Making sense of the $25 rebate

5 minute read

This seems a laughably small recompense for general practice to take the covid load off hospitals.

When I first read about the new $25 rebate for GPs to treat covid-19 patients, I initially misread this as $2500.

I thought “what a good idea” and considered how this could save money by keeping patients out of large hospitals.

Please indulge me, dear reader, as I take this fantasy a little further!

For that sort of money you could approach a local small private hospital and customise a few rooms, maybe a wing? “PPE” could stand for “Positive Pressure Equipment” with puffy spacesuits with their own internal air supply. You could install negative pressure fans in the rooms and keep them all properly isolated. 

But then everything went all wavy and the dream ended.

The reality is we will be getting $25. The amazing things we could do with this paltry sum may also be a fantasy. With this money we are supposed to be able to treat covid patients in general practice. Let’s consider that for a moment, because up until very recently (and in some states this is still true), if you have a patient with covid in your surgery then the clinic gets shut down for several weeks, staff have to go home and quarantine and all the patients have to be contact traced. There is no way that these $25 rebates are going to come close to covering the lost income with repeated shutdowns.

So, presumably, these rebates are going to be applying in a new world where we are “living with the virus”. Everyone has been immunised and everyone is having a booster every six months. Ok, maybe not everyone is immunised. Maybe it is 80%? Or maybe it is 80% of the “eligible population”, which excludes children. So, you are treating covid patients in your surgery and you take that virus home and give it to your children who get sick and now you have to stay home and look after them and not go to work and these losses are presumably covered by the new rebate. Ok, let’s assume the children are now all immunised as well. Does this now mean nobody gets sick from this virus? Or more specifically, does nobody get sick with the past strains, the current more contagious delta strain, and possibly more virulent/contagious strains in the future? 

If people don’t get sick any more as they are immunised, then you don’t need to worry about PPE. You don’t need to worry about oxygen saturation measurements nor cleaning the surgery afterwards nor facemasks nor any of the precautions we have been taking over the last 18 months. If this is true, you don’t really need the $25 rebate because you are going to be treating these people the same way we treat coughs and colds and the flu. 

On the other hand (and this is more likely), if people are getting sick despite being immunised, then how exactly are these patients going to be managed? Do the staff wear PPE? If you do wear PPE do you wear it for all patients? The $25 rebate only applies for covid patients, so that is a lot of PPE where the costs are not being covered. You can’t afford to do that so maybe you just wear PPE for the known or suspected covid patients. The patients will see this and some will now be wondering if the person with a cough that was sitting next to them had covid. How does reception handle those questions? You can’t give out confidential medical information yet it is obvious to anyone what is going on. How do you handle the inevitable complaints to regulatory authorities?

Looking ahead to what the government is planning, it appears this $25 rebate only applies to face-to-face consults. The government has also said it is planning for telehealth to be wound back. This presumably means a return to how things were before covid, with waiting rooms full of patients. No telehealth and lots of sick people in one place. I’m old enough to remember the concept of “chickenpox parties” where you would deliberately try to get your children infected early in life as the illness is milder. Is this the plan – let the virus run free? 

It is hard to envisage a scenario where this $25 rebate is useful. If you are trying to keep covid patients out of your clinic (eg by phone triaging patients with colds into telehealth) then you are not going to have covid patients in the clinic face to face, so you can’t claim the rebate. On the other hand, if you are encouraging covid patients to come in, then you can claim the rebate but the real costs are going to be much higher than what this rebate pays. 

What is the scenario where you can claim this rebate and it makes financial sense?

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