[The Conversation]

Need a bulk-billing GP? Why throwing more money at Medicare isn’t the answer​

Last financial year, the Australian government spent almost A$29 billion on Medicare. Most was spent on primary care – a patient’s usual first contact with the health system when sick or injured, such as GP, allied health and diagnostic services. Every year, this spending increases.

Yet, many patients are paying more to see their GP, some cannot afford care and emergency departments are overcrowded with patients who could be treated by a GP.

Last week, the Strengthening Medicare Taskforce released its much-anticipated report on how to improve the primary health-care system. The report provided broad-brush recommendations mostly focused on delivering patient-centred care, supported by better health data and information technology.

Medicare is set for an overhaul​

An important subtext of the report is to overhaul Medicare, Australia’s national public health insurance scheme. Medicare pays a proportion of costs for every Australian that receives subsidised primary care services.

There has not been a major reform to Medicare since its introduction in 1984. If successful, reforming Medicare will be the greatest change to primary care in decades.

It will help governments usher in long sought-after integrated care pathways – with patients cared for by a team of health professionals that better meet their needs, especially those with chronic conditions.

But let’s not celebrate just yet. Major funding reform is not a given. Health Minister Mark Butler concedes there’s a long road ahead, telling the ABC this week that we’re not going to fix Medicare in one budget.

A battle looms ahead​

A potential battle between health providers and the Australian government looms on the horizon.

That’s because the most ferocious national health-care debates are often about how GPs should get paid. Medicare needs to pay providers based on patient health outcomes. Some providers, like GPs, may be worse off financially if they perform poorly.

That will be a hard pill to swallow. Pressure from strong lobby groups that represent primary care providers may water down reform. That runs the risk of worsening patient outcomes compared to what could be achieved.

A bulk-billing GP has become harder to find. So we need widespread reform to improve access to quality, value-for-money care. Shuang Li/Shutterstock​

How did we get here?​

Successive governments over the past 30 years have tried to tighten the reins on runaway Medicare spending. Most attempts have failed.

The Hawke government introduced a $2.50 co-payment in 1991, which GPs could charge to non-concessional patients when they received bulk-billed services. In 1992, Keating abolished this when he became prime minister. The Abbott government tried to introduce a $7 co-payment in 2014, but dumped the budget announcement against fierce community opposition in 2015.

The Abbott government did manage to freeze the annual increase in Medicare Benefits Schedule fees (fees doctors are paid to perform certain subsidised services) between 2015 and 2020. This led to fierce opposition from primary care providers.

The Australian Medical Association (AMA) suggested this would force GPs to increase co-payments and reduce bulk billing to maintain their business returns.

While co-payments have increased, annual bulk billing rates have only declined in the past year.

Bulk-billing rates have only declined in the past year. Productivity Commission​

How should we fund primary care?​

It’s clear Medicare is no longer “fit for purpose”. Some patients avoid care because they cannot afford it. Patients with higher incomes, and patients living in more affluent areas, often pay more if not bulk billed, but can access primary care easier.

Increasing Medicare rebates, as the AMA proposes will not fix those problems.

A financial incentive for providers to deliver care of little value to patients will remain. Providers will still be paid regardless of the health outcomes they achieve, and care misaligned with best practice will continue to be funded.

We need a radical rethink​

A complete rethink of Medicare is required to support the vision presented in the Strengthening Medicare Taskforce report. The Australian government must start now, as the health-care system adjusts to a post-pandemic world.

Reforming Medicare cannot happen in isolation. It must sit within a cohesive national vision and a ten-year plan for health-care funding reform.

Medicare reform should be accompanied by public hospital funding, private health insurance and co-payment reform – the three other major funding sources for health care – to ensure Medicare does not remain siloed while governments seek to integrate care.

An independent national health payment authority should be developed and tasked with designing and coordinating the implementation of funding reform. This would work closely with state and federal governments, primary health networks and local health networks.

It would also clarify who is responsible for which elements of funding reform and reduce the potential for duplicating efforts across states.

We need to do things differently​

Australia could benefit from payment models being explored internationally. These include funding a pathway of multiple, integrated health providers – let’s say a GP working with a physio and nurse practitioner – to provide cheaper care that improves outcomes.

In such “value-based” payment models, there’s an incentive to improve health outcomes and reduce costs. Providers share the cost savings compared to what it would have cost using the current Medicare Benefits Schedule.

If we’re to reform Medicare towards paying for value, then we’ll need much more data on patient health outcomes, other factors that impact health outcomes but are outside the control of providers (such as socioeconomic factors), and data on the cost of delivering care.

That requires reforming the way data is collected and shared, and investment in better information technology infrastructure.

The government will need to work closely with providers to ensure they are equipped to manage the transition towards value-based payment models. It will also need to help providers connect and work together to coordinate different types of care.


This article was first published on The Conversation, and was written by Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie University

 

[Glo72]

The doctors surgery that I visit recently stopped bulk billing patients under the age of 60. My two daughters and a son-in-law go there too and all of them now have to have at least $69 cash or card to pay and then claim from Medicare. They are out of pocket by about $29. Medicare is stuffed and needs fixing urgently. There are a lot of people who won’t go to the doctor because they don’t have the money upfront.

 

[oilsfromoz]

I'm well over 60, on the Pension, and now my surgery has ceased bulk-billing, I'm out of pocket by $25 each visit. As I currently have a treatment that requires weekly visits, $25 per week is a bitter pill to swallow and so I now have to swallow less or cheaper food.

 

[Lizzie1149]

Whilst ever you have a system based on sick care, not health care, and food guidelines designed by bureaucrats who have no idea and/or are paid by vested interests to push the highly processed food by giving it 5 stars against real food that often gets 2 stars we will always have a problem. Medical services and pharmaceutical services have become a huge money maker so they will fight tooth and nail to keep us sick and seeing doctors, dieticians and buying pills and potions. This ends up bankrupting the people and the country. Kids are being taught these days that it's fine to eat whatever, whenever. They eat constantly and the poor diabetics are told just eat what you want and cover it with your medication then wonder why they end up with amputated feet and legs and other nasty stuff wrong with them. All about the money, nothing about the care and nothing in the current dietary guidelines (why do governments have to tell people what to eat and when) is worth following unless you want to get sick

 

[Jest]

Whilst ever you have a system based on sick care, not health care, and food guidelines designed by bureaucrats who have no idea and/or are paid by vested interests to push the highly processed food by giving it 5 stars against real food that often gets 2 stars we will always have a problem. Medical services and pharmaceutical services have become a huge money maker so they will fight tooth and nail to keep us sick and seeing doctors, dieticians and buying pills and potions. This ends up bankrupting the people and the country. Kids are being taught these days that it's fine to eat whatever, whenever. They eat constantly and the poor diabetics are told just eat what you want and cover it with your medication then wonder why they end up with amputated feet and legs and other nasty stuff wrong with them. All about the money, nothing about the care and nothing in the current dietary guidelines (why do governments have to tell people what to eat and when) is worth following unless you want to get sick

i am a diabetic and have been for 38 years. no one has told me to eat what i like. if one does not have the brains to act sensibly with a diagnosis nothing on this earth is going to help them. i guess medicare and the nds??? are there to be rorted? again the word morals, down the gurgler.

 

[Lizzie1149]

i am a diabetic and have been for 38 years. no one has told me to eat what i like. if one does not have the brains to act sensibly with a diagnosis nothing on this earth is going to help them. i guess medicare and the nds??? are there to be rorted? again the word morals, down the gurgler.

Are you type 1 or 2? Type 2s can put their diabetes into remission by cutting out the carbs and rubbish. Type 1s can take less insulin by doing the same. There is ample proof of this but not many are listening and the standard care for diabetics is eat what you like and bolster with your meds. Most doctors and dieticians tell their diabetics they must have a level of at least 6 or 7. And if you go below 5 as a diagnosed diabetic you aren't supposed to drive but the idea is to actually get your blood sugars below 5 with proper diet and less meds and you will not end up with the chronic, degenerative crap they tell you will happen

 

[Ricci]

I have nothing but praise for Medicare and the Medical profession. Four weeks ago I mentioned to my doctor that I had an ulcer in my mouth that wasn't getting better, three weeks ago I had a biopsy on the "ulcer" that two weeks ago came back as cancer. One week ago I saw a surgeon, this week it's a CT scan and a lymph node needle biopsy. Next week it's another consultation with the surgeon with a view to getting it all taken out. All this has been done through Medicare, sure I've had to pay a gap fee at each stage but what price health? It's scary (I have the same type of cancer as John Farnham) but I know I'm in good hands, getting the damned thing out is paramount and speed is of the essence.
On the other hand I am needing an operation on my spine to fix bulging discs, slipped discs and arthritic changes, the first available appointment time is this December!

 

[Penny4]

People are going to the accident/emergency section of public hospitals in lieu of paying GP's now. Yesterday, I was told by a mother that her daughter was hurt at primary school at lunch time. She went in the ambulance to the accident/emergency department at the local public hospital. They had to wait for 8 hrs until she got her head stitched. This wait time will only increase with emergency doctors stretched to the limit.
I blame food manufacturer's advertisements for kids wanting processed foods. Pester power is awful for parents.

 

[myopinion]

Whilst ever you have a system based on sick care, not health care, and food guidelines designed by bureaucrats who have no idea and/or are paid by vested interests to push the highly processed food by giving it 5 stars against real food that often gets 2 stars we will always have a problem. Medical services and pharmaceutical services have become a huge money maker so they will fight tooth and nail to keep us sick and seeing doctors, dieticians and buying pills and potions. This ends up bankrupting the people and the country. Kids are being taught these days that it's fine to eat whatever, whenever. They eat constantly and the poor diabetics are told just eat what you want and cover it with your medication then wonder why they end up with amputated feet and legs and other nasty stuff wrong with them. All about the money, nothing about the care and nothing in the current dietary guidelines (why do governments have to tell people what to eat and when) is worth following unless you want to get sick

I totally agree with these comments and have been saying these things for a while.
I am not a health professional, just a person who has lived quite a while. These are my opinions.
I am of the opinion that very many of our health problems are food related. (except for things like broken legs, and car accidents) Over the years there have been people who claim to cure just about everything with food, like Dr Gerson. There are many more. So let us look at these alternatives and not down grade them because someone else has said that their way is better.

 

[DrivingGirl]

Whilst ever you have a system based on sick care, not health care, and food guidelines designed by bureaucrats who have no idea and/or are paid by vested interests to push the highly processed food by giving it 5 stars against real food that often gets 2 stars we will always have a problem. Medical services and pharmaceutical services have become a huge money maker so they will fight tooth and nail to keep us sick and seeing doctors, dieticians and buying pills and potions. This ends up bankrupting the people and the country. Kids are being taught these days that it's fine to eat whatever, whenever. They eat constantly and the poor diabetics are told just eat what you want and cover it with your medication then wonder why they end up with amputated feet and legs and other nasty stuff wrong with them. All about the money, nothing about the care and nothing in the current dietary guidelines (why do governments have to tell people what to eat and when) is worth following unless you want to get sick

Totally agree, the information is out there but it should be mainstream and money is the reason that it isn’t- again if political campaign funding was banned and we all made up our minds how to vote, based on what each party proposed on their website, imagine the money we’d save as a country.
We might even get some real progress in healthcare!

 

[MindyMac]

Waiting, waiting, waiting for a refund from Medicare. Instead of maybe a couple of weeks it's now a wait of about 6 weeks or more for a claim to be processed and refund issued. I just wish 'all' specialists had access to a Medicare machine that they can scan your Medicare card, enter the medical code and the amount paid so Medicare could refund people. Having to go to limited Centrelink centres a now and then they ask "Have you made an appointment?" ... Like What!!!! .... As if .... Reply: "No." Then they sign you in and you have to wait and the officer expects you to leave with the claim form and come back. And I mean, come back days, weeks, months later. It's taken me over a year to get the strength to drive to the only Centrelink that has Medicare near me. Then, it's a short walk there as well. Unlevel footpath and tree rooted footpath as well. The last thing I need is another fall and the risk of breaking the bones in my left leg. For me, it will mean a total leg amputation. It is what it is, I suppose. I wish I knew how to scan/copy and attach on computer and claim that way, but I don't. Come'On Medicare, provide all medical people with your machine and a guideline for them, even if they work alone with no secretary so they can scan our Medicare card, enter the codes, the amounts and then the paper so it prints off the $Medicare refund. That the refund is done straight away.

 

[NotNats]

Need a bulk-billing GP? Why throwing more money at Medicare isn’t the answer​

Last financial year, the Australian government spent almost A$29 billion on Medicare. Most was spent on primary care – a patient’s usual first contact with the health system when sick or injured, such as GP, allied health and diagnostic services. Every year, this spending increases.

Yet, many patients are paying more to see their GP, some cannot afford care and emergency departments are overcrowded with patients who could be treated by a GP.

Last week, the Strengthening Medicare Taskforce released its much-anticipated report on how to improve the primary health-care system. The report provided broad-brush recommendations mostly focused on delivering patient-centred care, supported by better health data and information technology.

Medicare is set for an overhaul​

An important subtext of the report is to overhaul Medicare, Australia’s national public health insurance scheme. Medicare pays a proportion of costs for every Australian that receives subsidised primary care services.

There has not been a major reform to Medicare since its introduction in 1984. If successful, reforming Medicare will be the greatest change to primary care in decades.

It will help governments usher in long sought-after integrated care pathways – with patients cared for by a team of health professionals that better meet their needs, especially those with chronic conditions.

But let’s not celebrate just yet. Major funding reform is not a given. Health Minister Mark Butler concedes there’s a long road ahead, telling the ABC this week that we’re not going to fix Medicare in one budget.

A battle looms ahead​

A potential battle between health providers and the Australian government looms on the horizon.

That’s because the most ferocious national health-care debates are often about how GPs should get paid. Medicare needs to pay providers based on patient health outcomes. Some providers, like GPs, may be worse off financially if they perform poorly.

That will be a hard pill to swallow. Pressure from strong lobby groups that represent primary care providers may water down reform. That runs the risk of worsening patient outcomes compared to what could be achieved.

View attachment 13843
A bulk-billing GP has become harder to find. So we need widespread reform to improve access to quality, value-for-money care. Shuang Li/Shutterstock​

How did we get here?​

Successive governments over the past 30 years have tried to tighten the reins on runaway Medicare spending. Most attempts have failed.

The Hawke government introduced a $2.50 co-payment in 1991, which GPs could charge to non-concessional patients when they received bulk-billed services. In 1992, Keating abolished this when he became prime minister. The Abbott government tried to introduce a $7 co-payment in 2014, but dumped the budget announcement against fierce community opposition in 2015.

The Abbott government did manage to freeze the annual increase in Medicare Benefits Schedule fees (fees doctors are paid to perform certain subsidised services) between 2015 and 2020. This led to fierce opposition from primary care providers.

The Australian Medical Association (AMA) suggested this would force GPs to increase co-payments and reduce bulk billing to maintain their business returns.

While co-payments have increased, annual bulk billing rates have only declined in the past year.

View attachment 13844
Bulk-billing rates have only declined in the past year. Productivity Commission​

How should we fund primary care?​

It’s clear Medicare is no longer “fit for purpose”. Some patients avoid care because they cannot afford it. Patients with higher incomes, and patients living in more affluent areas, often pay more if not bulk billed, but can access primary care easier.

Increasing Medicare rebates, as the AMA proposes will not fix those problems.

A financial incentive for providers to deliver care of little value to patients will remain. Providers will still be paid regardless of the health outcomes they achieve, and care misaligned with best practice will continue to be funded.

We need a radical rethink​

A complete rethink of Medicare is required to support the vision presented in the Strengthening Medicare Taskforce report. The Australian government must start now, as the health-care system adjusts to a post-pandemic world.

Reforming Medicare cannot happen in isolation. It must sit within a cohesive national vision and a ten-year plan for health-care funding reform.

Medicare reform should be accompanied by public hospital funding, private health insurance and co-payment reform – the three other major funding sources for health care – to ensure Medicare does not remain siloed while governments seek to integrate care.

An independent national health payment authority should be developed and tasked with designing and coordinating the implementation of funding reform. This would work closely with state and federal governments, primary health networks and local health networks.

It would also clarify who is responsible for which elements of funding reform and reduce the potential for duplicating efforts across states.

We need to do things differently​

Australia could benefit from payment models being explored internationally. These include funding a pathway of multiple, integrated health providers – let’s say a GP working with a physio and nurse practitioner – to provide cheaper care that improves outcomes.

In such “value-based” payment models, there’s an incentive to improve health outcomes and reduce costs. Providers share the cost savings compared to what it would have cost using the current Medicare Benefits Schedule.

If we’re to reform Medicare towards paying for value, then we’ll need much more data on patient health outcomes, other factors that impact health outcomes but are outside the control of providers (such as socioeconomic factors), and data on the cost of delivering care.

That requires reforming the way data is collected and shared, and investment in better information technology infrastructure.

The government will need to work closely with providers to ensure they are equipped to manage the transition towards value-based payment models. It will also need to help providers connect and work together to coordinate different types of care.


This article was first published on The Conversation, and was written by Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie University

My grip with Medicare (The Government) is still with how they first set it up in the first place. To me there should have been a kind of a 3-tier type system.

Tier 1. People/Families who are on some type of Government or Veterans Card, or similar type card.

Tier 2. Low to mid income working people/families.

Tier 3. Upper income people/families.

This is how I think it should have looked like back in 1984.

Type 1: Anyone who is on a government or Veterans Card got cover 100% by Medicare through their Health card.

Type 2: People/Families who's combine wage is under a certain amount (something like the ATO Tax Level as a guideline). But this amount must be updated every 3 years to reflexed REAL living costs. This group would get up to 40% to 50% (or could be a bit more) covered by Medicare and the rest either from their own private medical cover, (depending on the level of cover they are on) and the rest out of their own pocket. And this level gets an ATO Tax incentive like we do today for belonging to a private medical cover.

Type 3: This level would be split into two options for medical payment as this level doesn't get anything from Medicare. This level either has some type of private medical cover or no private cover at all. This level would only get a type of ATO Tax incentive for belonging to a highest private medical cover.

1. If they have private medical it would cover up to 100% of the medical bills, depending on the amount they are covered for. Then the rest would be paid out of their own pocket.
2. If they don't have any private cover at all, then they would pay 100% of the bills out of their own pocket. And they would have to pay an extra ATO Medical tax because they don't have private cover.


I still remember back in the late 70's to mid-80's paying into my own private Health Cover and they paid 100% of all my medical bills as I was in the highest cover (transfer straight from my parent’s cover). Now a days I get very confused to what I'm covered for and by whom and how much I would still need to pay out of my own pocket. And yes, before you ask. I'm still in a high medical cover, only dropped down to extra's only in mid 2022 and I could no longer pay for private hospital part, as I'm now on a Government Health card due to the amount of hours I work. Still too young for a pension or retirement, still 4 more years to go.



Thank you for taking the time to read my grip.

 

[Penny4]

My grip with Medicare (The Government) is still with how they first set it up in the first place. To me there should have been a kind of a 3-tier type system.

Tier 1. People/Families who are on some type of Government or Veterans Card, or similar type card.

Tier 2. Low to mid income working people/families.

Tier 3. Upper income people/families.

This is how I think it should have looked like back in 1984.

Type 1: Anyone who is on a government or Veterans Card got cover 100% by Medicare through their Health card.

Type 2: People/Families who's combine wage is under a certain amount (something like the ATO Tax Level as a guideline). But this amount must be updated every 3 years to reflexed REAL living costs. This group would get up to 40% to 50% (or could be a bit more) covered by Medicare and the rest either from their own private medical cover, (depending on the level of cover they are on) and the rest out of their own pocket. And this level gets an ATO Tax incentive like we do today for belonging to a private medical cover.

Type 3: This level would be split into two options for medical payment as this level doesn't get anything from Medicare. This level either has some type of private medical cover or no private cover at all. This level would only get a type of ATO Tax incentive for belonging to a highest private medical cover.

1. If they have private medical it would cover up to 100% of the medical bills, depending on the amount they are covered for. Then the rest would be paid out of their own pocket.
2. If they don't have any private cover at all, then they would pay 100% of the bills out of their own pocket. And they would have to pay an extra ATO Medical tax because they don't have private cover.


I still remember back in the late 70's to mid-80's paying into my own private Health Cover and they paid 100% of all my medical bills as I was in the highest cover (transfer straight from my parent’s cover). Now a days I get very confused to what I'm covered for and by whom and how much I would still need to pay out of my own pocket. And yes, before you ask. I'm still in a high medical cover, only dropped down to extra's only in mid 2022 and I could no longer pay for private hospital part, as I'm now on a Government Health card due to the amount of hours I work. Still too young for a pension or retirement, still 4 more years to go.



Thank you for taking the time to read my grip.

I totally agree about those years ago with private health cover. eg. When mothers had their babies in a private hospital, it only cost a minimal or zero gap. These days, I'm told that mothers who pay for private health cover can't afford to have their babies in private hospitals as the gap costs thousands for the Gynaecologist.
The Govt doesn't seem to do anything about Doctors who charge exorbitant gap prices for private health.
Specialists say they are worth it, but I think these days it's all about shopping around.
With the public health system, there's no wait time for a cancer diagnosis, however there is a long wait time for elective surgery.

 

[PepeLePew]

Overcrowding in hospital emergency rooms is a real thing. Rocked up at my local hospital last night with a fractured wrist, eight & a half hours later I finally got to go home with a temporary cast on. There was close to 40 people ahead of me but some of them couldn't handle the wait time and left after a few hrs without seeing a Dr. You also have ambulances coming in & those patients then take priority. From what I overheard a lot of the patients in the waiting area were there for throwing up, constipation, sore throught, coughs etc. These are symptoms that could have been easily handled by a GP but obviously their doctors not longer bulk bill, hence the visit to the hospital and tying up the system for people who have broken limbs or other major trauma.