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Issue #1646      July, 9, 2014

Medicare

For-profits cash in on co-payment

The concept of a co-payment and abolition of bulk billing for medical services has been on the Coalition’s agenda for some time. It is part of the drive for the complete privatisation of Medicare and Americanisation of Australia’s health care system. Woolworths and a new outfit called Doctus have not waited for the actual introduction of a co-payment to make their moves to pick up the most disadvantaged who cannot afford a co-payment. Such schemes have the potential to lay the foundations for a second class, second tier of health services for the poor and those on lower incomes.

Part of the Bust the Budget rally in Sydney on Sunday. (Photo: Tom Pearson)

The Woolworths scheme which began trials last October in selected Queensland and NSW stores, offers free health checks for customers. The company claims it uses qualified nurses to carry out its supermarket-aisle tests for cholesterol and blood pressure. The tests and discussion of results are literally done in the aisle – no privacy.

There is controversy around the qualifications of those doing the medical check-ups. The media has pointed to XPO Brands ads (www.seek.com.au), but Woolworths has now denied that they are their ads or that they are employing pharmacy students or graduates. There was a pharmacy job advertisement which has been removed from the seek.com.au website but the one for nurses remains at the time of writing. XPO Brands website does boast Woolies as one of its clients but it is impossible to obtain further information as its website is under reconstruction.

One advert says an unnamed employer is looking for “final year pharmacy students, graduate pharmacists and entry level nurses” to conduct checks such as blood pressure and cholesterol, and “engage in general health discussions”.

The ad also describes the person they are seeking to be “passionate about complementary health and general wellbeing” and be “a real people person, and is happy to talk with shoppers passing by.” But Woolworths denies any link. It has not revealed where or how it advertised for the positions.

Woolworths also says the staff providing health checks do not offer medical or product advice. It is “just another thing we can do for our customers”. If any customers have readings outside a normal range, they will be directed to a doctor or pharmacist for medical advice.

The meat or complementary medicines aisles are not the place for medical checks.

Deregulation

Woolworths has been fighting for some years for deregulation of the pharmaceutical industry so that it can dispense prescriptions in-store. If the free check-ups become popular, especially for people unable to afford a GP, it could strengthen the hand of the giant retailer for deregulation. That would spell the end of many local pharmacies, unable to compete.

The pharmacists have so far thwarted attempts by the major supermarkets to “increase competition” and enter the pharmacy market. Their entry would spell the end of local pharmacies and result in monopoly control of the industry by two or three major retailers.

Are major retailers who rely on tobacco, alcohol, soft drink, sweet biscuits and other products loaded with sugar, fat and salt, really going to give the sort of advice required and hurt their profits? Of course it could be used to promote “weight reducing products”, recipe books, etc.

Supermarket medicine could mislead shoppers into thinking they could get their medical advice and products from a supermarket. It could replace or delay patients seeing their doctor.

The core of the Australian health care system is the GP who has access to the patient’s history, knows the patient, knows what medications they are on, carries out the initial examinations, monitors patients and can prescribe appropriately or refer to other professionals. The GP is central to preventative and primary health care.

There are huge dangers involved in the supermarket scheme, including the risk that people will think they do not have to see their doctor, that the nurse in the supermarket is sufficient. Nothing could be further from the truth.

Online doctors

Another dangerous development is on-line doctors or self-diagnosis with the supply of scripts without a physical examination by a qualified professional or the patient’s history. There is a risk that in the future, if a co-payment is introduced then people who cannot afford to see a GP will go online. They may have even been told they have high blood pressure or high cholesterol in a supermarket health check.

“The online doctor means no co-payments required.” That is how Doctus promotes itself on its website. “A novel concept from an Australian GP, Doctus wants to become Australia’s premier online doctor, providing advice on contraception, digestion, erectile dysfunction, osteoporosis and cholesterol.”

It also offers prescriptions and supply of medications for these conditions as well as for asthma, emphysema, blood pressure, gout, inflammation, chlamydia, hayfever and pain relief.

“Australian-based online medical company, Doctus, has been launched to offer a convenient and cost-effective way for people to access health advice on simple, low-risk medical conditions,” according to their onsite marketing.

How anyone could describe asthma, emphysema, blood pressure, high cholesterol, etc, as “simple, low-risk medical conditions” is beyond belief. How they could be monitored without a physical examination by their GP or other medical practitioner is also beyond belief.

As their promo suggests, they seem to be cashing in on the co-payment. There is so much confusion about the co-payment – some GPs are reporting a fall in the number of consultations as patients who cannot afford it believe it has already been introduced.

“Doctus saves our patients money – no co-payment, no gap, no petrol, no parking costs, and no time off work. At the same time, every Doctus consultation saves the healthcare system money because we are not Medicare eligible,” said Dr. Beckwith, who is the Medical Director at Doctus.

Doctus charges patients a flat $24.95 for each online “consultation” enabling patients to avoid the proposed $7 co-payment! They are not Medicare eligible – no refund from Medicare. They clearly realise that the conditions surrounding the proposed $7 co-payment will result in many doctors charging much more than that. They also know that the co-payment would not stop at $7 once established.

Doctus prescribes PBS medications and offers the choice of sending the medications or a script through its pharmacy partner.

The Australian registered doctors as well as their pharmaceutical partner are not named on the website. There is no phone number or email address on the site. The only way in for more information involves supplying personal details, including your Medicare number.

This online “consultation” and dispensing of medications without a physical examination by a qualified health professional is potentially even more dangerous than supermarket medicine.

When these developments are looked at in the wider context, they represent one facet of the Americanisation of Australia’s health system, its privatisation and deregulation. The rich will continue to have access to the highest quality services, but the most disadvantaged will increasingly rely on second class health services – a two tier system based on wealth, not need.

That is why it is so important to defend and strengthen Medicare and the public health system, in particular bulk billing and universal access. PBS charges should be reduced and medications free for pensioners, the unemployed and others on low incomes.

At the same time there is an urgent need to strengthen health regulations so that medical advice and care are only carried out by qualified professionals.

Next article – Vic Williams – A tribute

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