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Issue #1715      January 20, 2016


Return of the co-payment

In the dying days of 2015, Health Minister Sussan Ley announced cuts to Medicare rebates paid to bulk billing providers of pathology and diagnostic imaging services. Consistent with other government cuts, the full brunt will be born by women, Indigenous Australians and the most vulnerable and disadvantaged in the community. As far as the Turnbull government is concerned, if a diabetic cannot afford a blood test or a pregnant woman an ultrasound, then he or she can go without. These are just the latest in a series of cuts that are undermining Medicare and the public hospital system.

Doctors’ Reform Society vice president Tim Woodruff, described the cuts as “a kick in the guts” to those who struggle daily and weekly with their medical bills. Pathology tests and imaging are vital to primary and preventative health care. They are used for diagnosis and the monitoring of a vast range of conditions. They keep people out of hospital, assist in preventing complications and save lives. Whether it is testing for hepatitis C, a pap smear, monitoring cancer treatment or a urine test for an infection, delaying or not having a test could have serious consequences.

The cuts are to incentive payments (over and above the standard rebate) introduced by the former Labor government to encourage bulk billing. They worked. The rate of bulk billing for pathology increased from 87 to 92 percent and from 67 to 85 percent for diagnostic imaging.

The cuts to the pathology rebate paid to the provider apply to all patients, including concession card-holders. They range from $1.40-$4.00. The diagnostic imaging cuts are far larger and could see patients paying hundreds of dollars for multiple services. The dollar amounts may not sound a lot to some people but if tests are weekly the amount could become quite considerable. To a pensioner and others battling to make ends meet, every dollar counts. If the government gets away with these cuts, more will follow. The aim is for people to fund their own health costs.

Instead of absorbing the reduction and continuing to bulk bill, pathology companies have indicated they will pass on the costs to patients. That spells the end of bulk billing for pathology. They must charge a fee and the patient claim a refund (rebate) from Medicare. There will be a gap between the fee and the refund – a co-payment. There is no guarantee that the co-payment will not be larger than the cut by the government. A co-payment will deny many patients access to necessary tests.

The Coalition government is determined to abolish bulk billing. It was forced by strong public opposition to withdraw previous attempts to introduce a co-payment. GPs and specialists now face a four-year freeze of Medicare rebates after several decades of below CPI increases. This is to force doctors to abandon bulk billing for economic reasons.

The private health insurance, private hospital and other corporate operators are driving the government’s privatisation agenda – a highly profitable one (for them) – based on the US model.

Older Australians may recall pre-Medicare days. As recently as the early 1970s, it was not uncommon for people to die because they could not afford to buy prescribed medicines, visit a GP, see a specialist or pay hospital bills. The non-payment of medical bills was one of the major reasons for personal bankruptcies and imprisonment of debtors. That was in Australia then, and that is where the Turnbull Coalition government is taking Australia now.

Those truly bleak years came to an end with the introduction of a national health insurance scheme called Medibank (later renamed Medicare by the Hawke Labor government) on July 1, 1975 by the Whitlam Labor government. The aim was to provide universal coverage, equitable distribution of costs, and a scheme that was administratively simple to manage. It was funded centrally from government revenue, with the availability of bulk billing for out of hospital services and free treatment in public hospitals. The one shortcoming was the omission of dental services.

Health care was no longer a privilege but a right. The Whitlam government also provided tied grants to the states for Aboriginal health initiatives and funding for emerging Aboriginal community-controlled health services. It’s time to restore Medicare and extend its coverage.

Next article – Joan Williams an outstanding Communist

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