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Government’s ‘Plan B’ for copayments widely criticised

*Updated to include responses from the RDAA, NACCHO and the AMA*

 

 

 

 

The Government’s announcement of its ‘Plan B’ for Medicare has generated a wave of responses from stakeholders.  The plan, in essence, is to reduce Medicare rebates for Level B consultations for non-concessional patients but has been dressed up as a package to ensure Medicare’s ‘sustainability. An excellent analysis of the proposal and the response from other parties and interest groups has been prepared by Michelle Grattan for The Conversation.

The central part of the plan, is to allow GPs to charge non-concessional patients a $5 co-payment if they have spent 10 minutes or more with them.  This has been presented as a quality measure to discourage the practice of ‘six minute medicine’.

In promoting the proposal, Health Minister Peter Dutton said “The Government’s changes to the GP co-payment will keep Medicare strong and sustainable while helping the budget”

However, experts, health professionals and consumers strongly criticised the proposal as undermining the universality of Medicare and creating a two-tier system which disadvantages those most vulnerable.  Rural patients and non-concessional card holders with chronic illnesses were particularly noted as suffering from these changes”.  A sample of some key responses is below:

Rural Doctors Association of Australia

The RDAA said the Government’s decision to exempt children and concession card holders from the co-payment was a ‘welcome development’. However, President Professor Dennis Pashen expressed concern that the co-payment will deter more rural people who do not fall into these categories from seeking timely healthcare.  He said “Many rural families are asset-rich yet cash-poor. The ongoing drought is impacting badly on both property owners and rural businesses. Given the current Medicare underspend in rural areas, we should be encouraging people to see their GP more regularly, and making it easier for them to afford to do so, not harder.” Professor Pashen also warned that the changes could make some rural practices unviable which could compromise care at local rural hospitals and other health services.

The National Aboriginal Community Controlled Health Organisation

Chairperson Matthew Cooke said the majority of Aboriginal Community Controlled Health Services, whose overriding purpose was to encourage Aboriginal people through their doors, would choose to absorb the discretionary $5 co-payment.   “Aboriginal Community Controlled Health Services are making the biggest gains against the closing the gap targets – helping Aboriginal people to live longer and healthier,” Mr Cooke said.

Mr Cooke said that the co-payment would be defunding Aboriginal health services when what we need is greater investment at this less costly end of the health system. We are now likely to see more people present at emergency departments of public hospitals to avoid the co-payment.  “It is extremely disappointing to see that Aboriginal and Torres Strait Islander people, some of the sickest in the nation, have not been taken into consideration with this revised policy,” Mr Cooke said.

The Australian Medical Association

The AMA described the package as a ‘mixed bag’, with a thumbs up for the co-payment exemption for concession card holders, children under 16, and residents of aged care facilities and no additional payments for pathology and diagnostic imaging.  However, AMA President Professor Brian Owler said he remained disappointed that rebates for GP services for everyone else will be cut by $5. “This comes on top of a freeze on Medicare patient rebates until July 2018. This means that, by 2018, Medicare rebates for many services will have been frozen for almost six years, while inflation continues to rise.” Professor Owler said that the Government’s proposal represents a “disinvestment in quality general practice” at a time when general practice is in need of significant new investment to cope with an ageing population and more people with chronic disease.  

Consumers Health Forum

The Government is abrogating its responsibility to set an overall policy to improve health and instead is just focusing on health financing.  This policy simply shifts the burden to doctors and ultimately patients.  It is claiming that financial cuts must be made to health while independent evidence indicates that the Australian health system overall performs well within international cost measures, apart from the increasingly heavy burden borne by individual consumers

Public Health Association

“Our GPs are being forced to do the dirty work of the government,” added Professor Yeatman, the President of the PHAA.  “Either they lose $3billion from their own pockets over the next three and a half years or drag it from the wallets of the bulk of their patients.  This is simply unacceptable.  The message has been clear.  The criticism widespread.  A universal health care system is one that provides appropriate access to the community without distinguishing on the grounds of ability to pay”. 

CEO of the PHAA, Michael Moore said “This $5 cut in the Medicare Rebate is in effect a pay cut for doctors.  Have government ministers taken a pay cut themselves?    It is a deliberately targeted pay cut to GPs. This is comparable to the minimal pay increase offered to the military.

 @drkerrynphelps

Dr Kerryn Phelps tweeted: Universal bulk billing became a political fantasy long ago when MBS started to fall behind pace of inflation.

 Rural doctor Kate Graham sent the following clear message to the Prime Minister”

“Dear Tony, thanks for the pay cut, love, a female, bulk-billing GP in a country town with the nearest bank 25k away”

The Doctors’ Reform Society also raised its concerns about the impact of the proposal on universal health care.

The Government’s press release claims it has ‘listened to the community” on co-payments. However, given the response to its Plan B today, it might need to listen more carefully if it wants to get any of its health agenda up before the next election.

 

 

Comments 3

  1. Edwin York says:

    I sometimes wonder in which universe the Liberal party lives.

  2. Delia says:

    Conservative governments are ignoring billions being misspent in health funds while grandstanding about small change. I wonder why?

    In America the privatised health model is openly discussed by bankrupt patients and their families on Facebook https://www.facebook.com/groups/payingtillithurts/?fref=ts. A number of key figures emerge. 1/3 of heath care expenditure provides no health benefits http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America/Infographic.aspx. Over servicing, fraud and waste are said to affect 30% – 40% of the USA health budget
    http://www.amazon.com/Unaccountable-Hospitals-Transparency-Revolutionize-Health/dp/1608198367/ref=sr_1_1?ie=UTF8&qid=1349264649&sr=8-1&keywords=Unaccountable%3A+What+Hospitals+Won%27t+Tell+You+and+How+Transparency+Can+Revolutionize+Health+Care.

    By default, that means up to 46 billion a year of Australia’s yearly budget of 140 billion could be be wasted. Cross referencing PCEHR records with Medicare, private health funds and Best Practice Clinical Guidelines, then refusing to pay for unnecessary tests, hospital admissions and treatments would save tax payers billions. But it would also cost the booming pathology industry, private hospital industry and pharmaceutical industry billions. What would the heath lobby mafia in Canberra make of that?

    The ‘money saved’ by charging patients five or seven dollars for a GP visit is small change. Why bother? Unless it’s a red herring for the radio shock jocks and shallow mainstream media.

    Is is any co incidence that so many politicians have links to private companies who are bidding for services in the sell-off of the National Health Service in the UK? http://www.mirror.co.uk/news/uk-news/selling-nhs-profit-full-list-4646154. When politicians profit from inefficient practices, aren’t the tax payers entitled to ask hard questions about where their hard earned money is really going?

  3. Scott says:

    Why so much emphasis on GP’s taking a pay cut? GP’s are hardly doing it tough, being in a business where there are large barriers to entry.

    Average GP salary is around $100,000 with senior GP’s (practice owners) earning close to $200,000.

    I think they will be fine. Surely it is in the Government’s interests to worry more about the costs of health care, rather than topping up doctor’s salaries.

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#UnmetNeedsinPublicHealth
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Health in All Policies
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Media Doctor Australia
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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017