Medicare Australia State of Play 2016-2018

The Australian Minister for Health and Liberal MP for Flinders Greg Hunt tweeted this on 16 August 2018:

Here are the facts on Medicare:
✅Today’s Medicare data shows a record bulk-billing rate of 86.1%
✅This is 4% higher than anything Labor could achieve
✅Almost 9 out of 10 trips to the GP are free
✅Funding for Medicare this year alone is $5.5 billion higher than Labor put in

— Greg Hunt (@GregHuntMP) August 16, 2018

So what is all this self-congratulatory chest-beating about?

According to the Department of Human Services in 2016–17 a total of 24.9 million people were enrolled in Medicare.

In 2017-18 Medicare recorded a total 419,852,601 Schedule Items on which Medicare benefits were paid.

This figure represents on average 1,672,091 items per 100,000 people.

According to Heath Minister Hunt the Medicare bulk billing rate in 2017-18 stood at 86.1 per cent of the total number of Medicare benefits claimed, leaving 13.9 per cent of Medicare benefits to be claimed by the patient.

Based on 2016-17 figures this would indicate in excess of 13.3 million of these Medicare benefits were claimed online by the patient.

Medicare also recorded 3,318,396 payments of Schedule Item 3 General Practitioner Attendances To Which No Other Item Applies, which is a medical service for which there is a 100% Medicare benefit.

That’s an average 13,216 items per 100,000 males and females between 0-4 years and 85 years or over.

However, none of these statistics reveal the number of GP or specialist doctor medical practices which charge patients an upfront amount above the scheduled Medicare benefit amount.

According to the Royal Australian College of General Practitioners (RACGP) the real percentage of patients who had all their GP visits bulk billed during 2016–17 was an est. 66 per cent.

Which meant that an estimated 34 per cent of GP patients in that financial year paid an upfront cost that might not have been able to be fully claim from Medicare.

The Australian Medical Association (NSW) in a 2018 statement suggests that these patients are likely to be paying an average of $48.69 in out-of-pocket fees.

The Australian Institute of Health and Welfare states in its Health Services Series Number 80  that in 2016-17 there were 7.8 million attendances at public hospital emergency departments and “at the conclusion of clinical care in the emergency department, 61% of presentations reported an episode end status of Departed without being admitted or referred”, which indicates that this percentage may contain an unspecified number of individuals who attended a public hospital emergency department because a bulk billing GP was not practicing in their local area and they were not able to readily afford an upfront fee or additional out-of-pocket expenses.

ABC News reported* on 17 August 2018 that:

> 1.3 million people delay seeing a doctor because of the cost;
> 1 in 2 Australian patients faced out-of-pocket costs for non-hospital Medicare services, with the median cost sitting at $142 per person;
> almost 35 per cent of out-of-pocket expenses were spent on specialist services, while almost 25 per cent went to GP gap payments; and
> a further 12 per cent was spent on diagnostic imaging services, like radiology.

Greg Hunt's tweet has definitely avoided facing the Medicare elephant in the room. 

* Based on MyHealthyCommunities: Patients' out-of-pocket spending on Medicare services 2016–17 released August 2018.

Turnbull Government's data retention privacy blunder just rolls on and on...

“If data can be re-identified with no more than SQL, there's no "if" about a leak, and the "when" is history.” [Journalist Richard Chirgwin, Twitter 18 December 2017]

“But why are medical records so attractive? Well, it turns out that there’s a metaphorical holiday feast of enticing data served up in your average health record. Family history, demographic data, insurance information, medications, etc. means there’s enough information to completely steal an individual’s identity and commit medication fraud, financial fraud, insurance fraud and a wide array of other crimes. When this very private, unchangeable information gets into the wrong hands, devastation can ensue.” [Robert Lord writing in Forbes, 15 December 2017]

First the Australian general public were told that patient data was well protected and data breaches wouldn't happen as a result of government's drive to collect, cross-match and retain as much information about each and every Australian citizen/permanent resident as possible.

Then when the inevitable day came where poor data security was laid bare - as the personal histories of 550,000 blood donors were placed on an insecure computer and accessed, as Medicare details began to be offered for sale on the Internet's dark web and Medicare itself became careless with its encryption -  the public was told in the first instance that misuse was unlikely, in the second instance that personal medical information couldn't be accessed and that patients couldn't really be individually identified in the third instance where a billion line encrypted data set was publicly released.

After that the Turnbull Government assured the population that it would create legislation which would make it illegal for anyone to de-encrypt anonymised data and create a Notifiable Data Breaches scheme.

We were all going to be safe once more in the arms of the Turnbull Government.

Now the cat is out of the bag, because that billion-line 30 year's worth of personal health information about est. 3 million people just won't stay in the back of the ministerial cupboard where Greg Hunt shoved it.

 [Fairfax journalist Ben Grubb, Twitter 18 December 2017]

The Sydney Morning Herald, 18 December 2017:

One in ten Australians' private health records have been unwittingly exposed by the Department of Health in an embarrassing blunder that includes potentially exposing if someone is on HIV medication, whether mothers have had terminations, or if mentally unwell people are seeing psychologists.

A report, published on Monday by Dr Chris Culnane, Dr Benjamin Rubinstein and Dr Vanessa Teague from the University of Melbourne's School of Computing and Information Systems, outlines how de-identified historical health data from the Australian Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS) released to the public in August 2016 can be re-identified using known information about the person to find their record.

The study reveals unique patient records matching the online public information of seven prominent Australians, including three (former or current) MPs and an AFL footballer. While a unique match may not always be accurate, Dr Rubinstein said there was the possibility to improve confidence by cross-referencing other data.

"Because only 10 per cent of Australians are included in the sample data, there can be a coincidental resemblance to someone who isn't included," he said.

"We can improve confidence by cross-referencing with a second dataset of population-wide billing frequencies. We can also examine uniqueness according to the characteristics of commercial datasets we know of, such as bank billing data."…….

Privacy analyst and Lockstep consultant Stephen Wilson said the breach damaged public confidence in health policy makers and data custodians.

"It's a huge breach of trust," he said.

"Promises of 'de-identification' and 'anonymisation' made by health officials, and ABS too in connection with census data releases, have been shown to be erroneous.

"The ability to re-identify patients from this sort of public release is frankly, in my view, catastrophic. Real dangers are posed to patients with socially difficult conditions.

"It beggars belief that any official would promise 'anonymity' any more. These promises cannot be kept."

Computer security researcher Troy Hunt said re-identification of anonymised records was attractive to researchers and nefarious parties alike.

"In this case, clearly more work needs to be done to protect individuals' identities,' he said. "My hope is that the government embraces responsible research like this and strives to improve confidentiality rather than penalise those seeking to report deficiencies such as this."

The federal Department of Health was notified about the issue December last year.

"The Department of Health takes this matter very seriously and had already referred this to the Privacy Commissioner," a Department of Health spokesperson told Fairfax Media......

Meanwhile, the Office of the Australian Information Commissioner, which houses Australia's privacy commissioner, said it was investigating the publication of the datasets.

"The investigation was opened under section 40(2) of the Australian Privacy Act 1988 (Privacy Act) in late September 2016 when the Department of Health notified the OAIC that the datasets were potentially vulnerable to re-identification," a spokesperson said.

"Given the investigation into the Medicare Benefits Scheme (MBS) and Pharmaceutical Benefits Scheme (PBS) datasets is ongoing, we are unable to comment on it further at this time.

However, the commissioner will make a public statement at the conclusion of the investigation."

The OAIC said it continued to work with Australian government agencies to enhance privacy protection in published datasets.....

Can anyone believe anything Australian Human Services Minister Alan Tudge and his motley crew say?

The New Daily,  21 November 2017:

The Department of Human Services flagged the illegal sale of Medicare details on the dark web almost a fortnight before the illicit trade was exposed in a bombshell media report, The New Daily can exclusively reveal.

Internal emails, obtained under freedom of information laws, reveal that department officials discussed the security issue as early as June 22 – nearly two weeks before revelations that Medicare numbers were being sold online.

On July 4, The Guardian revealed that a dark web vendor was advertising the sale of any Australian’s Medicare number for the bitcoin equivalent of just $22 after exploiting a government system vulnerability.

In the wake of the revelations, Human Services Minister Alan Tudge said that he and his department had only learned of the illicit trade when contacted by a Guardian journalist on July 3.

However, high-priority correspondence within DHS shows that senior officials discussed the trade on the dark net, which is only accessible through a customised browser, nearly two weeks before it made the news.

On June 22, Rhonda Morris, national manager for serious non-compliance, raised the issue with Kate Buggy, national manager for internal fraud control and investigations, and Mark Withnell, general manager of business integrity, as well as several unnamed officials.

In a later email on July 3, Mr Withnell apparently connected The Guardian’s inquiries to the department’s earlier discussions on the issue, writing to colleagues: “This is the one I was mentioning last week.”

It is unclear exactly what DHS knew about the sale of Medicare details on the dark web prior to July’s media report.

Citing exemptions related to law enforcement and criminal investigations, the department redacted most of the content of the emails released to The New Daily.

It refused to release numerous other related emails entirely.

A DHS spokesman denied the department had knowledge of a specific breach in June and said its internal discussions had only related to general matters……

In September, DHS told the Senate that as many as 165 people may have had their Medicare numbers sold to unknown parties, although there had been no unauthorised access of any Australian’s health records.

Last month, a seperate review commissioned by the department recommended beefing up the authentication procedures required to access the online database used by healthcare professionals.

Although the AFP is continuing to investigate the source of the breach, the government has said it was likely the result of “traditional criminal activity” rather than a cyber attack.

In February, DHS was embroiled in controversy after it released the personal information of a Centrelink recipient to a journalist in order to diffuse claims she made in the media.

If you're not feeling well but think things can't get any worse - you forgot to factor in the Australian Minister for Health's cost cutting ways

The Age, 4 August 2017:

State and territory health ministers say hospital treatments and services will suffer under a Commonwealth proposal to withhold budgeted funds and reduce spending.

Federal Health Minister Greg Hunt has drafted a directive to the Independent Hospital Pricing Authority to review its public hospital funding method.

It would result in retrospective funds not being paid and reduced services in future, Queensland Health Minister Cameron Dick said in a joint statement issued after the COAG Health Council meeting in Brisbane on Friday.

Mr Hunt drew condemnation from Queensland, Victoria, Western Australia, South Australia, the Northern Territory and the ACT when he confirmed he would uphold the direction.

"States and Territories have already funded services and boosted frontline staffing taking into consideration Commonwealth funding," the statement said.

Independent Hospital Pricing Authority (IHPA), media release, 17 July 2017:

IHPA releases Consultation Paper on Pricing Framework for Australian Public Hospital Services 2018-19

The Independent Hospital Pricing Authority (IHPA) today released its Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2018-19. The consultation is open to the public until Thursday 17 August 2017.

The Pricing Framework for Australian Public Hospital Services 2018-19 outlines the major policy decisions which will underpin the National Efficient Price and National Efficient Cost Determinations for 2018-19.

This year IHPA will seek feedback regarding work that has been progressed on pricing and funding for safety and quality as well as canvassing options to enable new and innovative approaches to value based or preventative health care models.

The Chair of the Pricing Authority, Shane Solomon said, “IHPA has continued to work closely with the jurisdictions, clinicians and other stakeholders to make significant progress on the implementation of national reforms to incorporate safety and quality into the pricing and funding of public hospitals in Australia.

“A range of factors must now be considered including risk adjustment and how the approach can be embedded as part of broader system change.

“The success of a safety and quality pricing and funding mechanism is dependent on national, state, and local health systems working together to support the implementation of a model and ensure that it is working to improve safety and quality across all services,” he said.

“The Consultation Paper is an important opportunity for stakeholders to engage with IHPA on the approach to pricing and funding for safety and quality as well as the emergence of new innovative pricing models to help improve public hospital services across Australia. We strongly encourage all interested parties to provide feedback as part of this process,” concluded Mr Solomon.

The Consultation Paper on the Pricing Framework for Australian Public Hospital Services 2018-19 is available on the IHPA website.

Submissions should be emailed as an accessible Word document to submissions.ihpa@ihpa.gov.au or mailed to PO Box 483, Darlinghurst NSW 1300 by 5pm on Thursday 17 August 2017.

– ENDS –

Independent Hospital Pricing Authority (IHPA), Ministerial Direction, 16 February 2017:

Ministerial Direction

On 16 February 2017 IHPA received a Ministerial Direction from the Hon. Greg Hunt under section 226(1) of the National Health Reform Act 2011.

The Direction requires that IHPA undertake implementation of agreed recommendations of the COAG Health Council on pricing for safety and quality to give effect to:

1. nil funding for a public hospital episode including a sentinel event which occurs on or after 1 July 2017, applying to all relevant episodes of care (being admitted and other episodes) in hospitals where the services are funded on an activity basis and hospitals where services are block funded; and
2. an appropriate reduced funding level for all hospital acquired complications, in accordance with Option 3 of the draft Pricing Framework for Australian Public Hospital Services 2017-18, as existing on 30 November 2016, to reflect the additional cost of a hospital admission with a hospital acquired complication, to be applied across all public hospitals; and
3. undertake further public consultation to inform a future pricing and funding approach in relation to avoidable hospital readmissions, based on a set of definitions to be developed by the Australian Commission on Safety and Quality in Health Care.

IHPA will incorporate the requirements under this Direction into the final Pricing Framework for Australian Public Hospitals 2017-18 due to be published on the IHPA website in early March 2017.

IHPA will undertake further consultation as part of its annual consultation process on the draft Pricing Framework for Australian Public Hospitals 2018-19 due for publication in June 2017 and provide a report back to the COAG Health Council by 30 November 2017.

Note: This follows on from a Direction received on 29 August 2016 which required IHPA to provide advice to the COAG Health Council on options for pricing for safety and quality.

More information

For any questions, please contact enquiries.ihpa@ihpa.gov.au

Links

• View the full Ministerial Direction online
• View previous Direction from 29 August 2016

Would you trust these men with your personal health information? Part Two

Left to Right: Minister for Human Services and Liberal MP for Aston, Alan Tudge

& Minister for Health and Liberal MP for Flinders, Greg Hunt

The Guardian, 8 July 2017:

The government found itself facing heavy criticism this week over how it handles Australians’ personal information, after a Guardian investigation revealed a darknet trader was illegally selling the details of any Medicare card holder on request by “exploiting a vulnerability” in a government system.

The data had been for sale since at least October 2016, and the seller appears to have sold the Medicare details of at least 75 Australians…..

“What’s happening is the community is wrapping these attacks together and seeing them as a threat, and it adds to a perception that their data is not safe,” said Australia’s privacy commissioner, Timothy Pilgrim. “All the players need to work out a way to build up that trust.”

But why do these breaches keep happening? And is the government doing everything it can to stop them, and reassure the public when they do happen?

After being alerted by the Guardian to the Medicare breach, the minister took swift action, referring it to the Australian federal police for investigation. Pilgrim welcomed this as an appropriate response…..

The most critical risk to Australians from the misuse of Medicare card data is one of identity fraud. A fake Medicare card with legitimate details can get a criminal a quarter of the way to an entire fake ID. This could then be used by organised crime groups in any number of ways, for example by leasing property or equipment. It could also be used to fraudulently obtain services from Medicare itself.

In this case, the darknet was the vehicle for this particular identity fraud scam. But it didn’t need to be, and it is likely similar, less-sophisticated scams are taking place right now.

Tudge has used an unusual line to explain the breach. He has said it was not a hack or cyber attack, but “traditional criminal activity”. What he’s edging around is that his department believe this was a case of an individual using a legitimate method to access Medicare data – but for an unauthorised and illegal purpose.

But contrary to Tudge’s assertion, access control is very much a matter of cybersecurity. And there are a lot of problems with the way Medicare card details can be obtained.

For instance more than 200,000 individual users can potentially look up Medicare card details through the department’s system. The department has declined to answer whether each access is logged, which could allow it to trace when a particular card was looked up. If those controls aren’t there, it’s unlikely the darkweb vendor selling this data will be found.

It doesn’t mean someone sitting in a doctor’s clinic has been supplying the data. A prospective patient could show up at a GP’s reception, pretending to be someone else, and just ask for that person’s Medicare card details. Guardian Australia has spoken with one employee at a medical practice who said people regularly asked for their card details to be supplied.

Identity fraud using Medicare cards is coming to be seen as a big problem in the government. The human services department acknowledged in February 2016 that there had been 1,500 “probable” cases of Medicare fraud, a jump from 269. The Australian reported that in 2014 the justice minister, Michael Keenan, set out to quantify the scale of Medicare card fraud taking place. A study found Medicare cards and driving licences were the mostly commonly used forms of ID for fraudsters.

The problem appears to be growing worse as those given credentials to access Medicare card details legitimately has increased – jumping 25% in the last financial year – and as organised crime groups grow more sophisticated in their methods.

All of this contributes to the loss of trust….

Would you trust these men with your personal health information? , 5 July2017

Would believing Australian Health Minister Greg Hunt's denials be the height of foolishness?

Along with making home-owning aged pensioners pay for their Centrelink/Vet Affairs pensions by way of a debt against the value of their houses, it appears as though funding private hospitals at the expense of public hospitals may be on the Liberal-Nationals-Murdoch-IPA Coalition wish list.

A list voters never actually get to see unless the Liberal and National parties are re-elected to government - at which time its contents are usually presented to the electorate as fixed policy.

Here it is. Minister claims to 'rule out' hospital funding overhaul but taskforce continued to meet. You can't trust Turnbull with Medicare. pic.twitter.com/3THdSs3kkx

— Senator Murray Watt (@MurrayWatt) May 29, 2017

Basic outline of unsubmitted recommendations of the
Global Access Partners (GAP) Taskforce on Hospital Funding

Via Twitter

The Sydney Morning Herald, 29 May 2017:

Health department bosses have described their radical proposal to remake hospital funding as "future gazing" after the Turnbull government declared it would never adopt the controversial policy.

The private health insurance rebate would be abolished, consumers would be charged more for extras cover and the states would be forced to find more money for public hospitals under the plan.

As revealed by Fairfax Media on Monday, the nation's most senior health bureaucrats – Department of Health Secretary Martin Bowles and his deputy Mark Cormack – are members of a secretive taskforce formed to develop the policy around a "Commonwealth Hospital Benefit" (CHB).

Health Minister Greg Hunt immediately ruled out adopting the policy.

"Not government policy. Won't be government policy. Will never be government policy," Mr Hunt said.

Mr Hunt said the taskforce – funded by the department but run by a private think tank called Global Access Partners – pre-dated his time in the portfolio and he had already told bureaucrats he was not interested: "I've rejected it once. If it ever comes forward, I'll reject it again."

Officials attended a GAP meeting that explored the proposal just four days after Mr Hunt apparently told them not to pursue the idea in March.

And Mr Cormack met with members of GAP as recently as May, two months after they say Mr Hunt ruled out the proposal…..

They insisted there was nothing secret about the taskforce even though it was never announced, never released anything publicly and branded its material – leaked to Fairfax Media – as "confidential".

Mr Bowles insisted the taskforce was fully independent – even though the government paid for it with a $55,000 contract…….

Under the plan, the Commonwealth would "pool" the approximately $20 billion it currently gives to public hospitals each year with the $3 billion it pays to private sector doctors and the $6 billion it spends on the rebate to help people pay their private health insurance premiums. 

It would use the money to pay a standard benefit for services regardless of whether they are performed in a public or private hospital, or whether people choose to be treated as public or private patients.

While the Turnbull government struck a three-year hospital funding deal with the states last year, it has flagged it wants a more long-term, less ad-hoc agreement – and a CHB proposal could fit the bill. COAG is set to revisit the issue of hospital funding next year to set the course for a post-2020 agreement.

News.com.au, 29 May 2017:

He told Senate Estimates yesterday it was his job as head of the department to look at the future of health funding.

He confirmed the department had entered into broad policy work on the proposal.

However, it emerged he did not put the $55,000 contract for the consultancy work to tender.

Mr Bowles said he gave the work to Mr Peter Fritz, the head of GAP, after they met in 2016 and told the Senate it was possible for him to award contracts for work costing less than $80,000 without a tender process.

Senator Watts probed Mr Bowles about connections between GAP and the Australian Health Research Centre which is funded by a number of large health insurers.

Members of the AHRC attended taskforce meetings, he revealed.

However, Private Healthcare Australia which represents insurers has raised major concerns about the plan.

“I’m genuinely stunned,’ Private Healthcare Australia chief Rachel David said when she was told the work had been paid for by taxpayers.

“It was a dramatic overhaul of the health system that totally changed the role of private health insurance, eliminated the difference between public and private hospitals and wold have put doctors on salaries,” she said.

“It would have been inflationary, there was no demand management,” she said.

This is what Global Access Partners Pty Ltd (formerly CSD Pty Ltd estab.1969) says of itself:

Global Access Partners (GAP) is an influential network that initiates high-level discussion on global issues, encouraging the sharing of knowledge, progress and policy change. Through its events, GAP promotes Australia’s capacity to find solutions to the challenges facing the worldwide community, and translates these solutions into business opportunities.

It appears to have been founded by:

Peter Fritz - who besides being GAP Chair & Group Managing Director of TCG Pty Ltd also chairs a number of influential government and private enterprise boards - and Catherine Fritz-Kalish currently GAP’s Managing Director.

Its offices are at 71 Balfour St, Chippendale NSW 2008 Australia.

GAP sees its participation in health public policy to date thus:

* The Australian National Consultative Committee on Health (formerly known as the Australian National Consultative Committee on e-Health) was established as a result of Global Access Partners’ 2004 Forum on ‘Better Health Care through Electronic Information’.

The ANCCH represents the major ICT industry players and other stakeholder groups. The Committee contributes to the debate around the public and private health agenda in Australia with a view to promote and realise better patient health outcomes through the application of changes to process, and the interaction of technology to improve efficiency, safety and productivity.

The group also provides a forum for public-private partnerships in order to promote improved execution and industry development.

The Committee  raises issues of national importance, influences government policy and supports the interests of its members. Its four broad areas of interest are agency coordination, chronic disease management, connectivity and infrastructure, and change management.

The ANCCH initiatives in the area of health and wellbeing over the last seven years have ranged from discussions of national health policy to the problems of implementing an Australia-wide e-health infrastructure and the potential applications of genetic testing in drug therapy to the management and long term funding of chronic "lifestyle" diseases in an ageing Australian population.

* GAP Taskforce on Government Health Procurement (2015-2016) is a cross-sectoral multidisciplinary group established by Global Access Partners to analyse Australia’s public health procurement and offer practical proposals for reform (see final report). The Taskforce considered the impact of procurement processes on the age and reliability of medical equipment, service levels, innovation and competition. Its final report highlights some of the inefficiencies of current health government purchasing  and calls for a more rational tendering process to reduce costs and waste in the system, while improving the quality and safety of care.

The Turnbull Government has been offering half-truths to voters once gain

In its 2017-18 Budget the Turnbull Government announced it would commence the phased re-introduction of Medicare Benefits Schedule rebates indexation.

Treasurer and Liberal MP for Cook Scott Morrison stated in his Budget Night speech that “We are lifting the freeze on the indexation of the Medicare Benefits Schedule. We are also reversing the removal of the bulk-billing incentive for diagnostic imaging and pathology services and the increase in the PBS co-payment and related changes.”

It now appears that it was premature to expect that out-of-pocket expenses for a number of radiology and diagnostic imaging services might be contained after the rebate freeze was lifted for these services in three years time.

The Sydney Morning Herald, 16 May 2017:

The Medicare rebate thaw will not apply to 93 per cent of scans, including the X-rays, MRIs and ultrasounds used to diagnose some of the most common forms of cancer.

Health Minister Greg Hunt's staged four-year thaw has been widely welcomed by doctors' groups such as the Australian Medical Association and the Royal Australian College of GPs. Under the plan, indexation will gradually be reapplied to bulk-billing incentives, visits to the doctor and allied health services.

On budget night, the Turnbull government said the final stage of the thaw, due in July 2020, would lift the freeze on "targeted" radiology and diagnostic imaging services - the first indexation since 2004.

Prime Minister Turnbull puts pressure on the Senate to back the increase to the Medicare levy after the release of two new opinion polls. Vision courtesy Seven News Melbourne.

But new Department of Health figures reveal precisely how "targeted" the changes will be: the freeze will be lifted on 59 of the 891 radiology items listed on the Medicare Benefits Schedule - just 7 per cent.

While mammograms and a number of CT scans will be indexed under the plan, X-rays, MRIs, PETs and ultrasounds for such common conditions as brain, lung, breast and ovarian cancer will not. The rebate on common scans for arthritis and nuclear medicine will also remain frozen. [my yellow highlighting]

As for the promised reversing of the increase in the Pharmaceutical Benefits Scheme (PBS), this is only the potential for a flow-on effect from other changes in the PBS and is in no way guaranteed to occur.

The Murder of Medicare in Australia

Labor’s Medicare Locals integrated health care scheme ceased operations on 30 June 2015 when the Abbott Government replaced it with the Primary Health Networks scheme.

The Abbott and Turnbull governments’ grand plan for further ‘reforming’ Medicare service delivery swam into view on News.com.au and other media platforms on 30 March 2016:

SEVEN MILLION people in the country with chronic diseases like diabetes, heart disease and cancer will have to enrol with a single medical practice under a revolution in GP care to be announced by the Prime Minister today.

Patients will get to choose the GP practice that will co-ordinate all of the medical, allied health and out-of-hospital services they need.

And those with multiple chronic illnesses will get a care plan individually tailored to meet their needs.

Instead of paying their doctor a fee for service every time they receive treatment for their chronic illness, the government will give doctors a quarterly lump sum payment to care for the patient.

A fee for service will still be paid when the patient sees the doctor for other illnesses such as the flu or broken bones or other acute illnesses.

And the performance of doctors will be checked by the government via a new information bank that will measure patient outcomes at a local level and highlight areas for improvement.

Malcolm Turnbull says enrolling patients in a single medical home will help keep people with chronic diseases out of hospital by giving them evidence-based treatment.

This it turns out was merely announcing stage one in the introduction of the Health Care Homes model, which in October 2016 saw Prime Minister Turnbull and Health Minister Ley officially announcing the selected regions, based on Primary Health Network boundaries, for Stage One implementation of Health Care Homes. These include: Perth North, Adelaide, Country South Australia, South Eastern Melbourne, Western Sydney, Tasmania, Nepean Blue Mountains, Northern Territory, Brisbane North, as well as Hunter, New England and Central Coast in New South Wales.

The Hunter New England and Central Coast Primary Health Network includes, but is not limited to, the following locations: Armidale ,Bulahdelah, Cessnock, Forster, Glen Innes, Gosford, Gunnedah, Inverell, Moree, Muswellbrook, Narrabri, Nelson Bay, Newcastle, Quirindi, Tamworth, Taree and Tenterfield.

Therefore in NSW the scheme will be initially implemented in three primary health care networks which stretch from western Sydney through to the NSW-Qld border.

By 4 November 2016 this scheme had quietly morphed in right-wing political backrooms into this according to the Herald Sun:

THE nation’s sickest cancer patients and people with diabetes and other chronic illnesses will get a maximum of $1795 worth of GP care a year funded by Medicare under a revolution in the way doctors are paid.

And Medicare will fund just five extra visits to the doctor if these people need medical attention for issues aside from their chronic illness under the Turnbull Government’s Health Care Homes model.

Doctors were expressing deep concern about the adequacy of the payment levels that were released without consultation with medical groups on November 4.

“The modelling is concerning and potentially leaves the whole program at risk of falling over because of being underfunded from the beginning,” AMA vice president Dr Tony Bartone said.

The Health Care Homes policy is a signature government policy which it claims will solve the woes of the Medicare system by providing comprehensive care for one in five Australians who have a chronic illness, keep them out of hospital and save the health system money.

Patients will have to enrol with a single GP practice to get a new form of wrap around health care under the model but Doctors are worried they’ll get less money than they receive now to care for the sickest patients.

Currently doctors are paid on a fee for service model and get paid $37 by Medicare every time they see a patient for a standard 20 minute visit, they get paid more for longer visits.

There are no limits on how many times a patient can see a doctor and get a Medicare rebate.

Under the new model patients with the least complex chronic conditions will get $591 a year worth of GP care, those with a slightly higher level of complexity will get $1,267 worth of GP care and the most complex patients will receive $1795 worth of care.

The sickest 12 per cent of patients account for 40 per cent of Medicare benefits and on average they receive 51 services a year, Dr Seidel said.

The maximum funding under the government’s health care homes model is only enough to cover 48 GP visits a year, or less than one per week.

Dr Seidel says a patient with diabetes and an infected leg would need to visit the GP at least three times per week to get it dressed.

The RACGP had asked the government to provide doctors with an extra $300 per patient per year on top of existing funding to make the new Medicare model work.

The current funding suggests doctors will be receiving less than they currently get.

Dr Bartone said the Health Care Homes model was based on a long standing method of paying GPs for caring for war veterans.

So now we all have a slightly clearer picture of how multi-millionaire Malcolm Bligh Turnbull and his fellow travellers intend to further pervert Medicare’s aim of providing universal health care.

Those with a chronic or complex medical condition will be tied to one general practitioner or medical practice and be restricted as to how many times a year they can see their doctor. Bulk billing is not guaranteed if that is not the policy of the medical practice/GP with which they are enrolled and, if they require more than 48 standard GP visits a year they may possibly be forced to pay the full cost of any additional ‘chronic illness’ visits . As for any other type of illness or injury they might experience – only five extra GP visits a year will be covered by a Medicare rebate [See update below].

At the moment participation on the patient’s part is allegedly voluntary, however if they agree to enter the Health Care Homes scheme they are forced deeper into the Abbott and Turnbull Governments’ insecure national database and ongoing government data retention scheme.

According to the Australian Dept. of Health, enrolment of up to 65,000 patients begins in 2017 and implementation of services delivery begins on 1 July that same year and continues through to the end of stage one on 30 June 2019. During this initial stage, Health Care Homes services will be limited to Medicare-eligible patients with two or more complex or chronic conditions.

Ongoing evaluation and refinement of Health Care Homes is also promised which probably means that, like e-Health aka My Health, the scheme will cease to be opt-in and become opt-out - or possibly even mandatory.

The Turnbull Government intends to fund Stage One of Health Care Homes by redirecting $93 million in MBS funding between 2017-18 and 2018-19 and providing an additional $21.3 million over the next three years to establish the design principles, IT systems and provide the training needed to assist health care providers to transition to the new system.

Thus far, this new scheme appears to offer no enhanced or additional health services to the chronically ill or those with complex medical conditions - it presents as nothing more than another federal government cost-cutting measure wrapped up in a public relation bow.

Stay tuned for the next instalment in the ongoing saga, “The Murder of Medicare”.

UPDATE

Turnbull Government backs down on capping number of extra GP visits for illness or injury not related to patient's chronic or complex medical condition. However, all other Medicare 
limits impacting on health services delivery to chronically ill patients appear to remain.

News.com.au, 9:35pm 8 November 2016:

The cap on doctor’s visits was revealed on Friday when the government announced details of its keystone Health Care Homes trial.

The trial will see 65,000 chronically ill patients in 200 GP practices enrol with a single GP practice for all their health care.

The Health Department revealed doctors would be given an annual budget of between $591 and $1795 a year to care for these patients, a budget doctors say amounts to a pay cut.

And in a fact sheet the Department of Health said:

“Enrolled patients can still access fee-for-service billing for a small number (up to five) of episodes of care not related to a patient’s chronic conditions”.

On Monday, in a tweet, Health Minister Sussan Ley denied there was a cap of five visits.

“No limit to Medicare fee for service under health care homes. 5 appts departmental guide only. Opt in not capitation. Co-designed with docs!”

Mysteriously, and without a new press statement, wording of the department’s fact sheet on Health Care Homes was changed on Monday to remove the five visit rule:

“Enrolled patients can still access fee-for service episodes of care not related to a patient’s chronic condition”.

Yesterday Ms Ley tweeted “Capped visits were never on the table”.

In response to an inquiry a spokesman for Health Minister Sussan Ley said the Department of Health said it had “changed its fact sheet on payment information”.

“The Department amended it to make it clear that there is no hard cap or limit on the capability of GPs to bill MBS services not related to an enrolled patient’s chronic conditions. The Department says it had nominated five as a notional number for planning purposes for these services and that it was based on clinical advice. The number of fee-for-service episodes of care will not be capped or restricted and will be monitored during stage one of Health Care Homes,” he said.