The Australian Society of Ophthalmologists is claiming that its deal with the Feds over cuts to the cataract surgery rebate is a victory for patients.
Croakey is particularly taken by the line in their media statement that says: “The
 ASO 
has 
always
 argued 
that
 the
 interests 
of
 patients
 should 
be
 the 
primary 
consideration
”.
But of course! (Naturally, Croakey does believe everything that she reads.)
The Consumers Health Forum, however, has quite a different take on the whole issue, arguing that the ophthalmologists and the medical colleges more broadly may ultimately prove to be the losers of what has been “an exploitative industrial campaign”.
Executive director Carol Bennett, who has previously written for Croakey on this issue, writes:
“Ophthalmologists are claiming victory over the Health Minister with the compromise agreement reached last week on cataract rebates.
At best, these victory claims are industrial spin, and at worse, they perpetuate the same misrepresentation that has underpinned the ophthalmologists’ entire industrial campaign against the Australian government, health consumers and all Australian taxpayers.
I do not know of many unionists who would see a 12.5% reduction in subsidies for their work as a good outcome.
Ophthalmologists are also faced with a major review of ophthalmology rebates and entitlements under Medicare.
Make no mistake – for health consumers, this review will be an opportunity to seriously question the rebates ophthalmologists are able to command for 15 minute procedures and associated follow up consultations. It is an opportunity health consumer groups will not miss after seeing vulnerable seniors paraded in the media to depict the government as cruel when it is the ophthalmologists who determine how much seniors pay for their cataract procedures.
Perhaps more importantly, ophthalmologists have now lost credibility by adopting an exploitative industrial campaign to what the evidence from Australia and overseas tell us was a justified government decision. Even the seniors’ organisations used in the media battles appear to have dropped their support for the ophthalmologists’ campaign.
It appears as though the AMA may also have lost some credibility through its public backing of what many other health professionals see as a self serving Royal College seeking to maintain their exceptional incomes at the expense of Australian taxpayers and health consumers.
It is these kinds of ego and income driven campaigns by self serving specialist health professionals that may ultimately challenge the merit of the closed shop Royal College system.
During the campaign, the government must have seriously considered recruiting ophthalmologists from overseas who were prepared to work for a measly few hundred thousand dollars a year. Needless to say, actual figures on how much Australian ophthalmologists currently earn remain completely unattainable, although the whole campaign was clearly about their incomes.
Medicare is unsustainable if Australian taxpayers continue to have to fund relatively quick and straight forward procedures at a level that generates thousands of dollars daily in costs courtesy of over-generous Medicare rebates.
We can only hope the negative attention generated by the ophthalmologist’s campaign will bring some measure of reason to the table as all Medicare rebates are reviewed over the next two years.”
An honest look at costs of equipment and consumables would be good for us all. Mohamed Khadra, in his book ‘The Patient’, alluded briefly to expensive fads in urological practice. Not trying to say modern lens replacement is a fad, because I am very happy with mine, at around $1K out-of-pocket. I’m just a little surprised and disappointed that the Minister couldn’t have gone to the negotiating table with a spreadsheet or two, to strike a bargain. Then, again, if the Minister was relying on DoHA – the massive, bloated, eat-their-firstborn DoHA – for actual data delivered in a timely manner …
On that note, did you read Alan Rosen in The Australian yesterday?
“Stakeholder consultation held during the formulation of these documents [mental health plans] was, at best, gestural and erratic. It was often ignored.”
There is very little evidence that the Feds taking over any aspect of health will improve anything. In fact most of the evidence suggests the opposite. I’m guessing if Ruddy went to a referendum this (an absurd use of a ref imo) he’d lose big time.
This whole thing has been handled amateurishly. It is as if we put Abbott in charge of sex education and gender sensitivity curriculum.
Sure the cataract rebate is now too high given increased skills and throughput. But the winding back of the rebate should have stared years ago. Ophthalmologists, for all their high income, are entitled to plan and, say, build a new clinic based on some reasonable forecast of income for the next 5 -10 years.
The Feds should have been signaling way back-“its in for a hefty reduction boys” – have a bit of a stoush then say “ok its reducing 20% a year” for 3 years.
Then we would have had a saving already of 20% a year and a new lower rebate with plenty of warning for the ophthalmologists. Standard good business practice, standard IR, standard good politics.
Instead what do we have – a bloody schemozzle worthy of Wilson Tuckey talking to Aboriginals about climate change.
Hardly inspires confidence in Canberra a “taking over” health. (I won’t mention Mersey Hospital in Tassie – still gobbling up millions)
Let me quote myself from an earlier comment:
One problem is that cataracts are a pretty fundamental health benefit – its relatively cheap, even fully privately, around $3,000 all up, even less in an efficient public hospital and is pretty bloody spectacular procedure. People come in blind and within two hours or so go back home and the next day they can see with little if any pain.
Cataract procedures enable people to avoid nursing home admissions, live active lives, read, cook, recognise loved ones and prevent falls. Falls are one of the biggest causes of A&E presentations, and by preventing falls we prevent hip operations etc.
The waiting lists for cataracts is huge anywhere in Australia – not necessarily the same overseas.
We could train up technicians to do them under supervision, some other countries do with success, but we haven’t made any moves to do so.
The College, and others, have neglected to point out that the halving of the rebate, from $800 to $400, is only the payment for the actual procedure, and does not stop the fees for other professionals at the procedure or consultations prior on rooms.
Still @$400 with 7 to 11 procedures per session = $2,800 to $4,700 a half day – it isn’t going to force opthamologists onto the street just yet.
No winners have emerged from the battle between the eye surgeons and the Government. The patients have been used as pawns by both sides. The eye surgeons have defended their incomes. The Government has tried to reduce their incomes. Ultmatley however, the battle between the two reflects the inherent flaw in how the surgeons are paid. Fee for service payments are very difficult to control. With such payments doctors can simply charge as they wish and use the size of the gap to pressure the Government to pay more by getting patients to complain.
The alternative funding model is salaried service. In public hospitals that’s what happens but the Government refuses to consider this as a way of controlling costs. Instead it increases support for the growing private hospital industry (through the PHI rebate) and fails to adequately fund States to run public hospitals.
This type of silly battle is being played out in general practice where a major corporate provider which established itself as a successfull bulk billing service, has now opted out of bulk billing. Patients can either pay extra and complain to Government who will do nothing, or they forgo the service.
This reliance on fee for service with copayments simply sets the scene for both doctors and Government to use the patients’ struggle to afford services as the weapon to bash each other.
It is a sad reflection on both doctors and the Government that neither is willing to put the interests of patients first. Until there is fundamental funding reform, such battles between doctors and Government will continue. Patients are pawns in their game.