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General practice under attack


The Government’s original co-payment proposal for GP, radiology, and pathology services, which was announced in the May Budget, was very bad health policy and the AMA advocated against it strongly.

The revised model announced recently is worse, much worse.

It is an unprecedented attack on general practice. And it will severely disadvantage patients.

Strong advocacy by the AMA saw the Government provide exemptions for vulnerable patients, but that is where the good news ends.

The triple blow to general practice and patients, which we have likened to a wrecking ball, involves:

  • The $5 cut to Medicare patient rebates for general patients;
  • The non-indexation of rebates until July 2018; and
  • The introduction of time-based changes to level B consultations.

The AMA went out to our members and asked our GPs what they thought of the new co-payment proposal. We wanted to hear first-hand how they thought these changes would affect their practices.

We received back some of the angriest emails the AMA has received over any issue in a long time.

The rebate cut is taking money directly away from general practice; it means that there are more costs for patients going to see their GP.

The second issue is the rebate freeze, which applies to general practice and specialists. It is a rebate freeze over the next four years. This comes on top of rebate freezes over the past almost two years.

It is inconceivable for any general practice, or any small business, to have a freeze of that duration and expect them not to have to pass on those costs to their patients

This affects both concession and non-concession patients.

Over time, as the rebate no longer reflects either the cost or the value of the service provided by general practice, and specialists, people are going to have to pay more out of their own pocket for their care.

The third aspect of the new co-payment proposal is perhaps the one that’s angered our GPs the most, and that is the change in terms of the level A and level B rebates.

Previously, the differentiation has been on complexity. The Government now says they will change the regulation so consultations taking less than 10 minutes will be level A consultations.

Many experienced GPs have told the AMA that efficient and highly skilled GPs can actually diagnose a problem by examining the patient and taking a history, and prescribing a management plan and explaining that to the patient, in eight or nine minutes.

Why should- that consultation, that quality care, be worth only around $11 now, compared to the $37 that it was worth last week? That devalues quality general practice. That is an insult to GPs.

Every GP practice is going to have to pass the so-called optional payment on to their patients.

But the long-term issue, particularly with the rebate freeze, is that we are going to see the value of the Medicare rebate – which is the patient’s rebate – be devalued such that the cost and the value of the service that is being delivered bears no resemblance to the Medicare rebate amount.

That is a real issue for the Medicare system, for our health system, and for all Australians.

Whether they have a chronic disease or not, people who need to see their GP and people who need operations are going to have to pay more out of their own pocket.

The rebate freeze for specialists will affect not only the Medicare rebate, but also the rebate in terms of the schedules that our private health insurers have.

This year, Medibank Private did not pass on any indexation, explaining that it would not do so until the Government provided indexation.

Many other health funds passed on indexation but we don’t know what they’re going to do over the next four years.

So, we will see medical practice costs rise, pressure to stop bulk-billing, no-gap schedules will not be used, and people are going to have to pay more and more for their care.

We are also hearing concerns that pressure will be shifted to hospital emergency departments.

Nobody is immune from this destructive health policy from the Government. General Practice will be hit. Specialists will be hit. Hospitals will be hit. Worst of all, our patients will be hit, and hit hard.

The AMA has no choice but to advocate strongly against the Government’s policy – in the Parliament, in the community, in the media, and in our practices.