Showing posts with label Health Services. Show all posts
Showing posts with label Health Services. Show all posts

Wednesday, 28 August 2019

Do you know exactly who Medicare, your GP, specialist doctor or local area health service are sharing your personal medical information with?


Electronic Frontiers Australia, media release, 26 August 2019: 

Australia, Melbourne — Monday 26 August 2019 — EFA, Future Wise, Digital Rights Watch and APF today call again for a comprehensive review of privacy provisions for healthcare data. 

 Following the HealthEngine scandal in 2018, and the recent use of Pharmaceutical Benefits Scheme (PBS) data to assist recruitment into research on Bipolar disorder, a Twitter user on Friday 23 August shared a SMS message attempting to recruit him into a clinical trial. 

This appears to have occurred through the use of Precedence Healthcare’s InCa (Integrated Care) health platform. Research by members of digital rights organisations today revealed that sensitive patient details—including contact details, demographics and complete medical histories—can be shared with a wide range of partners, including, it appears, private health insurers. 

Dr Trent Yarwood, health spokesperson for Future Wise and a medical specialist, said “Secondary uses like this are a very ethically murky area. People don’t generally expect to have personal details from their healthcare providers made available to anyone, even if well intentioned.” 

The terms and conditions of the application include access to data from myHealthRecord. “While the My Health Records Act includes privacy provisions, once this data is accessed by an external system, these provisions no longer apply,” continued Dr Yarwood. “I’m very concerned that practices making use of this system are not aware of just how widely this data can be shared—and that they are expected to fully inform patients of the nature of the data use,” he concluded. 

“This kind of barely-controlled data sharing is only possible because of how little privacy protection is provided by the current legislation,” said Justin Warren, Electronic Frontiers Australia board member. 

“People have made it clear time and time again that information about their health is extremely personal, private, and they expect it to be kept secure, not shared with all and sundry,” he said. “What people think is happening is quite different to what actually is, and these companies are risking catastrophic damage to patient trust with their lust for data.” 

“If you found out your doctor was sharing your full medical history with private health insurers, or the police, would you keep seeing them?” he added. 

Robust privacy protections are needed for all Australians, such as by finally giving us the right to sue for breach of privacy, requiring explicit consent for each disclosure of medical or health data to a third party, and proper auditing of record-access that is visible to the patient. It is imperative that the risks of health data sharing receive greater attention. [my yellow highlighting]

Australian Health Information Technology, 25 August 2019: 

This Seems To Be A System Of Sharing Personal Health Information That Is Rather Out Of Control. 

I noticed this last week: How does Inca collect and share health information? 

Updated 1 month ago 

Precedence Health Care’s Integrated Care Platform (Inca) is a cloud- based network of digital health and wellness services, including MediTracker mobile application services. 

It is important that all users of Inca services understand how the network collects and shares health information (“personal information”) and are aware of their responsibilities for gaining informed consent from patients. 

To the extent applicable (if at all), the Health Privacy Principles (or equivalent), which operate in some jurisdictions, should guide your actions. In the absence of applicable Health Privacy Principles, you should refer to relevant Commonwealth, State or Territory privacy legislation, and assistance can also be derived by referring to the website of the Office of the Australian Information Commissioner. You should make sure you are familiar with the applicable principles or other relevant guidance, and also with Precedence Health Care’s Privacy Policy. 

Inca collects and shares personal information about patients and other persons under care (also called “consumers”) who consent to this information being stored and shared in the network. This information may come from a variety of sources, including the clinical software systems used by GPs (e.g., Medical Director, Best Practice); other members of the patient’s care team (e.g., allied health professionals, medical specialists); the patient themselves; participating health services and pathology services; and the Commonwealth’s My Health Record. 

Inca uses this information to provide a range of health care and wellness services to the patient and their care team. 

Prior to contributing a patient’s personal information to be stored in or used by Inca, users must obtain informed consent from patients for the collection and sharing of this information. Ensuring that patients are informed about what will happen with the information that is being shared is a fundamental component of best practice in privacy, so it is important that all Inca users and patients know what information is available on Inca and who has access to that information. 

When a patient’s GP or other person authorised by the GP uses Inca to collect personal information from their general practice clinical system, Inca will extract and share the following information: 

· Patient demographics 
· Alcohol consumption and smoking status 
· Allergies and adverse reactions 
· Family and social history 
· Observations and results 
· Current medications 
· Immunisation history 
· Current and past problems 

If the patient or the GP does not wish to share some of this information, the GP’s clinical system should provide a means for declaring such data “confidential” and thereby preventing it being sent to Inca. 

GPs who do not know how to do this should contact the provider of their clinical software. Inca may also collect and share information obtained from other sources. 

These include: 

· Information that the GP or any member of the care team or the patient themselves adds to the patient record or to any notes concerning the patient’s care using Inca services, web sites or mobile devices. This information may include contact information, measurements, care plans, assessments, referrals, progress notes, appointments, and other related personal and health information. 

· Information from participating Health Services, including discharge summaries and emergency department attendance. 

· Information obtained from My Health Record. This information may include some or all of the data stored in the patient’s My Health Record. 

It is the responsibility of the provider of information stored in or used by Inca, or the person who grants access to such information, to inform the patient of the type of personal information that is so provided or made accessible. 

Inca will provide access to a patient’s personal information with the patient’s GP and care team, the patient (or their carer as authorised by the patient), participating Health Services, and some others as necessary to provide the services of Inca. Precedence Health Care may share de-identified data (that is, data from which it is impossible to ascertain who you are) to persons or organisations who are engaged in research, trials and analyses relating to improvements in health and the management of health services. The way Inca shares and protects this information is described in the Precedence Health Care Privacy Policy. 

It is important that patients understand what information is being shared, who it is being shared with, and for what purpose. It is the responsibility of the persons providing this information to ensure that each patient is aware that their personal and health information is being stored on a computer system hosted on a secure site in Australia, as described in the Precedence Health Care Privacy Policy. 

It is also important for all users of Inca to be aware that this information may not be complete, up to date, or accurate. 

In seeking informed consent to participate, patients should be advised that any measurements or notes that they enter into Inca are not continuously monitored and will be available to members of the patient’s care team only when the provider next logs in to Inca. 

Patients who are concerned about any condition should contact their GP or other health care provider using their normal means (e.g., phone) and should not use Inca for this purpose. 

Please contact Precedence Health Care’s Privacy Officer on (03) 9023 0800 or email privacy@precedencehealthcare.com if you have any questions or concerns about our Privacy Policy, or if you wish to suggest improvements. You may also contact your State’s Privacy Commissioner or Ombudsman to get advice about privacy or make a complaint. 

Here is the link: https://phc.zendesk.com/hc/en-us/articles/360021090952-How-does-cdmNet-collect-and-share-health-information- 

For background Precedence Health run a shared patient data base which is accessible to GPs, Specialists and Allied Health Staff for the purpose of care planning and co-ordinating care. Using their system allows GPs to claim a Medicare Item No for this service. They also provide patient access to the data and have services such as reminders etc in an app. 

All that said this system, on its own statements, just sucks information from everywhere (GP systems, health services and the myHR) and pops it into one database. One user, who is now switching it off, revoking consent and getting out has described to me a collection of erroneous and mis-sorted data on their record. 

More they seem to be happy to hand out the data to others claiming it is de-identified – and we all know how in-effective that can be! 

The rather loose way consent rules for disclosure appear to be enforced is also a worry. 

They even have the legendary myHR disclaimer that “It is also important for all users of Inca to be aware that this information may not be complete, up to date, or accurate.” Doh! 

You can see the Privacy Policy here if you wish! https://phc.zendesk.com/hc/en-us/articles/360021091012-Privacy-Policy- 

Don’t know about you but none of my information would go anywhere near this if I could help it! It looks like a serious unthought through shambles to me. 

What do you think? 

David.  [my yellow highlighting]

Sunday, 11 August 2019

Alleged data theft by HealthEngine leaves hundreds of thousands of Australians vulnerable


Perhaps now is the time for readers to check who owns the company they might use to make medical appointment online.

ABC News, 8 August 2019: 

Australia's biggest medical appointment booking app HealthEngine is facing multi-million-dollar penalties after an ABC investigation exposed its practice of funnelling patient information to law firms. 

The Australian Competition and Consumer Commission has launched legal action against the Perth-based company in the Federal Court, accusing it of misleading and deceptive conduct. 

In June last year, the ABC revealed HealthEngine was passing on users' personal information to law firms seeking clients for personal injury claims. 

The details of the deal were contained in secret internal Slater and Gordon documents that revealed HealthEngine was sending the firm a daily list of prospective clients at part of a pilot program in 2017.



The ACCC has also accused the company of passing the personal information of approximately 135,000 patients to insurance brokers in exchange for payments.


"Patients were misled into thinking their information would stay with HealthEngine but, instead, their information was sold off to insurance brokers," ACCC chairman Rod Sims said in a statement.

The information sold included names, phone numbers, dates of birth and email addresses.

The ACCC has not said how much money the company earned form the arrangement.

The ABC revealed last year that HealthEngine had also boasted to advertisers that it could target users based on their symptoms and medical conditions. 

HealthEngine has also been accused of misleading consumers by manipulating users' reviews of medical practices. 

"We allege that HealthEngine refused to publish negative reviews and altered feedback to remove negative aspects, or to embellish it, before publishing the reviews," Mr Sims said. 

Among a range of examples, the ACCC alleges that one patient review was initially submitted as: "The practice is good just disappointed with health engine. I will call the clinic next time instead of booking online." 

But when that review was made public, it was allegedly changed to simply read: "The practice is good." 

HealthEngine is facing a fine of $1.1 million for each breach of the law, but the ACCC has yet to determine how many breaches it will allege....

Wednesday, 31 July 2019

One of the reasons regional living is so good is the size and strength of community spirit


The Clarence Independent, 25 July 2019:



Iluka Bowls Club’s president, Ray Flaherty (4th form right, front), Ann and John McLean (centre with white t-shirts), pictured with bowls club directors and members. Image: Contributed

Iluka Bowls Club has offered to provide land for the proposed ambulance station in Iluka. 

Estimated to come with a $10million price tag, the NSW Government is currently working on “detailed service planning” and “site acquisitions studies” for the proposed station, Clarence MP Chris Gulaptis said after the NSW budget was released in June. 

The bowls club’s general manager, Nicola Donsworth, said the land is located next to the netball court on the corner of Denne and Spenser streets. 

“It would be a perfect central location, with two street accesses, next to the helicopter landing area on the sports oval and next to the skate park and, and as we know, the majority of our town’s population is ageing. 

“It may be necessary to rezone the land but it might be an offer that the council and state government might find difficult to refuse. 

“We are hoping that if this offer is viable it may speed up the process and get this ambulance station established.” Ms Donsworth said the club’s board is in favour of the idea, subject to the club members’ approval. 

Ambulance Action Group spearheads, Ann and John McLean, welcomed the offer.

“The need for an ambulance station in Iluka has become more important than ever,” Ms McLean said. “Response times are getting longer. 

“There have been many incidents where paramedics have been sent from Grafton and Evans Head, due to there not being an ambulance available in Yamba or Maclean.  
“This is often caused because the paramedics are being utilised to transport patients from Maclean to Lismore or the Gold Coast.....

The budget papers list the ambulance station as commencing “prior to March 2023”.

Sunday, 21 July 2019

Coraki still without a local doctor


According to Australian Bureau of Statistics 2016 Census data Coraki and neighbouring Woodburn have a combined population of over 2,000 residents and 499 families.

Half of those residents living in Coraki are over 45 years of age and half of those living in Woodburn are over 42 years of age. While children make up almost 19 per cent of the population of both villages.

Yet the Northern NSW Local Health District cannot even supply a sessional doctor for the health centre at Coraki.

The Northern Star, 20 July 2019, p.7:

Ray Hunt is more frustrated than most about living in a town where the hospital has no doctor.
“If you cut your toe, you can’t go there,” Mr Hunt said.
His late wife Anne used to be the “boss” of the original Coraki Campbell Hospital, before it was closed.
The two-year-old, $4 million Coraki Campbell HealthOne facility looks modern and slick and offers dentistry and dietary appointments but services are limited without a doctor.
Down the road on Thursday, about 10 people gathered to voice their frustration about no sign of a doctor for Coraki.
Eighty-five-year-old Tubby Daley was there. He was born in Coraki. He doesn’t drive so when he needs to see the doctor he has to use limited public transport to get to Casino or Lismore.
Peggy Gooley takes her sick husband regularly to Casino and District Memorial Hospital.
Mrs Gooley failed to understand why they couldn’t have a doctor on rotation, even if the doctor was only in Coraki for two days a week.
A list of 241 names of residents who would use a GP shows the solid customer base in Coraki.
Jennifer Sherwin wore a grim reaper outfit to emphasise how Coraki residents felt about the absence of a doctor.
Ms Sherwin believes the contracts the Northern NSW Local Health District is offering are too restrictive.
Northern NSW Local Health District chief executive Wayne Jones said efforts had been made to recruit a GP for Coraki Campbell HealthOne, however there had been no successful applicants....

Friday, 19 July 2019

Exodus of senior NDIS officials over the last fifteen months


When well-paid senior managementsome in the top percentile of Australia’s income earners – begins to abandon ship it’s time to consider if the Abbott-Turnbull-Morrison Government has finally sunk the National Disability Insurance Scheme.

The Australian, 5 July 2019:

...The NDIA has confirmed deputy chief executive Michael Francis has resigned and will leave in September to take a role “closer to home”.

A spokeswoman also confirmed chief risk officer Anthony Vella has recently departed, along with Antonia Albanese, who was head of markets, provider and market relations.

Ms Albanese and Mr Vella both directly reported to the chief executive.

The Australian has also been told the general manager of critical services issue response, Stephanie Gunn, has quit.

Mr Shorten told The Australian Mr Robert was “either oblivious or delusional” for telling parliament the scheme was being run well.

It is alarming that this group of senior executives lack such confidence in the way the NDIA is being run that they are choosing to leave,” he said. “This scheme is so important for the vulnerable but is being chaotically implemented.

Yet the minister in parliament has told the nation it’s all going swimmingly. He must be either oblivious or delusional.”

The NDIA spokeswoman said: “The NDIA is grateful to our departing senior executives, who have made significant contributions to the NDIS.

The NDIA has a strong and experienced leadership team, focused on continuing to guide the agency to deliver improved outcomes for NDIS participants. Interim arrangements with - experienced personnel have been put in place.”

The confirmation of executive departures came after Mr Shorten tweeted he was “hearing” that four senior staff resigned in the past seven days.

Former chief executive Robert De Luca suddenly resigned in May and is yet to be replaced. Former communications head Vicki Rundle is acting chief executive.

Mr Robert — a key numbers man for the Prime Minister in last August’s leadership contest — yesterday used question time to declare the NDIS was available to “all Australians on the continent”….. [my yellow highlighting]

Thursday, 20 June 2019

Tears before bedtime under The National Strategic Action Plan for Pain Management?



Painaustralia says of itself that it is “Australia’s leading pain advocacy body working to improve the quality of life of people living with pain, their families and carers, and to minimise the social and economic burden of pain on individuals and the community”.

On 11 June 2019 it released a copy of The National Strategic Action Plan for Pain Management having convinced the Morrison Coalition Government that this plan is the bee knees when it comes to pain management.

If the following article is anything to go by it will be tears before bedtime for many chronic pain suffers as the plan does not contain any mention of actually increasing the number pain specialists practicing in Australia or of attempting to lower wait times to see such specialists.

Currently NSW Health only lists 35 pain management services in the state and most of these are attached to metropolitan public hospitals.

Instead people experiencing acute and chronic pain are to be offered 10 Medicare-funded group services and 10 individual services each calendar year, with access to telehealth pain management advice for regional areas where pain management services are not available.

As for pain management using prescribed medications – that is apparently going to be more difficult to access as Painaustralia and the Morrison Government are alarmed that opiate prescriptions in rural & regional Australia have risen in the last ten years. 

Seemingly conveniently blind to any relationship between increased prescribing and low GP numbers, smaller often poorly resourced public hospitals, a reliance on what might be termed 'flyin-flyout' medical specialists who prefer not to live in those rural or regional areas their patients inhabit and the economic tyranny of distance for the patient.

The Daily Examiner, 18 June 2019, p.8:

Doctors will be sent back to school to be re-educated about treating chronic pain and patients given a Medicare boost under a new national strategy.

The first national pain strategy launching today also calls for a national one-stop website to be set up to educate people about how to manage pain without drugs and where to find help.

“There is a screaming need here because pain is a significant burden on the economy, on society and the health system,” Pain Australia chief executive Carol Bennett said.

More than 3.24 million Australians are living with chronic pain and many are becoming addicted to opioid medications while they wait up to four years to see a pain specialist for help.

Last year Australians paid $2.7 billion in out-of-pocket expenses to manage their pain and missed 9.9 million days of work because of the condition.

The new strategy funded by the Federal Government and developed by Pain Australia wants pain to be treated in the same way as mental health, with Medicare funding up to 20 medical and group sessions to help people get it under control. It also calls for a new certificate in pain medicine for GPs and other health professionals that would require six months of study.

The consultation work that took place around the development of the new plan found doctors’ knowledge about the latest pain management techniques was out of date.

“For lower back pain people are popping pills and having surgery but for the last 15 years we’ve known you’ve got to get moving and rehabilitate yourself with physical management,” Ms Bennett said.

Anti-inflammatory medications should not be used for more than a few days and long-term strengthening of the muscles, good nutrition and sleep were the key to treating the problem rather than drugs, she said.

Instead of helping patients manage pain in this way, doctors were prescribing increasing amounts of dangerous and addictive opioid medicines.

Tuesday, 4 June 2019

The National Disability Insurance Scheme continues a bumbling problem-filled roll out during which its clients suffer


Newcastle Herald Sun, 31 May 2019:

AT least 3000 NDIS recipients from regional NSW and Victoria will have to find new care providers after mutual company Australian Unity decided to cut back on disability services to concentrate on aged care in Sydney.

Australian Unity confirmed the decision after concerns were raised with the Newcastle Herald by the Public Service Association.

It did not dispute an assertion by PSA regional organiser Paul James that the decision was a consequence of the financial pressures facing NDIS providers.

The decision comes just three years after Australian Unity bought the NSW Government's Home Care agency in February 2016, picking up 4000 former government employees and 50,000 aged care and disability clients.

Australian Unity said it would "work closely" with the National Disability Insurance Agency (NDIA) to ensure NDIS participants found "another service provider of their choice".

It said 57,000 clients on aged care packages would not be affected. 
It did not expect the NDIS decision to cause job losses but Mr James questioned how this could be.

"Even if they say the majority of their clients are unaffected, there's still 3000 people in regional areas who will have to find new providers," Mr James said.

"The NDIS was originally supposed to be helping people with disabilities into work, but instead it's become an opportunity for the states to ditch their responsibilities for disability services."

Australian Unity said the decision to "scale down" its NDIS services came after a review of its "Home and Disability Services" business - as it renamed the former Home Care agency.

According to the Dept. of Human Services (recently renamed Services Australia) In NSW as of 31 March 2019:

101,963 people have a NDIS service;
4,219 initial plans have been approved; and
34,397 people will be receiving services for the first time.

While according to the National Disability Insurance Scheme (NDIS), 12 April 2019:

There are now 250,000 participants nationwide;
Almost one in three of these participants are receiving disability supports and services for the first time; and
Costs to NDIS clients for individual service delivery have risen between 10.9 per cent and 20.4 per cent from 1 July.

This price rise will include a minimum rise of almost $11 per hour for therapists, and up to a 15.4% price increase to the base limit for attendant care and community participation and appears to be driven by the demands of service providers.

The number of NDIS participants is set to rise to 460,000 at full roll-out in 2020.


Due to the demand for home care packages, for most people, the expected wait time for approved packages is:

www.myagedcare.gov.au

The expected wait time for the level of interim package you agree to receive (while waiting for your approved level to be assigned) is:

www.myagedcare.gov.au
In May 2018 the Commonwealth Ombudsman investigated the National Disability Insurance Agency (NDIA) handling the annual reviews of those already receiving service under a NDIS plan after around one-third of all complaints he received about the scheme related to review issues.

The conclusions drawn was that the NDIS scheme was administratively under-resourced for the rollout task, however there were a number of areas where NDIA could improve its administration of participant-initiated reviews. Otherwise the review process would remain unwieldy, unapproachable and the driver of substantial complaint volumes.

If you are in New South Wales and have a complaint about a support or service you have received under the NDIS, you can contact the NDIS Quality and Safeguards Commission.

Wednesday, 29 May 2019

AMA accuses Morrison Government of deliberately constraining supply of public hospital services


ABC News, 24 May 2019:

"Have you got insurance?"

It is one of the first questions any patient is asked when they walk into an emergency room in the United States, no matter how sick they are.

And now Australian doctors are warning our own health system is shifting towards a similar US managed care model — a patchwork of private and public systems, where health insurers hold an increasing amount of power.

The president of the Australian Medical Association (AMA), Dr Tony Bartone, made the comments as he addressed the group's national conference in Brisbane on Friday.

It was the first time Dr Bartone has spoken since the Coalition was returned to power, and he gave an unusually scathing assessment of Australia's health system and the Federal Government.

He called for further private health reforms, telling doctors the increasing corporatisation of the private health system had given insurers unprecedented power within the health sector.

Dr Bartone warned that could lead to a system similar to the model in the US, where patients experience significant variations in care depending on their insurance cover.

"Insurers should not determine the provision of treatment in Australia, they should not interfere with the clinical judgement of qualified and experienced doctors," he said.

"Australians do not support a US-style managed care health system, and neither does the AMA."

The AMA has consistently called for more money for public hospitals, and on Friday Dr Bartone went even further as he accused the government of "making a choice" to constrain the supply of public hospital services.

"Let me be clear. Public hospital capacity is determined by funding," he said.

"The consequences are significant. They can include increased complications, delayed care, delayed pain relief, and longer length of stay for admitted patients."

Dr Bartone said the system was "stretched so tight" elective surgeries were being cancelled.

"Our public health system should be better than this. It is unacceptable our public hospitals have been reduced to this," he said.

"Our public hospitals are struggling and require new funding to be better tomorrow.....

Friday, 24 May 2019

The 2019 federal election is over - so now the Morrison Government cuts are on again


Patient to GP Ratio [RACGP, General Practice: Health of the Nation,  2018]


Having waited until the 18 May 2019 federal election was over, Prime Minister 'Liar from the Shire' Morrison 7 his cronies are rolling out the funding pennypinching once more - and it's no surprise that it's the very young, very old and the poor who are the targets again.

ABC News, 22 May 2019:

Bulk billing of children and pensioners, as well as home visits to elderly and dying patients, could be scrapped in outer metro areas across Australia because of cuts which doctors say they will not be able to afford.

An incoming change to bulk-billing incentives has pushed GPs to breaking point, medical groups have warned, requiring them to provide crucial primary health services for less than the cost of a barber's cut.

The Federal Government has changed a key geographical classification, scrapping some outer suburban zones of incentives intended for rural areas.

From January 2020, the bulk-billing incentive in outer metro areas will be reduced from about $10 to $6 per patient, per visit.

The changes will affect GP practices in as many as 13 outer metro regions, including in Canberra, Adelaide's south, the New South Wales Central Coast, Geelong and the Mornington Peninsula.

The Australian Medical Association SA president, Dr Chris Moy, said many of the affected regions are low socio-economic areas.

He said the changes could put more pressure on already costly hospital systems, because patients could no longer afford to visit their GPs regularly.

"This is an example of a just a small change. It's not a huge change, but it's enough to break the camel's back," he said.

"It's more difficult for individuals to pay a gap in those situations so it's unfortunate this has happened."

Royal Australian College of General Practitioners president Harry Nespolon said general practitioners in the city and in the country were effectively being asked to work for free.

"The Medicare rebates are insufficient to provide the care that patients need," Dr Nespolon said.

"I don't think people want their GPs to do work for nothing but that's effectively what we're being asked to do.

"If the services become marginal in the sense they don't cover their costs, then they've got a choice — they can either go out of business or charge a fee.

"GPs in practices everywhere, rural or otherwise, are considering whether or not the current amount of rebate if they do bulk bill a patient is able to keep them in business."…….

Quick explanation of rebates:

·       The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate.

·        Each MBS item has its own scheduled fee — this is the amount the Government considers appropriate for a particular service (e.g. getting a blood test or seeing a psychologist).

·        Rebates are typically paid as a percentage of the Medicare scheduled fee. In the case of GP consultations, the rebate is 100 per cent of the schedule fee.

·       This means that bulk-billing GPs agree to charge patients the Medicare schedule fee ($37.60 for a standard appointment) and are directly reimbursed by the Government, and there is no cost to the patient.

·        GPs who don't bulk bill charge a fee higher than the Medicare schedule fee, meaning patients must pay the difference between the schedule fee and the doctor's fee — out of their own pocket.

·       For example, if your doctor charges $75 for a standard consultation, you'll pay $75 and receive a rebate of $37.60 — leaving you $37.40 worse off.

According to the federal Dept. of Health areas which will be losing the higher bulkbilling incentives (for treatment of patients with concession cards and children under 16 years) include:

Mandurah (WA)
Mornington Peninsula (Vic)
Canberra (ACT)
Newcastle (NSW)
Central Coast (NSW)
Queanbeyan (NSW)
Maitland (NSW)
Sunshine Coast (Qld)
Gawler (SA)
Geelong (Vic)
Melton (Vic)
Pakenham (Vic)
Ellenbrook (WA)
Baldivis (WA).

However the existing patient to GP ratio in an area is not necessarily the primary factor in determining who is on or off this list.

It seems you only have to live in an area where the local town/city has grown to over 20,000 residents since 1991 to find GPs being deprived of the full incentive payment per concession card/child patient seen.

Anyone living in the regions mentioned will know that what can appear to be a comfortable patient to GP ratio is not always evenly spread and in some areas certain GPs have already closed their books and are not taking new patients or are having difficulty attracting new GPs to established practices to fill unmet needs.

Just to make matters clear. some of the named places which will see GP incentive payments reduced on 1 July fall into the categories of regional or peri-urban area and, as at 30 June 2018 Australia-wide there were only 6,994 GPs in Inner Regional areas and 3,285 GPs in Outer Regional areas, according the the federal Dept. of Health statistics.