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Issue #1737      June 29, 2016

Driving Medicare to privatisation

The new head of the Australian Medical Association (AMA) has come out swinging in the middle of an election campaign defending the PM’s unbelievable statement that “we are not privatising Medicare”. The treachery of the AMA towards bulk billing GPs knows no bounds, especially as the immediate past president of the AMA Brian Owler had been attacking the policy of an extended Medicare rebate freeze and urging doctors to actively campaign against the Turnbull government.

Public health is union business. (Photo: Anna Pha)

The health policy of the Coalition (which is clearly one of many policies inherited from its predecessor Tony Abbott) is cleverly designed to force bulk-billing GPs to privately bill anyone deemed non-concessional. This is because the current rebate – frozen since 2012, and probably indefinitely at $36 – is not sufficient to cover costs for the doctor. In fact the AMA’s recommended fee for a Level B consultation (less than 15 minutes) is $76, almost double what bulk billing GPs currently receive.

While the PM can make claims that he has not privatised Medicare, essentially he is doing so. The only difference is that he is forcing GPs to do the dirty work and take the wrap. Make no mistake: the end of universal Bulk Billing is the very beginning of privatising Medicare. Legislation is already in place that undermines Medicare bulk billing’s competitive edge where doctors are now allowed to swipe credit cards together with the Medicare card in their medical offices.

While this has been marketed as increased convenience for the patient, it’s merely another step in the direction of a user-pays system of health in this country.

What’s worse is that this inevitable scenario is far graver than the initial $7 co-payment initiative of the 2015 budget that we all feared. Once GPs stop bulk billing, they will be more likely to charge the AMA rate of $76 – so the co-payment will be the difference between the AMA rate and the Medicare rebate which is $40.

Patients will live in fear, hoping that their consultation is not thorough or lengthy because as the minutes tick away so will the dollars like a taxi meter. If the consultation goes to 15 minutes then the AMA fee is $140. An after-hours consultation at the GP’s office is recommended by the AMA at $450. Add to this any additional pathology and radiology tests and patients will be forced to hand over the credit card as well as the Medicare card on multiple occasions prior to paying again at the pharmacy.

For years now a Medicare rebate freeze and lack of GP reform has seen bulk billing GPs become increasingly dependent on fast throughput and third party payments from pathology, radiology or other rentals – especially following the deregulation of blood pathology collection centre licences five years ago.

By withdrawing the pathology bulk-billing incentive (which sustained the high rentals pathology could pay GPs ), together with an indefinite Medicare rebate freeze – for another four years (but probably permanent) – Turnbull is effectively pulling the rug out from under the current high bulk billing rate of over 80 percent.

It does not take a genius to figure out that the only other source of funding available to GPs – other than direct billing their patients – is from the Private Health Insurance industry; trials have already begun in some Queensland GP clinics.

Let’s be clear, by privatisation we’re not talking about selling Medicare to the private sector, although the PM seems anxious to impose such a definition.

The freeze on the Medicare rebate and the cuts to pathology bulk-billing incentives will only worsen an already critical funding issue for bulk-billing GPs.

The only alternative for GPs will be to push patients through sicker and faster, with an increasing pressure to accept third party payments from the private health insurance industry.

We can already see indicators of the negative impact on health care with the changes to date. When you consider that the rate of vaccination in the elderly has dropped to as low as 30 percent – you know something is wrong. Either the elderly are not going to the doctor, which is unlikely, or GPs are not able to give these patients the time they need.

It is as clear as daylight that the Medicare system needs an injection of funds and support for improved patient outcomes – more bang for your buck and to reduce pressure on public hospitals. Whether his comes from the government, direct payment from patients or Private Health Insurance – this will ultimately decide whether Medicare is being privatised.

In the interim, any party supporting an indefinite freeze on the Medicare rebate on the one hand while taking away the Bulk Billing incentives for pathology and radiology with the other, is definitely pushing Medicare towards privatisation.

Next article – Statement: Culture of sexism must be tackled

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