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out of pocket costs
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palliative care
paramedics
pathology
Pharmaceutical Benefits Scheme
pharmaceutical industry
pharmacy
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Primary Health Networks
private health insurance
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screening
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surgery
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tests
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Fine print alert for those concerned about Aboriginal and rural health, and Medicare’s future

Thanks to the Croakey reader who has clearly been meticulous in their reading of the National Health and Hospitals Reform Commission report, and has written to sound the alarm that Aboriginal people are not included in the proposal for under-served remote and rural communities to receive top-up funding.

The top-up is aimed at overcoming the historic low levels of PBS and MBS spending in rural and remote areas, to ensure they’re receiving as much money as communities with better access to medical, pharmaceutical and primary care services.

Our reader notes:

“The Medicare ‘top up’ for rural and remote communities (fantastic idea, p. 89) excludes Aboriginal people on the grounds that they are served through strategies elsewhere (terrible fine print, p. 268).  I think this is outrageous as surely the principle is that Aboriginal people have as much right to Medicare as anyone else, and that the Aboriginal strategies are actually about the specific needs of that community given the appalling health status.”

Meanwhile, health writer and author Ray Moynihan asks in this piece, published in Crikey, whether we may see the end of universal health cover in Australia, if the Government pursues the Commission’s suggestions for a Medicare Select under which  people could “readily select” to move between government plans or to a plan “operated by a not-for-profit or private enterprise”.

Interestingly, Stephen Duckett (one of the Commissioners who produced the report) was quick to comment on the Crikey website that:

“The Reform Commission did not recommend ‘Medicare Select’, it recommended examining the issue. The points you raise would necessarily be part of any such investigation (recommendations 90.12 and 90.13 for example explicitly foreshadow the need to look at risk adjustment and anti-competitive behaviour).”

It is worth noting that the Commission felt able to make a recommendation that would signal the end of universal cover although its terms of reference (P 181) explicitly state: “The Commission’s long-term health plan will maintain the principle of universality of Medicare and the Pharmaceutical Benefits Scheme, and public hospital care.”

And yet we’ve been told that the Commission was unable to investigate the rights and wrongs of private health insurance incentives because this issue was explicitly excluded from its brief.

Mark Metherell reported in the Sydney Morning Herald on July 29 that: “When he announced the health reform commission last year, the Prime Minister, Kevin Rudd, specifically instructed the commission to keep clear of the rebate issue. This was in deference to the health insurance industry, to which Mr Rudd had given an undertaking before the election to retain the rebate.”

Assuming this report is accurate (and please speak up anyone who knows otherwise), isn’t this cause for some concern?

The idea that a Government would commission such a wide-ranging and important review but instruct that a critical issue be omitted “in deference” to an industry group! No wonder Ross Gittins is not optimistic about the likelihood of Rudd delivering on his health reform promises.

While I’m feeling optimistic in some senses – we have come a long way, remember, since we had a federal health minister declaring there was absolutely no need for health reform – it also seems that these may be times of both danger and opportunity.

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