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New year, same approach: implications of the Fed Govt’s confidence trick on Medicare

Much happened on the health front in the closing weeks of 2014, not least with the appointment of a new Health Minister Sussan Ley. See some interim advice to the new Minister and judgements on the contributions of former Minister Peter Dutton from Croakey contributors.

The Federal Government also finally came up with a Plan B to its proposed $7 GP co-payment that also raises significant concerns. Thanks to Tim Woodruff, Vice President of the Doctors Reform Society, for this clear and timely post that explains the implications of the latest changes, including the new requirement that a Level B consultation be a minimum of 10 minutes duration, which took effect on 1 January.

See also this article – GP co-payment 2.0: a triple whammy for patients – from The Conversation by Stephen Duckett and Peter Breadon from the Grattan Institute.

***

Dr Tim Woodruff writes:

The Federal Government’s revamped co-payment proposal consists of three parts.

The first is a $5 cut to the Medicare rebate which can only happen with parliamentary approval. Labor has rejected this as have some cross benchers.

The second is the freezing of the Medicare rebate until 2018 which over four years is a $3 cut because of inflation. It does not require any parliamentary approval. Both are clearly designed to reduce GP Medicare income and force them to decrease bulk billing rates and charge more and larger co-payments.

The third part of the revamped budget measures is more subtle, and although already implemented as of 1 January 2015, it can be disallowed by the Senate when it next sits. It requires that a Level B consultation be a minimum of 10 minutes duration (this change affects consultations with all patients including pensioners and health care card holders). Currently the difference between  a Level A and Level B consultations is worded as to the complexity of the content, with a Level B being less than 20 minutes but with no other time limits specified. (Level B $37.05 vs. Level A $16.95).

The stated aim of the policy is to reduce 6 minute or ‘turnstile’ medicine, whereby patients are given inadequate time for the service they require, rushed out of the consultation with a pat on the head and an unnecessary blood test,  x-ray , or prescription rather than the listening, questioning, and getting to the bottom of the problem that should occur. The corporatisation of some GP practices is likely to contribute significantly to this but neither of the major political parties have previously done anything to address the problems of corporatisation.

The change will be difficult to enforce as the only access the Government has as to how GPs categorise their visits is to look at aggregate data on the number of visits over time and, from that data, to identify GPs who are well outside the average and then to investigate them and look at their records (the task of the Professional Services Review). This picks up a very small number of GPs every year who appear to be overclaiming by claiming more Level A, B or C consultations over time than would seem possible, or sometimes not even seeing patients and putting in a claim.

Thus the likelihood that this change will have as much impact as the Government suggests remains unknown (no modelling, but what’s new?).  Superficial success of the change should be easily measured by noting an increase in Level A and decrease in Level B consultations. The net effect of that will be a decrease in Medicare income to GPs. Whilst this might primarily affect just the GPs who are practising poor quality ‘turnstile’ or 6 minute medicine, it may also have a significant impact on the Medicare income of GPs providing high quality service who feel that a 6 or 9 minute consultation is worth a Level B rebate, particularly as the next 3 consultations might each take 19 minutes.

An acceptable alternative to this policy would be to reinvest any savings from the proposal back into primary health care services, making it budget neutral. Thus, a corresponding increase in the payment for Level B or C consultations would send a much clearer message to GPs that the true intent of this change is to reduce inadequate short consultation. An increase in funding for other services managed by a GP practice, for example practice nurses, would send a similar but less direct message.

But as currently suggested the effect of this move will be to decrease the Medicare income of GPs. This is the unstated primary aim of the policy. It shares this aim with the freezing of the rebate until 2018 and the $5 reduction in the Medicare rebate. The secondary aim of all three policies is to force GPs to reduce or abandon bulk billing and charge more and/or larger co-payments. Although the rebate for pensioners and health care card holders is left untouched by the $5 rebate cut, the other two changes will mean that the Medicare income from all patients will be reduced.

This proposal is not about reducing 6 minute medicine, despite what the Federal Government has claimed. It is aimed at decreasing bulk billing and increasing copayments.

Doctors’ groups like the AMA may reasonably be criticised for being concerned primarily about doctors’ incomes. The reality for patients however is that their GP is faced with either charging co-payments and decreasing bulk billing or accepting a salary cut. Most will not accept a salary cut, any more than any other small business or professional group would.

Combined with the introduction of private health insurance into primary health care as the Federal Government has already done, the ultimate intent is to destroy Medicare as a system of public health insurance with universal access and replace it with an Americanised system of two tiered access with Medicare providing a dismal safety net.

Related Posts

Comments 13

  1. Leo Campbell says:

    When the Senate and polls tell the LNP that a policy is not acceptable, they do the honourable thing and try to pass that policy it a more subtle way.

    It’s so good to have a consultative government!

  2. graybul says:

    Should the Abbott Govt pull off these changes to Medicare it is entirely possible it will be Abbott’s signature policy of his first term Government. Dismantling of the Nation’s notion of a fair-go, universal health system will indeed secure a major ideological plank being inserted into the eye of the less well-off Australian public.

    The only viable defence against such bastardry rests with National print media truly living up to their professional journalistic standards. I hold my breath . . .

  3. bushby jane says:

    Wouldn’t Abbott squark if he was a GP, he was not happy about his reduced salary when he went into Opposition in 2007. Apart from the obvious aim of this govt to Americanize our health system, why would anyone want to reduce GP’s earnings, they seem to work harder and longer hours than anyone.

  4. kelanne says:

    The change to Level A/B consultations will have effects that this government hasn’t foreseen or if it has it doesn’t care so long as they save money. My husband is a GP who works only in aged care; he employs a nurse practitioner to maximise the effectiveness of his practice. We have spent from Boxing Day to New Year’s Day working out how he can work his practice from January 19 when these changes take effect without leaving patients without a doctor. Unfortunately, it will not be possible for him to continue seeing about 90 people in 3 facilities if he is to spend the minimum 10 minutes with most to receive the current rebate. This will still result in a 1/3 pay cut, but fortunately our children are now adults so we can absorb that. He is now officially semi-retired.

  5. old greybeard says:

    One way they could cut the costs would be by letting people pay a small fee for renewals of long running prescriptions. This used to be available for 5 dollars at my local medical centre. I take two medications, and have for over 20 years, that are likely to be lifelong and they work just fine, but every two scripts, back to the doc.

  6. kelanne says:

    Not sure if the above was entirely clear – the decision is to cut his patient load by 90 who reside in 3 facilities, leaving him able to see about 260 in 4 others and comply with the new rules – obviously he doesn’t see every one of them every week.

  7. zut alors says:

    Abbott is a wrecker, he has no constructive policies despite the risible claim he wishes to be known as the ‘infrastructure PM’.

    His expertise is in wrecking & dismantling. At an incalculable cost to our nation.

  8. David Hand says:

    “Destroy Medicare!!!”
    “Introduce an American two-tier system!!!”

    So much hyperventilation over a lousy five bucks.

    The alternative is more money and when that runs out, yet more money. The medical profession is compulsively unable to have a value for money conversation about any health spending whatsoever.

    Where’s the money coming from? Our grandchildren of course.

  9. drsmithy says:

    So much hyperventilation over a lousy five bucks.

    No, about a completely transparent attempt to begin disassembling publicly funded healthcare which, for some unfathomable reason, the right hate with a special passion.

    The co-payment proposal doesn’t even have a coherent argument behind it, let alone any evidence.

    The alternative is more money and when that runs out, yet more money. The medical profession is compulsively unable to have a value for money conversation about any health spending whatsoever.

    Australia has one of the most cost-effective healthcare systems in the world.

    Where’s the money coming from? Our grandchildren of course.

    No, us, right now, of course.

  10. AR says:

    DrS – Nice dissection of OneHand fapping.
    I still suspect that it is not a soft machine but a poorly programmed Turin word generator with a limited range of RWNJ responses to any given topic.
    Shame that we can’t even manage our own Strayan ratbags – the script is pure teabagger, almost cut’n’paste from mad Mark brainStain’s foamings re Obamacare.

  11. Norman Hanscombe says:

    Melissa, what’s far more interesting is how so many posters seem oblivious to the fact that Labor understood co-payments was one of the needed actions to deal with the unsupportable increases developing in the Health System, and set out [until we realised it wasn’t a popular step] to implement it.

  12. drsmithy says:

    Melissa, what’s far more interesting is how so many posters seem oblivious to the fact that Labor understood co-payments was one of the needed actions to deal with the unsupportable increases developing in the Health System, and set out [until we realised it wasn’t a popular step] to implement it.

    What are these “unsupportable increases developing in the Health System” ?

    If they are costs, why can’t they be covered through general taxation, or an increase to the Medicare Levy ?

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