The decision to introduce a $7 Medicare co-payment may remain at the centre of the political brawl over the federal budget, but doctors say for thousands of medical practices it represents a threat not just to their business models, but to their very survival.
Medical practices across the country have been trying to assess since the budget what the bottom line impact of the new co-payment on their practice – whether general practice, pathology or diagnostic imaging practice – will be.
The Australian Medical Association’s president, Associate Professor Brian Owler, said doctors aren’t against a co-payment but the specific proposal in the budget – which combines the co-payment with a $5 cut in the Medicare rebate, and changes to incentive payments – creates big problems for many doctors, particularly those with practices with overwhelming numbers of bulk-billed patients or patients with chronic diseases, which will see them up to $13 worse off per consultation.
The change also means that “instead of the government being one that is reducing red tape, the government is doing exactly the opposite” to the medical profession, he said.
As the pressure on the government over its budget announcement has increased, Health Minister Peter Dutton has repeatedly insisted that bulk billing will stay in the system as the safety net it was originally intended to be, and suggested market competition will sort out the bulk billing problem.
But doctors say the shift in payments means they will be heavily penalised every time they bulk bill a patient, and dismiss the federal government’s suggestion that they will receive a “windfall” of practice income from the new co-payment.
Dr Owler said simply that “doctors’ practices cannot survive by bulk billing under this sort of scheme”.
Doctors’ outcry overplayed
Department of Health officials appearing at a Senate committee hearing on Monday said the outcry from doctors over the impact on their business models was overplayed.
First assistant secretary Richard Bartlett said 89 per cent of doctors already billed at least some of their patients, and so would not need to make significant changes in order to collect the $7 co-payment.
“There aren’t that many doctors who don’t have any facilities in place,” Dr Bartlett said.
“Even in areas with high bulk billing rates, patient billing occurs.”
However, the department had to concede that no specific modelling had been done on the impact on patient behaviour of a $5 increase to co–payments on subsidised medicine, or the impact of cuts to public hospital funding on front-line services.
Professor Owler said the AMA was “not against co-payments per se”.
“Many doctors already charge a co-payment. The problem is that this particular proposal involves a $5 cut to the rebate at the same time. “If you decide to bulk bill and not charge the $7 co-payment, you lose the [$2 that a GP is allowed to keep from that payment] and, in addition to that the Medicare rebate is $5 less and you also lose the bulk billing incentive of about $6.
Significant loss
“So if you decide to bulk bill, you are up to $13 worse off. Where the rebate is only $36, this is a significant loss.”
Pathology and diagnostic imaging services face an even a greater problem financing their big technology investments, he said, with the possible loss of 10 per cent incentive payments for diagnostic imaging and continuing confusion over whether this would be applied on a per item or per consultation basis.
Doctors also argue that about half of the $2 co-payments they are scheduled to keep will be lost in setting up systems to process the payment.
It will also make GPs the determinants of who receives social welfare, he says, and it should not be up to them.
With heavy rates of bulk billing often being localised in low-income areas, that means some practices will have their viability at stake if they are compelled to continue offering bulk billing to patients who simply cannot afford to pay co-payments.
“We need better safety nets,” he said, but noted that meetings with the government last week revealed a reluctance to see the potential impact of the changes.
Dr Owler disputes the central idea that GP visits have been growing exponentially, saying they have grown at 2.9 per cent a year over the past decade.
Source: Australian Financial Review