MedicarePlus or minus

The future of primary health care is at the forefront of community debate in the lead-up to the next federal election. This issue has only become of real concern to politicians over the last 7–8 months.

During this time we have seen the release of the federal government’s Fairer Medicare Package, the Labor Party’s own Medicare Package, the revised Fairer Medicare package called MedicarePlus and now a community debate about the future of Medicare and primary health care services throughout Australia.

MedicarePlus is based on an assumption that most Australians should not only pay for the health care services through their taxes, but also at the point of delivery, in the form of an upfront fee to their general practitioner (GP).

It is acknowledged by politicians of all parties, the broader community and health economists that implementation of MedicarePlus will see decreased bulk billing rates.

The Australian Medical Association acknowledges that the extra $5 rebate to doctors for seeing patients with a health care card or those under 16 years is not enough to meet the practice costs of most GPs and will not encourage doctors to bulk bill. GPs will not return to bulk billing if it means charging less than they are at present. MedicarePlus offers no encouragement to GPs to achieve an optimal bulk billing rate. The package does not address the fundamental inadequacy of the amount of the rebate shortfall. This can only result in a decline in bulk billing and an increase in upfront fees.

The Minister for Health, Tony Abbott, has indicated that the Commonwealth government does not believe in universal access to bulk billing. MedicarePlus provides significant disincentives for people to use primary health care services. Establishing safety nets once people have reached either $500 or $1000 annually will still mean that those on low incomes will have to think twice before seeing a GP. Given that those who have the lowest incomes also have the worst health, it makes little sense to impose any obstacle to securing basic health care services.

The average out-of-pocket expense for attending a GP across Australia is over $13 per visit. In order to get to the $500 safety net or the $1000 safety net a person would have to visit the GP on about 40 occasions. It would also require the person to keep very clear records so that they could determine when they had reached the safety net.

The government’s proposals make the system extremely complicated and difficult for both doctors and patients to understand. One of the major benefits of Medicare has been its simplicity.

Despite recent increases in the overall number of GPs, MedicarePlus fails to address the need for a more equitable distribution of GPs. Present incentives designed to encourage GPs to move to country or outer urban areas are failing.

The MedicarePlus package does not address the need for better after-hours access to health care. Emergency departments throughout Australia are now flooded with patients who should have been seen in GP practices.

MedicarePlus also fails to address practice inefficiency. Recent studies have shown that most medical practices spend over 50 per cent of their revenue on operating costs. This is clearly an inefficient use of money. We need to consolidate GP practices into more economically viable operations.

It is my view that the package will cost more than the projected $2.4 billion over four years, as the resulting decline in access to health services will inflate overall costs to the system. As we enter a market-based, ‘user pays’ era of health care, we will see significant increases in the prices that GPs charge. Already consultations cost $50 in some areas and it will not take long for the charge to reach $55, $60 and even $70.

This will see a much higher level of Australia’s gross domestic product spent on health care than the current 9.3 per cent.

The Victorian Medicare Action Group, in consultation with over 300 members, has recently developed a draft Consumer Medicare Charter. This has allowed us to be proactive and positive in determining
what we want from our health care services.

The charter calls for the development of a National Health Reform Council capable of determining state-Commonwealth demarcation issues over funding, and the development of consumer-based Primary Care Trusts, which will hold funds from the Commonwealth and state governments.

There is a need for significant incentives for GPs to lift bulk billing rates. Further, GPs ought be licensed to practice in nominated areas to prevent over- and under-supply of services. The charter also outlines the need for more university places for training GPs, nurses and allied health workers.

Primary health care teams ought to be integrated and the community would profit from a stronger emphasis on health promotion. In this way the effectiveness of the health care system might be measured by health outcomes rather than how many patients are seen.

The Public Dental Service requires a further $500 million commitment from the Commonwealth government in order to provide adequate care. Scrapping the $2.5 billion health insurance rebate, which is clearly ineffective, may go some way to addressing funding shortfalls in other areas.

The charter is intended to act as a catalyst for discussion among community groups and people seeking to develop a positive and feasible blueprint for the delivery of health care services in the community.

It is worth noting that surveys conducted following the last round of federal tax cuts indicated that consumers would far prefer better access to basic health care services than further tax cuts.

The principle of access to health services based on need rather than ability to pay should be at the core of our health service. Historically, Medicare has been able to provide this for the vast majority of Australians. It has become less effective as GPs have moved away from bulk billing. We now have an opportunity as a community to voice what it is that we want from our health care services in the lead-up to the next election. 

Rod Wilson is the Convenor of the Victorian Medicare Action Group.



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