With Medicare rebates, specialists are very special

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GPs only account for 5% of total expenditure, yet this is where the government makes cuts, writes Dr Bastian Seidel


GPs only account for 5% of total health expenditure, yet this is where the government chooses to make cuts, writes Dr Bastian Seidel

“I was in and out in two minutes, and they told me that I needed a new referral and also that you should backdate it.”

I’ve lost count of how often I have heard my patients saying that, after they have come back from seeing a medical specialist, be it in private practice or in a public hospital. Over and over again. It’s become predictable. It’s also expensive, and quite often a waste of time.

I wonder why among the debate and political drama about Medicare co-payments and six-minute medicine, our esteemed colleagues in the tertiary care sector seem to be exempt. In Australia, it is the tertiary care sector that is the main cost driver in the healthcare system. Not primary care, and certainly not general practice.

Yes, 80% of all consultations in general practice are bulk-billed. Whether that’s a good or bad thing is debatable. The fact is though, that general practice Medicare item numbers account for less than 5% of the total health expenditure nationally. Therefore, one really has to question what services account for the remaining 95%.

No, this is not about the income of medical practitioners at all. I’m not going to point out that the average taxable income of a GP in Australia is now less than half the average taxable income of a hospital specialist. I would not do that. After all, we GPs had a vague idea about the very limited income potential when we applied to be admitted to our cost-effective but underfunded vocational training scheme.

It’s not about income. It’s about funding. And it’s about our patients’ Medicare rebate. It’s about common sense when it comes to the Medicare rebate.

Common sense would see equality of GP and specialist consultation item numbers.

Here’s the thing: if a GP refers to a specialist, the initial consultation attracts a substantial rebate: $75.25, almost double the value compared to a subsequent consultation ($36.55). So, the rebate for the subsequent consultation is pretty much on par with a standard level B consultation of up to 20 minutes duration in general practice.

Even then, there is no time-based descriptor for specialist item numbers. Whether the consultation is 19 minutes or two minutes (as with my patient above), the specialist Medicare rebate remains the same. Is this equitable? No.

Even if the specialist has seen the patient 25 times before for the same condition, the moment a new referral has been issued, it attracts a higher rebate. Is this sensible? No.

So, there are two options now. We could demand that the time descriptor for GP item numbers needs to be withdrawn. GPs are the only health professionals monitoring the length of our consultations (and yes the average is 14 minutes rather than the commonly quoted six minutes), but thanks to the defunding of BEACH, nobody is going to survey that for much longer anyway. Very clever.

We could also argue that the first consultation with a GP after the patient has been seen by a specialist should also attract double the standard Medicare rebate.

In fact, it should attract triple the standard Medicare rebate if no communication from the specialist has been received in time. And while we’re at it, why not make it the norm whenever the patient has seen any other healthcare provider? But let’s keep it plain and simple. As applicable to our specialist colleagues, that first consultation should be double the standard Medicare rebate. Would that be fair? Yes.

But it’s not going to happen. Equity, equality, fairness and value are not part of the Medicare Benefits Review, or any politically influenced health policy initiative. Some medical associations would cry foul too. That’s what lobby groups do: protect the loud majority of members by selling out the silent few.

It’s sad and disappointing. So, I will have to continue to write new referrals when requested, and make indefinite referrals when I can. After all, it is the patients’ rebate, not the doctors’. But even if I wanted to, I can’t backdate them. Rather, I could ask the specialist to ‘forward-date’ the appointment. But no, that would be illegal…

Dr Bastian Seidel is a GP in Tasmania

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