My recollection about the initial Medicare arrangements in respect of doctor visits was as follows: patients were expected to contribute 15 per cent of the cost and the MBS reimbursement covered the remaining 85 per cent. A doctor could decide to waive the 15 per cent but would be out of pocket for this amount. More could also be charged (above the 15 per cent). There may have been some arrangements for concessional card holders (a much smaller number and proportion than today), but I’m not sure.
Given that many citizens are always keen on free stuff, the promotion of bulk billing at some stage became an objective of government policy – even when Tony Abbott was the Health Minister and certainly under Labor.
What I was surprised to discover is that there is now an additional fee paid to doctors who bulk bill, in addition to the standard MBS. It is currently around $7 in the cities (apart from Hobart) and around $10 in rural and regional areas plus Tasmania (I wondered who swung that one, just another example of Tasmania being a mendicant state.)
I understand that the extent of bulk-billing among GPs has increased in recent times and now sits around 80 per cent of all consultations. And 70 per cent of patients who are bulk-billed (not number of consultations) do not hold a concessional card. (I would need to check these figures – I’m not sure they sound right.)
There is a real issue about the impact of bulk billing in terms of distorting the nature of general practice medicine – something that the government has not mentioned much, but something on which they should have data – eg. lots of repeat short visits of the same patients, over-servicing those who don’t have much else to do.
The government seems to have made a complete hash of explaining the impact of the sort-of imposed co-payment – Dutton seemed to imply yesterday that doctors could (should?) keep bulk-billing in certain instances. But presumably they lose the $7/$10 bulk-billing incentive fee (I guess this will be removed from the MBS) as well as the $5 lower standard MBS fee. That looks like a relatively big loss per consult for many GPs.
Capping the number of non bulk-billed consultations at 10 visits per year also looks quite complicated. Who tracks the number, particularly if you don’t always go to the same GP practice? Presumably this will be done through swiping your Medicare card. Is the GP then reimbursed at the new MBS rate after the maximum number of visits is reached?
And why would the government think that the savings associated with the imposition of the co-payment should be directed to another government boondoggle – the Medical Research Future Fund? If all the savings are going to be used up, how does this make Medicare more sustainable?
And please, please spare us the drivel about Australia being good at medical research (where is the evidence of that?); that there are job multiplier effects; and that there will be cost savings down the track because of all the discoveries that will be made (and will be shared with the rest of the world). More like business class travel for medical researchers.
I think if I had my druthers, this is what I would do:
- Exempt concession card holders and children from the co-payment initially;
- Evaluate the impact of the co-payment on GP/pathology/imaging use (surely the government believes in collecting evidence?) for those impacted;
- Use the savings to pay down the deficit and make this the messaging;
- Drop the idea of the Medical Research Future Fund or scale it down drastically and without using any savings from the Medicare co-payment.
The reality is that the real waste is in the hospitals, particularly in terms of undertaking completely pointless and/or unnecessary procedures, but the states are in the driving seat when it comes to doing something in this space.