Doctors Reform Society of Australia
			supporting health care reforms to ensure justice, equity and quality care for all
| What's New | About Us | Articles | Letters | Journal | Search | Media Releases | Policies | Links | Discussion Board |

BULK BILLING AND THE PIECEMEAL DESTRUCTION OF MEDICARE

 When Medicare was introduced in 1984, only 52 % of GP consultations were bulk billed. By 1996 when the Howard Government came to power, the rate of bulk billing was up to 80.6%. It has since fallen to 69.6%.

The bulk billing rate is falling for many reasons but the central one is that GPs are not happy with their working conditions. In addition a lack of competition due to a shortage of GPs is a factor especially in country areas.

 General practice needs support. An increase in the rebate is required. But by itself, rebate increases are not enough. The Doctors Reform Society recommends a package to support bulk billing, a package directed to bulk billing practices only. That package could include financial support for a practice nurse, medical indemnity costs, practice administrative costs, capital funding for infrastructure, and a bonus payment of  $10,000 / year.

GP numbers need to be increased as the government has belatedly suggested (after limiting provider numbers and training places since it came to office).

 Increased support for comprehensive medical centres with salaried GPs would be of huge benefit.

 The Government has finally recognised that there is a problem. It has attempted to re write history by suggesting that Medicare was never meant to be about bulk billing if one could afford to pay but rather that it was meant to be a so called ‘safety net’. Nothing could be further from the truth. It was envisaged as a public health insurance scheme for everyone. Everyone pays premiums through taxes. Everyone is entitled to the insurance product: access to high quality health care. It is not a scheme to help the poor. It is not a ‘safety net’, not welfare. It is universal cover.

The plan by the Government to allow doctors to charge the patient just the copayment, and then electronically access the rebate quickly has short term superficial attractiveness and long term disastrous consequences. Patients would not have to pay so much up front, so instead of finding the forty, fifty, or sixty dollars, they would only have to find fifteen, twenty five, or thirty five dollars. But the idea of bulk billing was always to make it the hassle free and preferred method of payment. This change would mean doctors would be more likely to ask for copayments, and if they already charge them, they would be more likely to increase them bit by bit and for many patients they would be hefty payments. Even fewer patients would be bulk billed. Then, with private health insurance allowed to cover the hefty payment, premiums would rise even faster than the current rate of 7% per year.

 This is about a return, not to two tiered, but to three tiered medical care. The most needy will be clearly identified by their health care card, and sadly will be treated accordingly by some staff and doctors as different, as the non paying patients. Those who can afford the ever increasing, uncapped, taxpayer funded private health insurance premiums will have timely access to whatever health care they choose. Those working Australians who cannot afford private insurance will just have to pay more, and more, and more. Those who suffer from chronic disease could easily be paying hundreds of dollars per month to access proper treatment. Those whom we are hoping will attend for preventive health advice will definitely think twice about the visit.

We should be alert and alarmed. The Howard Government’s major health financing decisions, the private health insurance rebate, gap cover, the proposed increase in drug copayments, and the latest proposals, are all about the piecemeal destruction of Medicare and the introduction of US style credit card medicine. That is a system where the commonest cause of personal bankruptcy is failure to pay medical bills, where nearly twice as much per capita is spent on health care in the US compared to Australia and where life expectancy is shorter.

 These changes are based on the Howard belief that a public health insurance scheme is wrong, that access to health care should be related to one’s income, and that a so called `safety net’ is the way to manage the health needs of the most desperate. Such a system is not Medicare, it is welfare. Medicare is a UNIVERSAL health insurance scheme. When it is turned into a safety net by John Howard (with the support of the AMA), the result will be that all Australians will miss out as health costs skyrocket, ‘safety net’ standards fall and the value of the Medicare card plummets.

Dr Tim Woodruff

President

Doctors Reform Society

Published in Australian Doctor

March 2003

.		.	The Doctors Reform Society of Australia, Box 992 Gosford 2250 Phone 02 9264-9084 Fax 02 9267-4393.	.
			This page was last updated on 16 June 2003.
Articles Menu | What's New | Home Page | Top of Page