*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.
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.