TAXPAYERS will have to pay “hundreds of millions of dollars” to build a centralised database for 25 million people that would update in real time to cater for the Abbott government’s proposed $7 medical co-payment scheme, IT experts say.
The government has proposed that people pay $7 each time they visit a GP, get an X-ray or a blood test from July next year. A patient who visits a doctor and needs a pathology test and an X-ray will be slugged with $21 in upfront fees.
The $7 fee is applicable to everyone except concession card holders and children under 16 who will pay for the first 10 services combined.
The controversial plan has drawn the ire of consumers and many in the healthcare fraternity who say it marks the demise of universal access to healthcare in Australia.
One of the biggest challenges with the proposal is there is no way to determine — in real time — the number of times a patient has made a co-payment.
The federal Department of Human Services, which runs Medicare, declined to say how long it would take to develop special software or a portal to provide the real-time information and how much it would cost.
Jorn Bettin of IT consultancy IBRS, said given the fragmented nature of health IT systems and the multitude of different healthcare providers, it would be “extremely hard to develop a system that reliably tracks all visits of healthcare service providers”.
“In terms of costs, the underlying platform will cost several hundred million dollars to develop and roll out. Adding a feature that tracks $7 payments is the easy part,” Mr Bettin said.
“Given recent news about government budgets and NEHTA (National E-health Transition Authority), it is questionable to what extent it is realistic to assume that such a platform will be available in a timely manner for the payment proposal to be implementable,” Mr Bettin said.
When asked how GPs, patients and the respective labs would be able to identify the number of co-paid services in real time, a DHS spokeswoman said the department was “designing the technical solution for the implementation of co-payment policy as outlined in the federal budget”.
“This will include the ability for health professionals (general practitioners, pathologists and diagnostic imaging services) to check concession eligibility through various Medicare systems.
“Health professionals will also be able to use the same systems to confirm whether the service cap for a patient has been reached according to the information held by the Department of Human Services at a point in time,” the spokeswoman said.
She said medical practice software vendors would be engaged “in an appropriate timeframe to ensure they have the required co-payment technical information in order to upgrade their software and make it available for health professionals using Medicare electronic claiming systems”.
Mr Bettin said the main issue was “not so much provisioning basic software for managing patient data, as such software exists in numerous variants, but that of integrating all the disparate systems, and propagating data and payment updates in a manner that is reliable and traceable”.
“Over the next year I can’t foresee the realisation of any solution that is capable of reliably ‘counting to 10’,” Mr Bettin said.
That same issue makes the introduction of centralised patient data management so challenging, he said, as potentially life-critical information must be propagated securely and 100 per cent reliably for such a system to deliver tangible value.
The Australian Medical Association is one of the loudest critics of the controversial proposal which it says will disadvantage Australia’s poorest and most vulnerable, including those with severe mental illness.
The peak medical body says the proposal was costly and “impossible to implement” within such a short timeframe, and the IT system to underpin the program could be as unreliable as the personally controlled e-health records system.
The need for a centralised, real-time system for GPs, pathology and imaging labs to check the number of co-paid services a patient had had would be crucial, said Dr Brian Morton, chair of the Australian Medical Association’s Council of General Practice.
Dr Morton said the desktop software which GPs havd did not have the ability to tell the number of co-payments in real time.
He said the centralised patient database would be quite a change for industry and he questioned whether Medicare and each (GP) had the capacity to make the change.
“In practice it’s just not going to work,” he said.
Also, GPs bundle their claims and submit them infrequently to Medicare. “Some might submit them once a week, once a day and others the next day,” Dr Morton said.
He said medical practitioners who bulk billed would have to incur additional costs as they might not have an EFTPOS facility.
“We pay for the transaction cost, rental of the EFTPOS equipment, which is part of our normal management cost, but for someone who’s been directly bulk billing they don’t have EFTPOS,” Dr Morton said.
He said his practice had an EFTPOS facility and the patients got their money refunded back into their bank account by Medicare.
Dr Morton said that to meet the government’s July 2015 deadline there would need to be trial sites very soon. “You can almost imagine the system crashing from time to time … like the PCEHR,” he said.
Dr Morton said it was “not unreasonable” that $14 would have to be spent for every $7 collected. This would cover front-office staff, back-office staff, administrative staff, EFTPOS terminals and new software for the central database.
A Department of Health spokeswoman said it would not cost $14 but declined to say how would have to be spent to collect the fee. A spokesman for Health Minister Peter Dutton declined to comment on Dr Morton’s remarks. He referred all IT-related questions to DHS.
Dr Morton, who makes home visits and goes to nursing homes, says: “(It) is really impossible for a demented old person lying in a bed, who sometimes doesn’t even know who you are”, to give $7 to the GP.
“It’s not compassionate at all (and) it’s just about impossible to implement.
“You have to take money from them, otherwise that patient is forever disadvantaged because they would never get to the threshold because they have to be charged to contribute to the threshold.
“This (scheme) is simplistic and haven’t been thought through well enough,” Dr Morton said.
Source: The Australian