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.
