Medicare rebate freeze ‘co-payment by stealth’
Patients could be left close to $10 out of pocket every time they see a GP if the Federal Government persists with plans to freeze Medicare rebate indexation until mid-2018.
As private health insurers urge the Federal Government to allow them to provide cover for GP visits, Sydney University researchers have warned family doctors will have to slug their non-concession patients extra to make up for losses caused by the rebate freeze.
In a study published in the Medical Journal of Australia, researchers from the Family Medicine Research Centre estimated that the freeze would cause a 7.1 per cent drop in GP rebate income in the next three years, the equivalent of a shortfall of $124.96 for every 100 consultations next financial year, rising to $384.32 per 100 by 2017-18, as the value of the rebate fell ever-further behind rising practice costs including wages, rent and utilities.
AMA President Associate Professor Brian Owler has urged the Government to dump the freeze along with all its other unpopular co-payment policies in order to provide space to consider other pressing health issues, including hospital finding, mental health care, e-health, workforce planning and Indigenous health.
Given that GPs were likely to continue to bulk bill patients with concession cards, the Sydney University researchers said non-concession patients would have to be charged proportionately more to make up the difference. They predicted the additional charge would rise from at least $2.74 per visit in 2015-16 to an extra $8.43 a visit in 2017-18.
The estimates, which the researchers said were conservative, suggest the rebate freeze will result in even greater patient out-of-pocket costs than the Government’s original $7 co-payment plan and a subsequent $5 cut to the Medicare rebate – both ideas that have been dropped following outcry from the AMA, consumers and other health groups.
Grattan Institute Health Program director Professor Stephen Duckett said the rebate freeze would result in “a co-payment…by stealth”.
Professor Duckett said the most GPs were in no position to absorb the scale of income cut caused by the freeze, and faced two choices – increase how they charged patients already being hit with out-of-pocket expenses, or start billing bulk billed patients.
He said that for the many practices that currently bulk billed all their patients this policy would force them into making a big step involving introducing new procedures for issuing receipts, issuing bills and handling cash.
The Sydney University researchers, led by Christopher Harrison, warned that increased bad debts, the costs of implementing new billing systems and the probability that many non-concession patients would continue to be bulk billed because of financial hardship, meant it was likely the additional charges would be even higher.
“Public discussion has mainly focused on the now retracted $5 reduction, and the freeze has received far less attention,” the study authors wrote. “Yet, with time, it will have a greater impact…nearly double the amount.”
They cautioned that their estimates could understate the scale of any possible extra charges: “There is no way we can predict the amount GPs will charge once they are forced, for economic reasons, to introduce a co-payment”,
“The freeze will result in Medicare savings; however, patient out-of-pocket expenses will be higher than these savings because GPs will need to charge more than their lost income to recoup the additional implementation and operational costs,” they said.
The Government is continuing to grapple with ideas about how to gouge savings from Medicare.
Health Minister Sussan Ley, who has undertaken wide-ranging consultations with the AMA, doctors, other health groups and consumers, has reiterated the Government’s commitment to sending a “value signal” to consumers.
Private health insurers, particularly Medibank Private, are pushing the Government to consider lifting the ban on cover for non-hospital primary health care.
Shadow Health Minister Catherine King said such a change would be tantamount to dismantling Medicare.
“Allowing private health insurers to enter general practice would create a two-tiered health system, with health insurance members able to jump the queue,” Ms King said. “It would also open the door to US-style managed care, with health insurers able to interfere in the relationship between doctors and patients.”
Published: 07 Apr 2015