This week the Federal Government announced several changes to Medicare:
1. A reduction of $5 in the Medicare rebates for patients who do not qualify under the Medicare plus scheme (ie anyone who does not hold a health care card, who is not a pensioner and is over 16).
2. An extension of the present freeze on Medicare Rebates to 2018 – effectively this will mean that Medicare rebates will remain at November 2012 levels.
3. An increase in the minimum time for a ‘standard consultation’ that attracts the medicate rebate for item 23.
What this amounts to is a deliberate attempt to undermine Medicare and ‘bulk-billing’ under the guise of fiscal restraint without actually going to the electorate and obtaining their support at the ballot box.
So what does it mean for patients and doctors?
Since 2007, Medicare rebates have been steadily eroded in real terms. Rebates have increased by 15.4 per cent while the consumer price index has risen 23.8 per cent in the same period.
Worse still, the cost of running a medical practice has actually risen by around 30 per cent in the same period.
For practices that primarily bulk-bill their patients, the $5 reduction on the non-qualifying patients will reduce the actual practice income by a further 2 to 3 per cent and the freeze on Medicare rebates will likely reduce income in real terms by a further 12 to 15 per cent.
So by 2018, if doctors do nothing to recoup the reduction in fees, their fee income will have fallen by over 30 per cent in real terms in a 10 year period.
By changing the standard consultation times, the government is also attempting to restrain doctors from seeing more patients in an attempt to recover the reduction in fees.
In my view, if this scenario were to prevail, bulk-billing will cease entirely in rural areas and be under great pressure in metropolitan areas.
No doctor is going to sit back and see the real value of their incomes drop to 30 per cent below 2007 levels.
The Australian Medical Association’s recommended fee for a standard consultation was $71 in 2012, and is probably about $75 now, compared with the present bulk-billing rate of $37.05 (plus a further $9.25 in a rural area such as Wonthaggi for patients who qualify under the Medicare Plus scheme).
The AMA recommended fee will no doubt go up in line with inflation.
Going to fully private billing involves additional costs for a practice in terms of additional staff, bank merchant fees, delayed payment and bad debts.
Private billing will also deter many people from seeking help when they need it or will cause them to attend the emergency department instead of seeing a GP. Reduced patient numbers will then put further pressure on GPs to lift their fees.
If the Federal Government succeeds in its avowed changes then we can look forward to the end of bulk-billing; a standard GP fee of around $75 may be expected in the future with an out of pocket expense of over $40 per GP visit.
Indeed some practices are already charging fees at this level. The result will be quality medicine for those that can afford it and too bad for those that can’t.
The net result will be much higher costs to the government in the acute care sector in the future. Is this what the electorate voted for?
John Turner, Inverloch.
The end of bulk billing?