Doctors Reform Society of Australia
			supporting health care reforms to ensure justice, equity and quality care for all
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BULK BILLING AND THE DESTRUCTION OF MEDICARE

 All Australians know what bulk billing is, the hassle free health care that they have paid for in taxes.

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%.

 So what does this mean for patients? In areas where rates are very low, patients have several options. They can pay the forty, fifty, or sixty dollars if they can afford it, or they can delay seeing the doctor, simply not go to the doctor, or go to the public hospital emergency department. In areas where they can find a bulk billing doctor, they will probably have to wait a long time in a full surgery to see an exhausted doctor struggling to cope with inadequate resources, wondering how long he or she can continue to provide high quality care for everyone. So, unless the patient can afford the payment, the end result of any of these options is likely to be poorer health care.

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 paid to GPs per consultation 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 would be increased by the removal of current Government restrictions on provider numbers and training places, and an increase in medical school intake.

 The Doctors Reform Society would suggest that increased support for comprehensive medical centres with salaried GPs would be of huge benefit.

After months of declining bulk billing rates, the Health Minister has finally recognised that there is a problem. The suggestion to address the problem by targeting the needy or means testing is a disaster for all Australians and a nail in the coffin of Medicare. Medicare is a public health insurance scheme for everyone. Everyone pays premiums through taxes. Everyone is entitled to the product of that insurance scheme. The product is access to high quality health care. It is not a scheme to help the poor. It is not a safety net. It is universal cover.

 Thus, any targeting of services on the basis of socio-economic status, geographical area, number of doctors per capita, is immediately supporting a two tiered health system divided on the basis of the selection criteria. Targeting will leave many patients struggling because for example, they live in a middle class suburb but are the poor people of that suburb, or, they are not quite needy enough. Those targeted will be seen as different by the GP and staff and, as already happens, will be treated differently: ‘you can wait while doctor sees the paying patient’. Those patients who are not targeted will wonder why they are paying their Medicare levy and taxes to support Medicare which doesn’t support them.

 But the targeting proposal should be seen in the light of other major health financing decisions taken by the Howard Government, the private health insurance rebate, gap cover, and the proposed increase in drug copayments. All these initiatives are designed to convince Australians that Medicare is a ‘safety net’ and if you have money, you can pay more and get better care. The Doctors Reform Society believes that these assertions are false and that most Australians agree that Medicare is meant to be for everyone. It is a UNIVERSAL health insurance scheme. But, with a continuation of the current policies, we are seeing the piecemeal destruction of Medicare. In spite of assertions to the contrary, that is the agenda. And 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

Radio National

April 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.
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