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Govt spares vulnerable but increases burden on general practice

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Doctors face little choice but to collect a $5 co-payment from many patients under the Federal Government’s revised plan to cut Medicare spending and funnel the savings into medical research.

Following sustained criticism from the AMA, the Government has ditched its original plan to impose an across-the-board $7 co-payment on all patients and has proposed that there be no change to rebates and bulk billing incentives for vulnerable patients, including children younger than 16 years, concession card holders, veterans and nursing home residents. It has also scrapped any change to rebates and incentives for pathology and diagnostic imaging services.

But, in a major blow to general practitioners and their patients, the Government will cut the Medicare rebate for consultations with adult patients without a concession card by $5, extend the freeze on rebate indexation through till 2018 and reduce the rebate for consultations that last less than 10 minutes.

Unveiling the package yesterday, Prime Minister Tony Abbott made it clear that the Government hoped most doctors would seek to recoup the $5 rebate cut by charging their patients an equivalent co-payment.

“Plainly, what we’re saying to doctors is that, with adults who don’t have concession cards, we don’t mind you charging a co-payment of up to $5,” Mr Abbott said. “That’s we’re saying, obviously we’re saying that. Frankly, we think that’s an entirely reasonable position, an absolutely reasonable position.”

AMA Vice President Dr Stephen Parnis said the protections for vulnerable patients in the package meant it was a big improvement on the proposal outlined in the May Budget.

“What we are very pleased about is that they have moved away from hitting the vulnerable, and from imposing a co-payment on radiology and pathology,” he said.

But Dr Parnis said the new model put doctors in an invidious position.

“That is a very difficult scenario, because what they are faced with is if they don’t impose this $5 co-payment, that is a cut to the income that keeps their business going,” he said, warning that the combined effect of the rebate cut and indexation freeze amounted to a “huge hit” to general practice.

“We are looking at five and a half years without a rise in the Medicare rebate, and that is a huge hit, let alone a $5 cut to GP rebates.”

Dr Parnis said the Government’s proposal took money out of primary health care and undermined general practice, which was the most cost-effective area of the health system.

“The big question is, does the whole package…help the system, or is it going to undermine it?”

Under the Government’s plan, most of which can be introduced by regulation, the following rebate cuts for non-concession adult patients will apply:

·        level A consultation rebate (less than 10 minutes) – $11.95 (was $16.95);

·        level B (10-20 mins) – $32.05 (was $37.05);

·        level C (20 to 40 mins) – $66.70 (was $71.70); and

·        level D (more than 40 mins) – $100.55 (was $105.55).

In addition to cutting the rebate, the Government is also looking to save money by slowing growth in the number of GP consultations subsidised through Medicare by boosting consult times.

Mr Abbott and Health Minister Peter Dutton tried to present the change as a measure to boost the quality of care.

 “We think the change in the way in which the [level] A and B [consultations] can be charged, so having a minimum of 10 minutes before they can charge a level B consultation, that that will concentrate a lot of the doctor’s effort on those who are most in need of help, those with chronic diseases,” Mr Dutton said. “It will skew the finances, when doctors are considering this, towards spending more quality time with patients, as opposed to just churning people through”.

Mr Abbott said the revised co-payment plan would save about $3.5 billion in the next four years, including $1.3 billion from extending the Medicare rebate freeze to 2018, $1.3 billion from encouraging longer (and fewer) consultations and $873 million from the $5 cut to rebates.

But the Government has yet to clear up the muddle surrounding the rationale for the co-payment. Mr Abbott and Mr Dutton alternately justified the measure as sending a “price signal” to patients about the cost of health care, as helping improve Commonwealth finances and slow health spending, and as a contribution toward medical research.

As with the model it ditched, the Government plans to direct all the savings realised from its new co-payment plan to the Medical Research Future Fund – an arrangement Mr Abbott has relied on to rebut accusations he has broken a pre-election commitment not to cut health spending.

So far, the new co-payment model does not appear to face the same political hurdles as the Government’s original plan.

Most of the changes, except the provision to allow doctors to recoup the $5 Medicare rebate cut by charging their patients a co-payment, can be introduced through regulation.

Furthermore, the plan does not appear to face the same level of hostility among Senate cross-benchers that the earlier proposal did.

While Labor leader Bill Shorten criticised the Government for trying to turn GPs into tax collectors, and Greens health spokesman Richard Di Natale said the new model would “destroy the fabric of Medicare”, only two of the crucial cross-bench senators, Nick Xenophon and Jacqi Lambie, so far appear set to oppose it.

Labor and the Greens would need the support of three of the eight cross-bench senators if they were to successfully disallow the changes made by regulation.

Mr Abbott said he was “very confident” the changes would stand: “I would be amazed if they [the Labor Party] would want to further sabotage the task of fiscal repair”.

Adrian Rollins

 

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