President's email update - Friday 13 August

The AMA this week called on the major parties to commit to proper indexation of the Medicare Benefits Schedule (MBS) should they be elected on 21 August.

We also sought a promise that there would be no further cuts to specific MBS items, as happened last year with cataract surgery, joint injections, cardiac angiography, pathology, and IVF procedures.

At the National Press Club health debate this week, Health Minister Nicola Roxon could not commit to an MBS increase and conceded that some Medicare items could be cut as part of the MBS Quality Framework review – an admission that the Prime Minister tried to reverse almost immediately.

Shadow Minister Peter Dutton said the Coalition would increase rebates for after hours visits and long consultations, but did not give much detail.  He also conceded that broader MBS increases were not on the Coalition agenda.

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.

The AMA believes that proper MBS indexation is long overdue.  I have more to say in my President’s blog on the AMA website.  Click here to tell us what you think.

Dr Andrew Pesce
AMA President

This week's Presidents Blog

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 over the past 20 years, the MBS fee for a standard GP consultation has only increased by 63 per cent.

In 1989, the MBS 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?

Click here to comment