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Cost cutting Budget in need of medical advice

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Watching Australia’s Chief Scientist Professor Ian Chubb on ABC television recently express his surprise and concern that he was not consulted about the Federal Government’s $20 billion medical research fund underlined to me what everyone has been saying about the recent budget, which is that with consultation it could have been so much better.

The average rural GP has a lower socio-economic patient demographic, with higher rates of both unemployment and welfare dependence. Making bulk-billing non-viable will hurt rural Australia considerably and serve to make rural practice less attractive as a career option.

Many have asked how the corporate giants will handle the proposed changes. If I was them I would set up a charitable trust to fund the “most needy” $7 co-payment. The total cost per patient would be $70 a year but, as it should be tax deductible as a charity, that could make it more like $35 per annum per patient. It would enable free access to GP consults and pathology and radiology services. Not a huge cost in the scheme of things, and easily recouped by an extra service per annum. Such an arrangement would make a mockery of the proposed changes.

If I was advising Government I would ask Centrelink to classify the truly vulnerable in society and issue them with a “co-payment” credit card with $70 credit on it, able to be used only for the stipulated 10 GP/pathology/radiology services.

GPs do not have access to a patient’s financial details, and are not in a position to make decisions about how ‘needy’ they might be.

We all get regular surprises when elderly retirees who insist on bulk billing turn up for vaccinations for prolonged overseas jaunts. The credit card approach would also enable real-time determination of when the 10 services requiring co-payment have been completed.

It would restrict GPs from gratuitously bulk billing to lure patients, and focus charity (given that bulk billing is a most charitable act) to where it is most needed.

Needless to say, I would ban “charitable bodies” set up by the big end of town to circumvent co-payments.

And what of General Practice Education and Training getting folded into the Department of Health?

This is a major cause for alarm, and seems consistent with the underlying principle on which the Budget seems to have been framed – that maintenance of quality is a low priority when cost cutting is the mantra.

The Prevocational General Practice Placement Program has been stopped, despite it being a huge window of opportunity to get doctors to experience rural health before they are locked in to a specialist training scheme.

Successful projects such as the “Murray to the Mountains” trial of the intern year in rural Victoria will be no more.

All medical groups, led by the AMA, must fight hard to ensure the training of tomorrow’s rural GPs is not compromised and downgraded.