New figures from Cleanbill suggest that upcoming reforms to Medicare are unlikely to meet government expectations, but the Members Health Fund Alliance says it’s time to try something new.
Letting insurers into primary care would be the next logical step in supporting Australia’s universal healthcare system, according to a group of non-profit health funds.
The renewed call to allow private health insurance to cover GP consults – it has been barred from covering out of hospital care for which there is an existing MBS item since 1984 – comes on the back of a new analysis from healthcare directory Cleanbill.
According to the new report, the additional funds from the incoming bulk-billing PIP and expanded bulk-billing incentive payment will not be enough to convert the majority of GP clinics to universal bulk billing.
“The vast majority (72%) of GP clinics are located in metro areas, where the new total Medicare payment is still $16 below the current average total cost of a non-bulk billed standard consultation,” the paper said.
“Because clinics can’t supplement the new total Medicare payment with out-of-pocket costs, it only makes economic sense for clinics to accept the bulk-billing incentive instead of charging an out-of-pocket cost if… their current out-of-pocket costs are lower than the national average (as is the case in much of South Australia ) or… they are located in more remote areas (as is the case in Tasmania and the Northern Territory).”
It is worth noting that Cleanbill’s report assumes there are only two options for GPs – private billing and universal bulk billing, in which the practice receives both the bulk-billing incentive and the BB PIP.
This does not reflect the existence of mixed-billing clinics, which will receive the bulk-billing incentive on all patients that are bulk billed, but may still charge a proportion of patients an out-of-pocket cost and therefore won’t receive the BB PIP.
Federal health minister Mark Butler has dismissed Cleanbill’s previous reports and questioned how robust its methods are.
He has held firm that detailed Department of Health, Disability and Ageing modelling indicates that GP bulk-billing levels will reach 90%.
The Members Health Fund Alliance, the peak body for Australia’s 25 non-profit health insurers, claimed that Cleanbill’s modelling presented a “stark warning”.
“We’re really concerned that people are putting off GP appointments or are not necessarily seeing their GP when they should be,” alliance CEO Matthew Koce told The Medical Republic.
“And I think it’s incumbent on the government to look at how they can perhaps leverage the private health system to help support our universal healthcare system.”
Mr Koce said the push for private health in general practice was about supporting GPs, not “taking control away”.
“We should have all options on the table,” he said.
“We should be discussing all options and looking for a way forward that’s going to deliver the best possible outcome to consumers.
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“We’re already seeing some of the big corporate private health insurers moving into primary care – they’re buying and operating clinical practices. That’s already starting to happen.”
Last year, for-profit health fund Bupa launched telehealth platform Blua, which provides free video consults to members.
It was only able to do this because Medicare does not fund telehealth consults between a GP and patient who have never met face-to-face.
This year, Bupa announced its intention to open 130 GP clinics and 60 mental health clinics over the next few years.
Mr Koce called the idea that allowing insurers into primary care will result in American-style managed care “a long bow to draw”.
“I just can’t see a US-style managed care system taking place in Australia,” he said.
“It just won’t happen because it’s a very different system.
“We’ve got good regulation … this is just about allowing health insurers to help cover out-of-pockets in a GP setting.
“They already do it with dental, optical, physio and a range of other services through extras.”
