President's Blog, Friday 13 August 2010
The next Government must make a significant investment in the MBS in order to stop shifting more and more of the cost of health care on to patients.
MBS indexation has not kept pace with the increasing costs of running medical practices.
The fee charged by a doctor must cover all of the costs of running the medical practice including staff wages, rent, electricity, health equipment, computers, and professional indemnity insurance.
In order to maintain a high rate of bulk billing and remain financially viable, medical practices have had to increase their charges for patient-billed services. The patient-funded gap on patient-billed services has therefore increased.
Consequently, patient out-of-pocket costs are increasing. In 1998, each person on average contributed $76 towards his or her medical services, but this amount had risen to $102 in 2008, despite the Medicare Safety Net covering some of the out-of-pocket costs.
When Medicare rebates no longer reflect the true cost of providing the service, visits to the GP and having medical tests can become unaffordable for many families.
There must be better indexation of Medicare rebates and no further MBS cuts if Australia is to achieve genuine health reform and build a greater focus on preventative measures. Until rebates are at a reasonable level, the next Government must protect Australians from unaffordable out-of-pocket costs for medical services by ensuring there are no reductions to the extended Medicare Safety Net.
The MBS Quality Framework was set up earlier this year to review Medicare services and their rebates with the stated objective of ensuring Medicare rebates represent ‘value for money’. But we don’t want ‘value for money’ to mean more cuts to MBS rebates.
Medicare rebates have been wound back over time because the annual indexation that successive Governments have applied to Medicare rebates is always around half the increases in average weekly earnings and the consumer price index.
Against a backdrop of significant costly health reform, the argument that the Government cannot afford it just doesn’t stack up. An increase of $1 for GP services only would cost $108 million a year or $432 million over four years. An increase of $1 for all medical services - across all specialties including pathology and diagnostic imaging, and in- and out-of-hospital services - would cost $300 million a year or $1.2 billion over four years.
The case for MBS increase is compelling.
Pathology and diagnostic imaging services have not been indexed at all since 1998. Medicare fees for these services have been the same amount for 12 years.
Doctors have a strong commitment to their patients and will seek to bulk bill their disadvantaged patients where possible.
While about 40 per cent of the population holds health care cards of one sort or another, this group uses significantly more than 40 per cent of all GP services.
While average weekly earnings have increased by 130 per cent in the past 20 years, the MBS fee for a standard GP consultation has only increased by 63 per cent.
In 1989, theMBS fee for a Level B consultation was $21.00, compared with $34.30 as of 1 November 2009.
In 1999, the MBS fee for a blood test for diabetes was $19.70, compared with $19.10 in November 2009.
In 1999, the MBS fee for a CT scan of the spine was $326.20, which is the same as the fee in November 2009.
The original intended purpose of the MBS is to provide affordable access to quality medical care and advice for all Australians. Governments should not use it as a cost control measure, which ends up hurting patients.
We think there is a good case for proper MBS indexation. What do you think?
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MBS Indexation
100% agree - proper MBS indexation inline with CPI is LONG overdue, and would help take some of the pressure & costs off the public hospital system.
MBS
The MOU between Minister and RACGP in 1999 has frozen non VR consult rebates 52/53/54/57 at the 1991 payment. Why do FRACGP's get to practice other than in general practice and collect the "GP" items 9 / 23 / 36 yet non FRACGPs of 25 years experience doing the same can not access "9 / 23 /36 " as the RACGP deems that they are no "General Practitioners". A practice RN can earn a 10994 which is $22.70 while a 53 ( 25minutes) is $21.00 .
Do I have to just pay my exam fee to RACGP do an FRACGP and then never step foot in General Practice again.
In 2007 there were 923 melanomas recorded in the WA Cancer registry. I find and treat about 40 per year, an order of magnitude more than Prof Chris Del Mars view that the average GP will find 1- 2 per year.
I say the "blue collar union" call for equal pay for equal work is long overdue.
Frozen non VR consult rebates discriminate against the patient
2 matter that has not been considered in the freezing of non VR consult rebates.
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1) is the DISCRIMINATION that the FRACGP (with tacit support by the AMA) have against those women in medicine who have taken time out to raise families.
Returning to the workforce and look after a family is hard enough without demanding that they study and sit additional examinations to become a "specialist" General Practitioner. They remain a non-specialist general practitioner - refered to by Health Dept and RACGP as non vocationally registered practitioners. RACGP cannot deny that there are non VR practitioners who are diligent, have studied to become experts in their field of medicine and maintain continuing professional development.
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2) is the DISCRIMINATION against patients of the non VR practitioner. It is these patients who are denied their constitutional right for an appropriately indexed rebate from medicare of part of their expense incurred in seeing that non VR practitioner.
I think you make valid
I think you make valid points, but it's a lost cause. I charge what my services are worth (i.e. the same as they would have been worth in 1982 indexed for wage growth) and there is no hope of the MBS ever coming close to catching up. You talk about a $1 increase per service costing X millions of dollars, but my anaesthetic fees need to be increased by around $10 PER UNIT, or $150 per service to get back to what they were worth in the 80s. It's full time workers like us who will end up burdened by the massive tax increases that would be necessary, negating the increased fees in any case.
I think the AMAs energies should be directed to more fundamental reform, such as merging the public and private systems to some extent. For example, my public hospital has hundreds of people waiting for ENT surgery in pain and discomfort (for months or years), but what am I doing next Wednesday? Playing golf because the private patients on the list cancelled. I'd operate on those patients, even at a discount, and everyone would be happy, but the dysfunctional medical system here is so inflexible that simple solutions like that can never take place.
I should have added, playing
I should have added, playing golf WITH THE ENT SURGEON while the OR stands empty and the nurses drink coffee....
Medicare safety net
The drastic cutting of the Medicare Safety Net in December 2009 by the Labour Government has placed a huge financial burden on young couples having families across Australia. The MSN was a needed insurance to cover against the woefully low medicare rates for all pregnancy services such as obstetrician, GP , paediatrician, pathology fees and for diagnostic ultrasound ..... as you say, medicare fees for diagnostic ultrasound has not changed since 1998. (Practice costs, equipment,insurance and staff salaries etc as you know have not remained static. The general explosion in technology and published data in that time has meant that the scan times have increased as the detail of imaging and counselling of findings has become far more complex since 1998 and with this, the cost of delivering the service has increased significantly.)
There are a lot of services to pay for when an individual or couple is pregnant and having babies.... repeated US scans, obstetrician fees, +(IVF in many cases), paediatrician, GP, radiology and pathology fees for the new or addition to, the young family. These were well covered with the previous MSN but are no longer.
There has been about a 20% reduction in private workload since January 2010 and a trend for those previously delivering privately now using public hospital maternity services in QLD.
The Medicare Safety Net should be restored to its previous levels, and we should press for a committment from each party to do so prior to election day.
labour 's attacks on doctors
The Labour government has made clear it's position on the health care system and doctors. Recent attempts to cut Medicare rebates in opthalmology and other areas are in stark contrast to the shameful throwing away of money in failed insulation schemes (where millions went to crime syndicates), rip off school building projects and "stimulus packages" for people to either gamble away, buy bigger TV's or make their drug dealers richer!Planned are more Medicare rebate cuts to limit the incomes of those "rich" doctors!
The government sees doctors as soft targets politically . No other group in the community would tolerate their wages being reduced from those in force a decade or more ago.
Dishonest; Disgusting;Discredited. Nicola Roxon and her department must be held to account by our whole profession. We need to take action as a group. Now is the tine to make a stand politically so that the public know the truth. Any Doctor or member of a doctors family that votes for labour should be ashamed of themselves
Fees and provision of services
This election has been short on policy and long on personality issues.
Neither of the major parties appeal.
The fetish of growth at all costs, particular growth of large holes in the ground requiring thousands - sorry - hundreds of thousands of imported workers to help some Caesar of big business improve their bottom line imposes enormous strains on infrastructure, health care being an important part of this.
Paradigm shifts in our preoccupations with the economy and growth need to be made.
Many of us are heedless of the expense of our own services, but they pale into relative insignificance when compared with health funds providing full cover for $20,000 prostheses while less than half of medical services reasonable fees are covered.
Sadly, our community, whatever the result, will get the mediocrity most of it deserves as they worship false gods of consumption.
Phocomeliarisation of Medical Pracrtice by Medicare
This continued unilateral 'wing clipping' by Medicare of medical practice 'items' - be it withdrawal of intra-articular joint injections or the 'coning' of laboratories - is now ridiculous. You can do what you like provided you do not charge Medicare. This should be termed phocomeliarisation of doctors.
CMBS & Health Fund rebates
You've got Buckley's chance of getting the benefits for your patients that they deserve. If enough Doctors really cared they would do several things. They would charge what they think is reasonable for their services. This has nothing whatsoever to do with Gov't or fund benefits. Charging fees related to benefits is a recipe for retaining the status quo. Why should these benefits be increased any more than the minimum necessary if there is no serious pressure to index them properly. Secondly every concerned Doctor has to become politically active. If you don't exert pressure through your patients you will get zilch. Whenever medico's have been so upset that large numbers have threatened to withdraw services the gov't has reacted. No other section of the community allows itself to be taken advantage of like we do. Either take the issue seriously and personally do something about it by refusing to be a servant of the Gov't or health funds (which now have millions of $$$'s of our money in 'profits' which the Gov't is even talking about stealing from MBP)or go back to your newspaper.
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