Let the market find solutions for consumers who can pay (as it does currently) but put an ambulance at the bottom of the cliff for those who can’t.
Dear Mark Butler,
I’m sorry we haven’t had a chance to catch up – I’ll put a ForHealth Group sign out the front to catch your eye … but I digress.
I wanted to tell you why I’m sad about your bulk-billing changes coming in November. Like most mixed or private-billing GPs I was initially sad about Anthony Albanese flashing his Medicare card, saying it worked the same as a Visa at the desk (despite the $60 difference between my charge and what it pays).
But I’m extra sad at the opportunity we lost to help patients that desperately need that Medicare card to deliver Amex black card status.
Like a lot of gap-billing GPs I like to pretend I’m hard-nosed when it comes to fees. “That’s between you and the government – my fee is my fee”.
In reality I’m a giant socialist deep inside and about 30% of my services are actually bulk billed. Within that group is a desperately sad collection of patients that need my help more than anyone.
When I took over my practice I inherited a few absolute heart sinks. Multi-morbid patients with tragic tales that require huge amounts of care coordination and GP input. They cannot afford my gap. But I see them and lose money every time. I cannot sit opposite them, look them in the eye and tell them to go somewhere else. Often because they literally have nowhere else to go.
I speak often about how we service consumers in general practice but these people are very much patients. They depend on the health service to function. They aren’t going to be picked up by a virtual care-backed telehealth provider.
They need the taxpayer to be a backstop to their care and fee-for-service ain’t cutting it.
So, when you poured billions of dollars into incentives to bulk bill incidental care for my middle and upper-class patients, you left my desperately ill patients out in the cold.
There was an opportunity to reform primary care to help those who actually need it most but instead you pegged your KPI to bulk-billed access for all.
So, what should you have done differently?
The super short version is, accept there is a divide between those who can pay and those who can’t. Leave a basic fee-for-service scheme in the background. But also offer salaried GPs to low SES and complex patients who cannot fit into the FFS model.
Direct any new large amounts of public funding into multidisciplinary salaried clinics.
Stop ignoring the huge numbers of young GPs who are no longer interested in the payroll tax avoidance game. Leverage the fact they would rather have a salaried position so they can focus on their complex patients.
Another group will want to work in private FFS clinics with a gap. And that’s fine.
Let the market find solutions for consumers who can pay (as it does currently) but put an ambulance at the bottom of the cliff for those who can’t.
Every other part of the public health system has a fallback for those who can’t afford private care. Except the most important part of all — primary care.
Dr Max Mollenkopf is a GP and practice owner in Newcastle, NSW. This article was first published on his LinkedIn feed. Read the original here.
