamped by the pharmacy for each prescription or if the pharmacist prefers they can keep a computer record of the patients records,
    Now I know my GP brings up a computerised medical history with dates on it up on the screen when I go in so they already know how often I have been in during the year. so if you stick to one doctor it would be straightforward to verify that you have reached the threshold. I don’t see why if a patient goes to more than one doctor a similar scheme to the PBS safety net would not be workable.
    Pharmacists must also be able to show that a patient has properly reached the safety net.

  188. Aristogeiton

    notafan
    #1318907, posted on May 25, 2014 at 1:30 pm
    I’m reading that the patient keeps a card which is stamped by the pharmacy for each prescription or if the pharmacist prefers they can keep a computer record of the patients records,
    Now I know my GP brings up a computerised medical history with dates on it up on the screen when I go in so they already know how often I have been in during the year. so if you stick to one doctor it would be straightforward to verify that you have reached the threshold. I don’t see why if a patient goes to more than one doctor a similar scheme to the PBS safety net would not be workable.
    Pharmacists must also be able to show that a patient has properly reached the safety net.

    Yes, creating a national database servicing every General Practice is a doddle. I’ll do it tomorrow after I change every GPs billing system to support the charging of bulk-billed customers.

  189. MemoryVault

    I don’t think people understand that changing all the administrative procedures involved in running your business costs money. I expect as much from a leftists, but would expect better from regulars here.

    Amen to that, Aristogeiton.

    I think if you discount all the “economists” (invariably ultimately on the public teat one way or another), “academics” (ditto), and “consultants” (ditto), those Cats who actually work for a living are in reality very thin on the ground.

  190. notafan

    Patients may try to trick the doctor though I would assume most would be aware that Medicare will know if they have reached the threshold so they might scam one free visit, I don’t know how many would bother to actively commit fraud.
    Medicare might well be able to send writen notification to the patient that they are now eligible for free visits if they are visting multiple doctors. I don’t see people coming in with fake bills to get out of a copayment when they can have something similar to a safety net card.

  191. notafan

    I don’t think people understand that changing all the administrative procedures involved in running your business costs money. I expect as much from a leftists, but would expect better from regulars here.

    I’m sorry but I have run my own business for over eight years. Unlike doctors I get no guaranteed income from the goverment so if doctors want to stay on the teat they can cover the costs of dealing with changes to goverment rules.
    They can always opt out of Medicare if they don’t like it.

  192. Grigory M

    So the patient brings the bills from their last ten visits to the surgery? Remember that the doctor has to ensure compliance, not the patient, as the doctor is levying the charge at the point of sale. Also, a Pharmacy is not a General Practice.

    Sigh – egg- – where are you? You’re the computer genius here – tell these folks that the record-keeping and notification of Safety Net limits being reached are not really as big a problem as they seem to think.

    Even the smaller GP practices have direct computer links to Medicare and can arrange on the spot re-imbursement of Medicare refunds into the patient’s bank account. The existing Medicare computer system keeps track of the patient’s claims history and, at the appropriate time, prints out a letter to the patient telling him/her that:

    – you are close to qualifying for higher Medicare benefits for the calendar year;
    – you should fill out and return the attached Family Safety Net Confirmation Form;
    – all eligible services for the rest of the calendar year will attract a higher Medicare benefit.

    So, Medicare tracking and notification of whether a patient has reached the 10 visit / $70 co-payment limit will be a snack.

  193. MemoryVault

    I’m reading that the patient keeps a card which is stamped by the pharmacy for each prescription

    The card is simply for the customer’s benefit in keeping track.
    If you go into a pharmacy (any pharmacy anywhere) and claim you have hit the PBS limit and wave your card, the pharmacist is STILL not going to charge you at the reduced rate until he has checked the database.

    Yes, creating a national database servicing every General Practice is a doddle. I’ll do it tomorrow after I change every GPs billing system to support the charging of bulk-billed customers.

    Don’t forget to add in a facility whereby GP’s can ascertain other GP’s motivations were for doing what they did and the referrals they made. This is important to ascertain whether the previous visit(s) count towards the magic “10″.

  194. notafan

    tell these folks that the record-keeping and notification of Safety Net limits being reached are not really as big a problem as they seem to think.

    Thankyou Grigory, I thought so.

  195. egg_

    Grigory M
    #1318928, posted on May 25, 2014 at 1:42 pm

    Probably more ERP-based stuff that Rudia?/Fleeced?/&c. could help with – I’m a hardware guy; but agree in principle, it would have to be a hosted database and I’m sure the whole scheme is at Treasury’s behest.

  196. MemoryVault

    Sigh – egg- – where are you? You’re the computer genius here – tell these folks that the record-keeping and notification of Safety Net limits being reached are not really as big a problem as they seem to think.

    Server-side changes at the Medicare end are not the problem.
    That’s just a function of how much taxpayer’s money is thrown at the situation.
    And we all know that pit is bottomless – especially now that Medicare comes under Human Services.

    GP software integration at the other end is another matter.
    Why would GPs bother when they can simply scrap bulk-billing and blame Abbott666?
    Probably in an election year.
    Yet another example of the LNP snatching defeat from the jaws of victory.

  197. egg_

    Probably more ERP SAP-based…

  198. Aristogeiton

    egg_
    #1318941, posted on May 25, 2014 at 1:53 pm
    Grigory M
    #1318928, posted on May 25, 2014 at 1:42 pm

    Probably more ERP-based stuff that Rudia?/Fleeced?/&c. could help with – I’m a hardware guy; but agree in principle, it would have to be a hosted database and I’m sure the whole scheme is at Treasury’s behest.

    I think that the claiming is done via “Medicare Online”, which seems to be a set of online APIs which support the claiming process, and support is integrated into your practice management software. The practice management software would still need to be upgraded at least. I’m not sure whether patient information is transmitted with the claim at present.

    http://www.medicareaustralia.gov.au/provider/business/online/medicare-online.jsp

  199. Jazza

    Interesting discussion.Not so interested in the nomenclature as in the effect on individual patients.

    Wonder if Mr Hockey knows all about the autonomy of the AMA?

    I was a Victorian for over 70 yrs and now am a Qlder–here’s the thing: referrals from a GP to a specialist of any kind in Victoria when I left in 2013, were of ONE YEAR DURATION.

    I recently was flattened by dire Menieres attacks after nearly 5 yrs of being clear and active subsequent to a Victorian operation and recovery program,though I had to pay a $69 fee for the MRI scan in May 2009 and $7 per visit to the hospital for the recuperation sessions twice weekly for 7 weeks, and my specialist was charging $120 per first visit and $70 thereafter and operated in the local hospital under the public system so the operation was not billed.
    I was referred in Qld to an ENT specialist who examined me, found a growth behind my eardrum and referred me to his colleague nearby due to ears being his speciality Each “first visit” cost me $180 on the day and when later my grandie took me to Medicare in the Centerlink place, I received back a little over $72. Follow up visits to my new specialist are $90 and the rebate is a tad over $32. ( I recently checked receipts and noticed the first specialist made the referral to 3 months–and this professional, charming and competent as he is,and I am grateful for that, knew I would possibly need an operation and surely, follow up visits.)
    However, I once again have been operated on in the public system(Mastoidectomy to remove a Cholestiatoma that had penetrated the bone into the brain behind my non Menieres eardrum( oh my silent world right now!)and have confidence in my specialist and am so glad and grateful he operates in the system on Mondays!
    I guess I will have to go back and ask my GP if HE can make a referral that will be a sensible length of time and be accepted–3months to me is not long enough for batteries of tests and operative arrangement s, let alone follow ups.Why is there such a difference, Smokin Joe needs to tackle this with the AMA and if things cannot be totally uniform at least make the extra financial help go to the needy via a two level cost system all specialists will use.

  200. egg_

    Aristogeiton
    #1318954, posted on May 25, 2014 at 2:01 pm

    I am aware that DHS is currently rolling out new (branch) software but am not aware of its nature.

  201. Aristogeiton

    egg_
    #1318964, posted on May 25, 2014 at 2:06 pm
    Aristogeiton
    #1318954, posted on May 25, 2014 at 2:01 pm

    I am aware that DHS is currently rolling out new (branch) software but am not aware of its nature.

    Over-budget and behind-schedule I hope?

  202. Grigory M

    GP software integration at the other end is another matter.

    A “doddle” (thanks Aristogeiton) – simple liaison between Medicare and the Practice Management Software companies to include it in the next scheduled software maintenance/upgrade (maybe even at no additional charge) will ensure it’s in place well before 1 July 2015.

  203. johanna

    Going back to taws, I keep seeing this claim that 84% of GP visits are bulk-billed, and have asked before for a citation, with no result.

    So I am asking again.

    Almost all GPs where I live have always charged more than the rebate, although they may well bulk-bill health card holders. My GP, who is worth every penny, charges $40 above the rebate. He is not taking any new patients; he is at capacity. So his fees don’t seem to be a major impediment to his business, and that is not because he has no competition. It’s because he is very good at his job.

    I find it very hard to believe that only 16% of GP visits attract a premium. That’s certainly not remotely the case where I live. It’s mathematically impossible.

    So either this figure is wrong, or there are thousands of bulk-billing factories patronised by hypochondriacs who are happy with 10 minute “medicine.” If the latter is true, then there might be some method in the madness by reducing the revenue of those bloodsuckers.

  204. MemoryVault

    there are thousands of bulk-billing factories patronised by hypochondriacs who are happy with 10 minute “medicine.”

    Hammer, nail, head, Johanna.
    Efforts to curtail it are good, and should be presented and sold as such.
    Trying to hide real motivations behind a smokescreen of “co-payments” and “research funds”, is simply creating another “it’s not a tax, it’s a levy” moment, next year when the truth becomes apparent. That it will happen within a year of an election just adds to the folly.

  205. johanna

    Thanks, notafan. It confirms that where I live (the ACT) has low bulk-billing rates, so I am not going mad.

    But it also mentions that the Feds top up the bulk-bill fee by up to $10 per consultation under current arrangements. In other words, the rebate is, in many cases, considerably higher than the standard Medicare figure. So a lot of the bulk-billing factories are getting a lot more revenue than the standard rebate for their 10 minute consultations. Say, $500 per day per doctor. Multiply that out across the nation and we are talking serious money.

    That said, from talking to friends and relatives in other jurisdictions, I still find it hard to believe that 4 out of 5 GP consultations are bulk-billed. Apart from health card holders, just about everyone I know pays extra to visit their GP. Then again, they don’t patronise the factories where you never know who you are going to see.

    I guess that it highlights that people don’t value what they don’t have to pay for. If little Shaquille has a sniffle, why not take him/her to the bulk-billing clinic? Can’t do any harm.

    Those of us who have taken the trouble to find excellent GPs don’t mind paying for excellent service. And, if little Susie has a sniffle, we consider whether it is worth $40 to be told that it is just a sniffle.

  206. Aristogeiton

    johanna
    #1319038, posted on May 25, 2014 at 4:10 pm
    [...]

    Those of us who have taken the trouble to find excellent GPs don’t mind paying for excellent service. And, if little Susie has a sniffle, we consider whether it is worth $40 to be told that it is just a sniffle.

    Bingo. Any price signal is a good thing.

  207. Notafan

    On the radio a short time ago, download the National Home Doctor app, and get an in home consultation all bulk billed (of course)
    What’s the schedule fee? A damn sight more than in the clinic, I’ll wager.
    As far as I know the arrangements for home visiting doctors were changed in the last couple of years and the target patients were the elderly and very young for out of hours consultations, makes sense. Now the general population is being encouraged to get the doctor to visit them at home cos you know, it’s free.
    No overservicing here.

  208. Jessie

    Johanna at 3.03
    I too found the % very surprising.

    Here? Annual Medicare Statistics

  209. Paridell

    the megalithic Department of Hot Drinks

    A lovely image, but “megalithic” denotes a very large stone, used in building structures such as Stonehenge.

    The Department of Hot Drinks sounds like it would be monolithic. Not that megaliths can’t be monoliths, in the sense of being very large stones. But “monolithic” can also refer to a large organisation that acts as a single unit. Not so with “megalithic”. It’s always and only a very large stone.

  210. MemoryVault

    Not so with “megalithic”. It’s always and only a very large stone.

    Not had much to do with the Department of Human Services then, Paridell?
    Trust me, it’s a very large stone.
    Nothing else.
    And half as intelligent.

  211. Jessie

    Bulk billing figures also include pathology, imaging diagnostic, other?

    1985- 2007 Explanations on right hand side of link and Graphs of Major Aggregates pdf
    Medicare Electoral reports

  212. Grigory M

    Not had much to do with the Department of Human Services then, Paridell?
    Trust me, it’s a very large stone.

    Yes – it needs to be broken up.

  213. johanna

    Jessie, if those figures include things like blood tests and x-rays, it is a whole different ball game, and helps to explain why almost nobody I know does not pay extra to see their GP.

    In other words, the figures do not just represent GP visits.

    I still maintain that the assertion that only 1 in 5 GP visits are not bulk billed does not accord with reality. And if it is true, there is massive fraud at play.

  214. MemoryVault

    Yes – it needs to be broken up.

    Nice thought, Grigory, but it ain’t gonna happen.
    I described it as a “megalith” but in truth, it is more like The Blob in the 1958 movie of the same name, starring a young Steve McQueen. It is slowly but surely absorbing everything in its path.

    It has been over 40 years in the making, and it is the culmination of the efforts of a small group of people dedicated to ideals that would turn your stomach. Together with Treasury and a couple of other departments, including the HRC, they now run the country.

    Politicians and elections are now merely bread and circuses to keep the ignorant masses entertained, while the real work continues elsewhere, unhindered and undisturbed.

    The New World Order – aka George Orwell’s 1984 – arrived over a decade ago, and nobody noticed.
    Get used to it.

  215. Stephanie Gray

    Re the $7.00 co-payment, I find it very difficult to believe that $7.00 is all it will be. Now that Doctors are expected to become tax collectors they will require new computer software to administrate this and perhaps more staff – hasn’t anyone given this any thought?

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