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How do you solve a problem like Medicare?

A coalition of health groups has today launched a campaign calling for reform of Medicare to address the rising out-of-pocket health costs, lengthening delays for elective surgery and widespread disparities in access to doctors and other health professionals. 

The MEND MEDICARE coalition comprises: the Australian Nursing and Midwifery Federation, Catholic Health  Australia, Consumers Health Forum of Australia, the Mental Health Council of Australia, and the Public Health Association of Australia.  The Coalition has released a report which highlights the many inequities in the current system, specific in relation to people with chronic and complex problems, those in rural and regional areas and in relation to preventive health care.  The Report calls on party leaders to spell out their plans for Medicare before the next election, including addressing waste within the current system, looking funding models that better support care for people with chronic conditions and addressing inequities of access.

The AMA is not (unsurprisingly) a member of the MEND MEDICARE coalition. However, it too has called for action on Medicare via increasing rebates in line with the rise in health care costs.  In a video on this issue, AMA President Dr Steve Hambleton argues that AMA rebates have been devalued by 40% since 1986 and that this is resulting in higher out-of-pocket costs for consumers.

The MEND MEDICARE coalition argues convincingly that it is time for major reform of Medicare.  Medicare was developed to meet the needs of a previous generation and since its inception in 1983 these needs have changed in a number of ways.  In particular, we have a much greater incidence of chronic and complex illness which typically requires care from multiple providers, in a number of settings and over a long period of time.   Medicare was designed to support short-term, episodic care, from a single health professional and its fee-for-service and medical-centric approach does not support the multi-disciplinary, coordinated and consumer-centred care that is now required.

Another crucial change is that since 1983 we have become much wealthier.  Rising property prices and increasing superannuation funds have resulted in middle and upper income earners acquiring much larger savings than at any other time in Australia’s history. The Australian Bureau of Statistics shows that in 2009-10, middle wealth households held $556,000, and the top 20% held $2.4 million in assets on average. While not all of these would be liquid, a significant proportion of them are, in particular as people reach retirement age and the restrictions on accessing superannuation are lifted. 

As the MEND MEDICARE coalition argues, Medicare no longer warrants sacred cow status. However, the assumption that most Australians, most of the time, need a government program to help them pay for their health care is a sacred cow that itself needs to be challenged.  The figures put out by the MEND MEDICARE coalition show that Australians spent, on average, more than $1,070 a year on health services and products, meaning a typical family can shell out more than $4,000 a year. It also states that the average out-of-pocket cost for a non bulk-billed GP consultation in 2012 was $46.50. Given the level of wealth of the average Australia family, those figures hardly seem unreasonable.  It is worth questioning whether they warrant a universal health insurance program of the scale of Medicare.

Of course, the issue in health is that few people are average.  People are either sick or well and those who are sick spend much more than average on health care and those who are well spend much less.  From both an equity and efficiency perspective we need to ensure that resources are focussed on those with the greatest need. This group (or groups) can be difficult to identify as health care affordability can be as much to do with the type of illness and the timing of care needs as it is to do with overall income level. A healthy young person on a low income is probably much more able to meet her own health care costs than a family on a middle, or even high, income where one or more members have a chronic illness. 

Identifying and targeting people with genuine difficulty affording health care, over the long term, is the key to ensuring Medicare resources can be used most efficiently to reduce current inequities of access and health outcomes.  This will be particularly difficult to achieve given that members of the MEND MEDICARE coalition have different views on how Medicare should be reformed. For example, Catholic Health Australia is promoting the Medicare Select proposal put forward by the National Health and Hospital Reform Commission. Medicare Select involves giving Australians a choice of a health and hospital plan, either insured by Medicare or a private health insurer. This would entrench the role of a third party payer for ‘normal’ health care expenses and expand the role of private health insurance, a funding mechanism that has administrative costs more than double that of Medicare(as a proportion of total funding).

The MEND MEDICARE coalition has a tough lobbying task ahead with both major parties.  Labor knows the brand value of Medicare – so much so that it named its Primary Care Organisations ‘Medicare Locals’, despite the fact that they have nothing to do with Medicare.  The Government will do nothing to risk undermining the value of this brand, but may recognise the need for some tweaking of Medicare to address the identified problems.

Perversely, the Coalition will be an even more difficult challenge. While its more market-oriented philosophy should lend itself to a Medicare reform agenda, the Coalition will shy away from any policies which Labor could argue undermine Medicare’s currency. For all its rhetoric, the Opposition is unlikely to find that its concept of ‘personal responsibility’ stretches as far as requiring a person on $200k a year to fund their annual flu shot without the aid of a government program.

However, regardless of whether this campaign achieves its outcomes this election, it has raised some important issues about the future of Medicare which future governments will need to address.

 

 

Comments 2

  1. Peter Walker says:

    Medicare definitely needs fixing. But the very first thing the government has to do, regarding Medicare, is to come clean over its dirty little pay secret to 4000+ Aussie GPs!

    These 4000+ Aussie doctors are on HALF Medicare rebates from the fedgov for the EXACT same work and responsibility as their other GP colleagues. The Medicare rebates of these highly-skilled doctors have been FROZEN since 1992! These doctors’ training and qualifications are absolutely IDENTICAL to the majority of their GP colleagues who get paid the normal GP Medicare rebate.

    The Medicare rebate these doctors get is now LESS than what a mowing man gets for cutting a tiny lawn, for the same time! And he doesn’t have any staff costs, practice costs, medical liability costs, etc that have to come out of the Medicare rebate before the doctor gets paid! (And the mowing man certainly doesn’t take the immense RESPONSIBILITY these doctors take every day.)

    If something isn’t done to stop this shocking discrimination these Aussie doctors will have to leave medicine and start all over again in another career, late in life. (How appalling.)

    Don’t we value our Aussie GPs? Mr Rudd, you certainly use the phrase a great deal, but do you really believe in the Aussie “Fair Go”? When are you going to stop blocking these doctors’ efforts to form a UNION so they can get EQUAL PAY??
    To learn more please visit:
    http://www.FairGoforDoctors.org
    http://www.facebook.com/fairgo4doctors

  2. Rhonda Kerr says:

    Is it Liberal Policy to sell Medibank Private? It was before the election but is not included in the lovely ‘Real Solutions’ booklet. Similarly prior to the election the Shadow Minister for Health Mr Dutton said the Independent Health Pricing Authority(IHPA), the Health Performance Authority and the Commission on Safety and Quality in Healthcare were “ unnecessary bureaucracies “ to be abolished. Is that the policy? I have written to Mr Dutton asking but cannot get a reply of any sort, nor can my local member. What are the plans for hospital funding in the event of a Liberal victory?

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social and emotional wellbeing
Uluru Statement
WA community closures
News about Croakey
PIJ Commissions 2021
Public health and population health
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
air pollution
alcohol
consumer health matters
COVIDwrap
environmental health
Fetal Alcohol Spectrum Disorders (FASD)
food and nutrition
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Government 2.0
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Health in All Policies
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Media Doctor Australia
media-related issues
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National Preventive Health Agency
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Summer reading 2020-2021
Tasmanian election 2021
Testing Croakey News category 1
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#IHMayDay 2014
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#IHMayday16
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#LoveRural 2014
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