Labor will ‘test the boundaries’ of the Constitution when it comes to curbing high out-of-pocket specialist costs.
“Non-GP specialist fees are out of control, and they genuinely are becoming a barbecue stopper,” federal health minister Mark Butler proclaimed this morning.
He was speaking on Nine Newspapers’ Inside Politics podcast and followed up his thoughts with an ABC News breakfast interview.
While GP bulk-billing rates were a focus of the Labor government’s first term of office, Mr Butler said he and his colleagues are moving on to the cost of specialists.
“[We’re hearing] stories of people not going to a specialist because they can’t afford the out-of-pockets, or not having a procedure because they can’t afford the out-of-pockets, or if they do have the procedure, getting news about the out-of-pocket [cost] only the day before. So that has got to be a focus of more work,” he said.
Mr Butler’s concern was that fees are become a barrier to accessing care. Already there is legislation being debated that would allow the government to publish specialist charges. However, he is also investigating other options, he said.
“Every option is on the table.
“There have been, for a long time, arguments that there are constitutional limitations on our ability to regulate specialist fees.
“We intend to test the boundaries of that,” he said.
Doctors were united in their response to government, saying blaming specialists was ignoring some of the bigger reasons why healthcare is becoming increasingly expensive for consumers.
President of the Royal Australasian College of Surgeons, Professor Owen Ung, while admitting that some specialists do charge excessively, he estimates it’s in the minority.
“I’m talking less than 5%, maybe 2% to 5%, that are charging well beyond what is reasonable,” he said.
He didn’t believe focusing on that group was going to fix the problem.
“We don’t agree that we can solve the problem by raining down on specialist fees,” he said.
“We actually need to fix the system that underlies why specialist fees have become higher and higher and higher. And it isn’t because doctors want to charge patients egregiously.”
AMA president Dr Danielle McMullin told The Medical Republic that most doctors were charging reasonable fees for their services.
“And what hasn’t kept pace is Medicare rebates, private health insurance benefits and the funding of our public hospital outpatients,” she said.
Decades of under-indexation and half a decade of Medicare freeze had left the rebate out of reach for the cost of care.
“While recent government injections into Medicare bulk-billing incentives are positive and have improved access to care, these relate to a tiny fraction of the more than 5000 MBS items,” she told TMR.
Related
“These are ‘bolt-on’ incentives, not Medicare reform. And they don’t do anything if you need to see a specialist for a consultation, a privately billing GP, or need surgery.
“The continuing attacks on doctors are neither helpful nor focused on the kinds of significant reforms that would make a difference,” she said.
Professor Ung agreed that Medicare rebates weren’t high enough.
“You see that the government approves private health insurance premiums, that last one was up by 4.4%. They get approved by the government from time to time, which means that the government obviously recognises that the premiums need to rise.
“But do you ever see the Medicare rebates rising by the same amount?” he asked.
He said increasing them simply wouldn’t be enough.
“There’s no way, we understand, that government are going to be able to put the Medicare rebates up to where they need to be, such that patients will get the appropriate amount of reimbursement following their procedures.
“And the longer we go on like this, the bigger the gaps are going to become,” he said.
To help improve access to private and public healthcare, the AMA is advocating investment in public hospital outpatient clinics and a review of private health insurance settings.
“There hasn’t been a large review since the gold, silver, bronze categories were introduced, and it’s high time to have another look at those,” said Dr McMullen.
“There are other policy levers, like the Lifetime Health Cover loading, the Medicare levy surcharge and private health insurance rebates that government has left on autopilot, and so the value of those has degraded over time, and private health insurers are also profiting more than ever before.”
Professor Ung is thinking even bigger. He said activity-based funding needs to be reconsidered in favour of outcome-based remuneration.
“Let’s start measuring and paying for quality service and clinically indicated service. Let’s not pay for things that aren’t indicated,” he said.
The problems are multifactorial and so are the solutions, he said.
“The solution forward for the community is for governments and colleges and universities to all work together. Not to take a position where we’re going to scapegoat a certain sector of health,” Professor Ung concluded.
