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Bulk billing hides true cost of care

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One of the more enjoyable aspects of being a GP is supervising and training GP registrars in my practice. It is rewarding to see these future GPs develop their skills and confidence during their placement with me.

It worries me, however, when I meet registrars outside my practice who have been put off and demoralised by what they see as the churn of patients through the surgery stimulated by bulk-billing. Sweatshop and battery hen farm are some of the terms I have heard!

Like the GP registrars, I understand only too well the perverse effects of artificially low fees for standard consultations on the long-term viability of general practice in this country.

The present system largely provides no real price signal to patients of the cost of medical care. It encourages patients to make unnecessary visits to the surgery because their GP bulk bills. In this environment, a GP’s time is wasted dealing with unnecessary presentations such as grazed knees or runny noses that could be managed at home with a little common sense.

At the same time, the inadequate rebate for a standard consultation encourages “6-minute medicine” in order to generate a high throughput of patients to pay salaries and rent and recoup the other rising costs of running a practice.

This means less time to manage patients with more complex issues and less time to deliver high-quality preventative care. Compressed consultations means unnecessary tests – more pathology and radiology investigations and increasing rates of referrals to higher-cost specialties.

The result is higher overall costs for the health system.

Inadequate rebates do not capture the true value of GP care offered to patients, and some practices have an over-dependence on chronic disease management items for a reliable income stream. On that score, perhaps it is time to rethink the chronic disease management items, how they are being used, and who they are benefiting.

Certainly, we need to be able to streamline and improve GP-coordinated access for patient multidisciplinary care and other support services for those patients where there is a clinical need, and where it will improve the quality of life.

The overall result of the present system is a distortion of the marketplace and questionable viability for quality general practice.

Unfortunately we GPs are our own worst enemy, as we willingly absorb the true cost of providing quality medical care. Of course we all have a strong commitment to our patients, especially to bulk billing those who are disadvantaged.

Sadly, the profession is seen as a soft target by the Government – witness the decision in the last Federal budget to delay MBS indexation by eight months, effectively cutting MBS rebates in order to save $664.4 million over four years. There was no consideration made of  how the decision would affect patient access to care. The assumption is always that GPs will absorb the costs and continue to bulk bill. This is usually backed by a proud boast about the high rate of bulk billing.

I encourage GPs to set their fees based on their practice costs and workload. We must be remunerated fairly for our services to maintain the viability of our practices.

It is important for you to review your fees on a regular basis to ensure that they reflect the true costs of running your practice and the value of the service you provide. The AMA has several resources on its website (policy/doctors-fees)to assist you to move to patient billing.