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Issue #1644      June 25, 2014

Health care for the privileged

There is almost universal opposition to the Coalition government’s proposed $7 co-payment for GP visits and related measures. Health professionals have come out strongly against these measures. The public are stunned by the biting inequalities and unfairness of the changes. Bit by bit the full consequences of the co-payment package are being understood. And it is not just low income patients who will be hit, but bulkbilling doctors, pathologists and radiologists. Patients could face hundreds of dollars in out-of-pocket costs.

Photo: Anna Pha

It is widely recognised that many patients would put off seeking a diagnosis or treatment because of the $7 co-payment for GP visits or tests. In particular, low income patients with chronic conditions that require frequent visits to a doctor or weekly blood tests simply would not be able to afford to see their GP or have their blood tested.

Concession card-holders and children under 16 are hit with the $7 charge for the first 10 services in a year and then no fee. But they have to reach that $70 first, which might for Health Minister Peter Dutton be a lunch in a restaurant, but is impossible for many on low incomes. This situation is set to worsen if unemployment benefits and other payments are reduced.

Delays in diagnosis or treatment are likely to result in more serious conditions, even death, as well as the need for far more expensive treatment at a later date.

Punishing the disadvantaged

Doctors who wish to continue bulkbilling their patients will be penalised by a $5 cut in their Medicare rebate and the loss of an extra $2 they would receive when charging a $7 co-payment. If the patient who is bulk billed is a concession-card holder, the doctor also loses the present $6.80 incentive payment. The original aim of this incentive payment was to encourage doctors to bulkbill the most disadvantaged patients.

The present incentive to bulkbill the disadvantaged is being turned on its head; doctors will lose $11.80 ($6.80 + $5) if they don’t charge the $7. They also miss out on the extra $2.

The $11.80 is a huge chunk out of the present $36 paid to bulkbilling doctors. No wonder there are reports of bulkbilling doctors in the poorer suburbs considering retirement if this gets through Parliament.

“Pensioners, the elderly the sick and the poor have all been targeted – but also a clear signal is being given to GPs to stop bulkbilling or they will be bankrupted,” Dr Con Costa, president of the Doctor’s Reform Society said.

“If GPs stop bulkbilling, the cost to see a GP will be around $72 (the Australian Medical Association rate) and thus the co-payment will then be $36 for the GP and $36+ for the blood test and $36+ for the X-ray. Health costs will quickly become out of the reach of many Australians.”

Radiologists and pathologists are also anxious about their futures and the consequences for patients who delay diagnosis of conditions. Delaying tests for a small lump on the breast or few drops of blood from the bowels, could be fatal.

The present 10 percent bulkbilling incentive payment for imaging will be axed from July 2015 if the budget measures are passed. It will be replaced by a low gap incentive when pensioners and children under 16 are charged $7. The new incentive is to stop bulkbilling the most needy.

At the same time the Medicare rebate will be slashed from 95 to 85 percent of the scheduled fee and then by another $5 which can be recouped from the $7 co-payment. Radiologists say that charging a $7 fee will not make up for the loss of 10 percent in their Medicare rebate, that they will have to charge a much higher fee or go out of business.

Diagnostic Imaging Association CEO Pattie Beerens warned that patients face the prospect of paying $90 upfront for an X-ray, $380 for a CAT scan or $1,000 for a PET scan. And when they have received their refund from Medicare, they would be out of pocket by much more than $7 – possibly as much as $160.

Associate Professor Roger Davies from Adelaide Imaging, which is one of the few radiology services that still bulkbills in South Australia, said the changes would make that unviable.

“In the last nine years, there has been no increase in real dollar terms in the medical imaging schedule while at the same time rent, electricity, wages etc have increased substantially – it would render most if not all bulkbilling practices unviable,” Dr Davies said.

The proposed co-payment and changes to Medicare rebates spell the end of bulkbilling. They undermine preventative health care and continuity of care in particular.

Their aim is to reduce the number of visits and tests, not on any medical basis, not because of overuse, but purely in readiness for the privatisation of Medicare. Consistent with this government’s anti-working class outlook, those being discouraged or prevented from accessing care are the most disadvantaged. The rich will not be affected.

There is scope for substantial reform to improve and extend Medicare. This includes the direct employment of doctors on salaries and universal bulkbilling. Then doctors would not have to churn patients through their practice to make ends meet. There would no financial gain in over-testing or servicing. The patient’s welfare would take primary place and patients, with no fee at point of delivery, could seek out the care they required.

Next article – Mining writ lodged

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