AMA warns budget cuts could GP push fees up, crunch bulk billing


The AMA has ramped up the pressure on the Federal Government to overturn Budget cuts to practice incentive payments, warning the move could force GPs to increase fees and reduce bulk billing.

AMA President Dr Steve Hambleton has put the Government on notice that its decision to scrap practice incentives for immunisation and increase treatment targets for pap smears and diabetics is likely to increase out-of-pocket expenses for patients and cut bulk billing rates.

“When the support for GPs falls, you really have got two choices: you can either close up shop, or you can charge patients a fair fee, and I think GPs will choose to charge fair fees, which means that out-of-pocket costs will rise,” Dr Hambleton said, adding that “we have seen the bulk-billing rate fall before, and I am suspicious that the bulk-billing rate will start to fall again.”

The blunt warning comes amid mounting anger over the hit to doctors in the Budget, and concern about the effect of the cuts – particularly to immunisation incentives – on public health.

The Government expects to save $83.5 million over the next four years by scrapping the GP Immunisation Incentives Scheme – which provided incentive payments of up to $4500 to practices that pushed immunisation rates among child patients above 90 per cent – as well as pushing up the threshold for other incentive payments.

Under the changes, practices will have to ensure 70 per cent of eligible patients are given pap smears – up 5 percentage points - to qualify for the payment of a incentive, and prepare care plans for at least 50 per cent of diabetic patients, up from 40 per cent.

Analysis of the Budget commissioned from Kilham Consulting by the AMA and available by clicking here, shows that although health was spared large spending cuts, the Government nonetheless expects to save a net $225 million in health expenditure in the next four years.

Kilham Consulting said the thrust of many budget measures, particularly cuts to practice incentives and changes to the Extended Medicare Safety Net – with caps imposed on all consultations and a much wider range of procedures than previously – was to shift costs onto doctors.

“These changes seek to move the goalposts to extract greater performance from the primary healthcare system,” the Kilham report said. “It does mean that GPs are being expected to do more work for less reward”.

Dr Hambleton said the AMA was seeking urgent talks with Health Minister Tanya Plibersek to try to have the incentive cuts reversed.

The AMA President said that by axing the immunisation incentive, the Government had ripped away one of the key remaining supports for comprehensive national immunisation.

Dr Hambleton said that the successful drive to lift immunisation rates above 90 per cent had been based on incentives for parents, practices and doctors.

“A couple of budgets ago they removed the incentive for doctors. This [budget] has removed the payment for practices. The Government has effectively kicked one more leg out of that tripod [of measures],” he said.

“The GP is central to immunisation for this country,” Dr Hambleton said. “GPs will, of course, continue to immunise, but the incentive for practices to get their rates over 90 per cent has now gone.

“We need to work together on this. We do need to make sure we maintain that funding.”

But the Government so far shows no sign of reversing its budget cuts.

In a post-budget speech Health Minister Tanya Plibersek said the savings made were “based on clinical and economic evidence of what’s good for patients and what’s good for the long term sustainability of our health system”.

The Kilham Consulting report can be found at: