The big chill

4 minute read

This month’s horror budget has left many GPs with little choice over bulk billing


This month’s horror budget has left many GPs with little choice over bulk billing

With an unprecedented display of unanimity, doctors have rallied to fight the federal budget decision to extend the Medicare rebate freeze for another two years to 2020.

The campaign focuses on what the freeze will mean to patients and the potential impact on the health of Australians, and encourages GPs to engage with their patients on the issue, using the slogan “You’ve been targeted’’.

The RACGP-led campaign stresses the freeze will result in those who are most vulnerable putting off seeing their GP, resulting in greater overall costs to the health system.

Doctors groups are also unanimous in warning that many GPs’ business models will collapse, and some will get out general practice entirely as a result of the budget decision.

The prolonged freeze is expected to save government $925 million, but no modeling has been done on the ramifications for doctors or patients’ out-of-pocket costs, despite the prospect of a looming election, health bureaucrats have admitted.

According to early results from an RACGP poll, 30% of GPs say they plan to abandon bulk-billing because of the freeze.

“That’s quite a figure – almost a third of GPs say they will cease bulk-billing,” RACGP president Dr Frank Jones told TMR.

“Some GPs have told us they will have to close their practices. Some have told us they will have to cut back on administrative and staff hours. Others have told us they’ll have to cut back on the medical supplies they stock.

“And many, many, are reconsidering bulk-billing of all or some groups of patients.”

The government says the current bulk-billing rate of 84% of GP services, an all-time high, is proof that GPs have adjusted so far to the rebate freeze introduced in 2013, and their response was “difficult to predict”.

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Andrew Stuart, a Health Department deputy secretary, told the Senate Community Affairs Committee that GPs had a range of choices.

“Because we are involved in a competitive environment, where GPs not only have to think about their billing practices in relation to their income, they also need to think about their billing practices in relation to the competition in their region,” he said.

“There are a range of possible GP responses to changes in the rebate. Obviously there is accepting an income reduction. There is doing extra consultations. The average hours worked by GPs have fallen quite a lot in the last 10 or 15 years…

“Essentially, we believe that it is competition from the increased doctor supply that is driving the bulk-billing rate,” Mr Stuart said under questioning by Greens Leader Richard Di Natale, a former GP.

The budget measure, estimated to cost the average full-time GP $50,000 in income in 2019-20 compared with 2014-15, has sparked a sense of betrayal and alarm among doctors who have absorbed the impact of the freeze so far, and had been told by Health Minster Sussan Ley she wanted to restore indexation as soon as possible.

“There was an implication that the freeze would be lifted after the PHCAG (Primary Health Care Advisory Group) report was done (in December),” Dr Jones said. “There is no logical reason why it should not be lifted.”

Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said the government appeared deaf to the evidence that investing in primary care resulted in fewer hospital admissions and saved overall health dollars.

“We can’t keep telling the same old story over and over again,” Dr McPhee said. “Obviously, the government doesn’t give a rat’s.”

Doctors were really torn, he said. “Particularly in rural areas, you cannot just increase your activity. People living in low-income rural areas simply can’t afford to pay a co-payment. Some practices will be sent to the wall.”

Former RDAA president Dr Paul Mara said the profession needed to fight for better than a rebate regime which has never served GPs well.

“The key point everyone agrees with is that GPs trying to do a good job are being sacrificed by this system,” Dr Mara told TMR.

“A political campaign is not going to achieve what everyone wants, which is a legitimate income for providing a quality service.”

The solution lay in freeing up the system so doctors could charge extra and society could still take advantage of bulk-billing arrangements, he said.

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