OPINION: Medicare isn’t all about GPs

UNSUSTAINABLE: All health sectors must contribute to fixing Medicare.THE Abbott government’s budget last May brought big cuts to the health sector and surprise new policies, most notably the $7 GP co-payment. The government has partially retreated from some of those plans since the budget, but they remain nonsensical.
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The government’s reasoning appears to be that Medicare – in its current form – is not sustainable in the long term, and that all health sectors must contribute to fixing the deteriorating budget position. This does not stand up to even cursory analysis.

General practice has been targeted for savings of $3.8billion over the forward estimates but GP is not the problem in health expenditure. GP accounts for $7billion a year of health expenditure, but expenditure in GP in real terms has been flat for five years: GP has done more work, but costs are unchanged. Public hospitals account for $40billion in spending a year and this expenditure has increased 20per cent in the last five years, without evidence of productivity improvements.

Furthermore, the estimated savings from GP cuts are not going to the budget bottom line. They are being diverted to an industry slush fund (no matter how much lipstick you put on it, that’s what the Medical Research Future Fund is).

It is unclear how Medicare is made sustainable by undermining its most efficient and productive sector, and it is unclear how robbing Peter to pay Paul helps the budget position.

The practice of the proposed changes in health policy is also flawed. In order to attack the so-called ‘‘GP factories’’ in capital cities – whose business model is based on bulk bill turnover – the rebate for privately-billed or bulk-billed non-concession patients will fall by $5. Regardless of choice of medical practice, all private paying health consumers will have to pay an additional $5 (at least) per consultation come January 19.

This is inequitable. Self-funding retirees, residents of regional centres (which have high private billing rates), and higher net worth individuals – who already shoulder most of the tax burden – will be required to pay more, on top of what they are already paying.

I guarantee you that GPs won’t be picking up the tab.

Moreover, to attract the standard ‘‘level b’’ rebate all consultations were required from January 19 to be a minimum of 10 minutes duration. No swings and roundabouts, shorter here longer there – a 10-minute minimum for everyone. While at first blush this proposal seems reasonable, the devil – as ever – is in the detail.

In a nutshell what this regulation will mean to patients is: longer waits to see your GP; no ‘‘squeeze in’’ appointments; increased diversion of injuries, accidents and emergencies to public hospitals; no simple procedures on the day of a consultation; curtailment of provision of wound dressings and much increased out of pocket costs – to name but a few.

GPs – by and large – are very decent people but we are not chumps. Our business costs are high and fixed – and goodwill towards the current government is approximating zero. Our costs will be passed on.

It doesn’t have to be like this. There are multiple workable alternatives, including – but certainly not restricted to – the following suggestions:

1. Introduce a flat $2 reduction in all private practice medical consultations. Doctors can recover at their discretion. The existing safety net provisions to remain in place. All the proceeds to go off the bottom line of the health budget.

2. Introduce a non-recoverable $10 cut in the rebate for any bulk-billed consultations for public patients in public hospitals (in most industries getting paid twice would be considered a rort).

3. Restrict the process of bulk-billing to under 16s and concession card-holders.

4. Have a Senate inquiry into what is going on in our public hospitals. Why do we have one of the highest hospitalisation rates in the world? (a little hint – follow the money).

5. Have a very careful look at PBS expenditure in terms of value for money. Statin use for those without coronary artery disease would be a good starting point.

6. Reward GPs for providing structured participatory care instead of paternalistic ad hoc care. At present the Department of Health is actively campaigning against structured care.

7. Introduce the concept of a ‘‘patient budget’’, that is patients have a specified budget for investigations. Normal results come out of your budget, pathological results do not.

8. Start the discussion about medical savings accounts for old age. If you want expensive care that has limited prospect of success in old age you need to contribute to the cost from your medical savings account. If you decide you don’t want the treatment the money in your medical savings account goes to your kids or beneficiaries.

At present federal health policy is an election losing mess: I fear a neophyte minister has been handed a poisoned chalice.

Dr Michael Reid has a mixed-billing general practice in McLaren Vale, South Australia. He sees about 150 patients in a six-day week