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Patients face hip pocket pain for specialist care

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Patients will be left almost $100 out-of-pocket when they see a specialist as a result of the Federal Government’s decision to freeze the indexation of the rebate for specialist consultations.

AMA analysis shows that the move to pause indexation of the Medicare specialist attendance initial consultation item 104 for two years from 1 July will push the gap between the rebate and the AMA recommended fee to $97.72 next year.

The blow-out in out-of-pocket expenses is particularly significant in light of the changes to the Medicare safety net also included in the Budget, with analysis by Deeble Institute for Health Policy Research Director Anne-marie Boxall suggesting they will effectively reduce support for patients faced with high out-of-pocket expenses.

In the Budget, the Government revealed plans to “simplify” Medicare safety net arrangements by replacing the Original Medicare Safety Net, the Extended Medicare Safety Net and the Greatest Permissible Gap measure with a single Medicare Safety Net.

The new Medicare Safety Net, to come into effect from 2016, will contribute towards out-of-pocket costs incurred for Medicare-eligible out-of-hospital services.

Under the new arrangement, there will be a safety net threshold of $400 for concession card holders, $700 for single adults and families that are eligible for Family Tax Benefit A, and $1000 for all other families.

Once the annual thresholds have been met, Medicare will pay 80 per cent of any subsequent out-of-pocket costs, capped at 150 per cent of the Medicare Benefits Schedule fee. The out-of-pocket costs that accumulate to reaching these thresholds will also be capped at 150 per cent of the MBS fee.

Writing in The Conversation (to read more, visit http://theconversation.com/a-new-simpler-medicare-safety-net-but-with-ho… ), Dr Boxall said this was significantly less generous than current arrangements, where the cap is set at 300 per cent of the MBS fee, and would leave patients incurring significant out-of-pocket costs worse off.

Significantly, if providers charge more than 80 per cent of the MBS fee, the additional amount will not be covered under the safety net, and it will not count towards meeting the threshold.

The AMA analysis suggests that, if specialist charge the recommended fee for an initial consultation, patient out-of-pocket costs will be almost 135 per cent of the MBS fee and the safety net will not cover almost $40 of the out-of-pocket charge.

Dr Boxall said that although safety net eligibility thresholds are lower under the new arrangements, people will have to pay more of the high out-of-pocket costs than they do now.

“[The new Medicare Safety Net] will not provide protection for costs well in excess of the Medicare scheduled fee. And it’s not clear yet whether caps for services that tend to have very high fees (such as obstetrics and assisted reproductive technology) will remain in place under the new arrangements,” Dr Boxall said.

She said that although the Government should be congratulated for starting to tackle the excessively complex Medicare safety net arrangements, “it could have done better”.

“To truly provide protection to the most vulnerable in our society, the safety net should have done two things. It should have covered all health services and products, not just out-of-hospital services. And, it should have shifted more of the risk of excessively high fees onto the Government rather than individuals,” Dr Boxall said.

Adrian Rollins

 

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