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    I note that one of the biggest barriers to accessing healthcare is cost.

    Rural and remote areas are unique in that both primary care and emergency services (hospital-based ED visits) are usually provided by the rural practitioner.

    The former, primary care services, are usually billed privately and a reimbursement funded through Medicare, which may or may not cover the Doctors fee (shortfall known. the Gap). This is the same for metro and rural areas, although there may be more bulkbilling in metro due to increased competition and lower overheads.

    It is in the provision of after hours emergency care that rural Australians are hit hard. The National Healthcare Agreement seems definite, in that public patients attending a pulic hospital are NOT to be charged a fee. A patient attending the ED with, say a shoulder dislocation or laceration can expect to be treated for free in the city at a public ED…

    …yet certainly in my State (South Australia) the Govt neatly cost shifts their responsibility by insisting that the attending doctor bill the patient privately – their rationale being a clause that allows for private fees to be charged ‘as part of an ongoing arrangement or where the patient elects to be treated as a private patient fo the GP’.

    Thus a clause designed to allow private fees to be charged in specific circumstances h become a carte blanche to all non-admitted ED patients to be charged privately by the attending doctor, neatly cost shifting reimbursement for such services from State to Medicare….and often a hefty gap for rural patients.

    I fail to see why a pateint attending the ED in the city receives services for free in a public ED, whilst their rural cousins are charged fees for the same services in a State-funded rural ED.

    Better that the attending doctor is paid by the Hospital (State Govt) rather than the patient.

    That such blatant cost shifting is tolerated despite being contrary to the Australian Healthcare Agreement seems bizarre, and yet another example of how costs to rural patients are conveniently ignored when politically suitable.

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