Sunday, 1 March 2015

Co-pay or no pay - there are options

"The ABC says [health minister] Ley recently told a small group of backbenchers the $5 payment plan would be scrapped, but the government will freeze the indexation of the Medicare rebate." - The Guardian, 28 February 2015.

“The Government’s Budget measures… appear to be driven by ideology rather than based on evidence and have not been developed within a vision and framework of systemic reform. ... 

“Ideology favouring private enterprise over public sector delivery should not be the driver for determining how MBS and PBS claims and payment services should be provided.” - Australian Medical Association, September 2014.

"The AMA strongly opposes the $5 cut to the Medicare patient rebate, the freeze on Medicare patient rebate indexation until July 2018, and the Government's flawed GP co-payment model. Put together, these policies would have a devastating effect on the provision of quality primary health care services to the Australian people." - Brian Owler, AMA, 26 February 2015.
“The prime minister has made it very clear that we won’t be pressing ahead with significant reform in that space without industry-wide consultation.” - Josh Frydenberg, 28 February 2015.

(Getty Images)

It’s understood PM Abbott might ditch the co-payment this week. He has spoken of listening to doctors regarding any changes to the policy.  Some might assume the doctors have given only minor feedback on the matter other than disagreement. In reading a media release from the AMA dated 21 August 2014, and their submission to the Select Committee on Health’s inquiry into health policy in September last year, one finds the Association indeed had much to say on the matter.

The AMA’s president Assoc Prof Brian Owler, called on the government to “dump its seriously flawed GP co-payments proposal” - he also wished for the AMA’s model to be adopted instead.

Brian Owler, (via News Corp)

The AMA said their co-payment model not only protects the vulnerable, encourages quality care and supports prevention and chronic disease management, it “also sends a price signal for non-concession patients.” Ah. There’s that well-loved, well-used, too-oft-repeated term: “price signal”. The Abbott government ought to embrace the model for that phrase alone.

[Note: The following figures from AMA are in response to government proposal of a $7 co-payment. It has recently been reduced to $5.]

The AMA's press release stated:

“The AMA has long supported well-designed and well-intentioned co-payments, and that is what we are releasing today. 
"Co-payments already exist. About 20 per cent of GP visits currently attract a co-payment.”

Their proposal is for a minimum $6.15 co-payment for all patients, the government would pay for those with concession cards and patients under the age of sixteen.  There would be no cut to the Medicare rebate. “All co-payments would be included in determining whether or not the Medicare safety net has been reached.” 

“The AMA has proposed that the minimum Medicare co-payment be fixed at the level of the existing bulk-billing incentive for GP services in metropolitan areas (currently $6.15), with annual indexation applied. 
"GPs may continue to charge more than this amount, as is currently the case.”

Under the AMA scheme, there would be far less red tape than the government model as it’s restricted to standard GP consults only (easier to administer, though the AMA “is open to” co-payments for pathology and diagnostic imaging), the ten visit threshold is removed, plus those of “disadvantaged patient groups” would be identified using “well understood and accepted systems”.

To encourage doctors to require a co-payment, if a GP doesn’t charge a co-payment (under applicable circumstances) “then Medicare will only provide a rebate equivalent to the lower A2 rebate level.” 

Now here’s news we haven’t heard as much as, golly, Medicare is unsustainable, oh my, panic now please: 

“The share of health spending as a proportion of the Commonwealth Budget has reduced by 2% since 2006-07” with state and territory spending remaining fairly constant…. “and certainly does not indicate that health expenditure is unsustainable.” Health spending in 2010 was 8.9%, lower than the OECD average of 9.3%.

Later in their submission to the Health Inquiry, the AMA states:

“The Government is justifying the health budget measures on the basis that Australia’s health spending is unsustainable. It is not. … Australia can afford the health system it currently has.

In addition to this, the AMA asserts that “utilisation of general practitioner services is not out of control.” Since 2007-08 there has been 1.5% in population growth, Medicare funded GP services have grown by 2.47% and GP services per capita grew on average by 0.94%; meanwhile, GP workforce numbers increased by 3.5%.

Also, the costs of medicines aren’t running wild like we're led to believe. In the last ten years, the Pharmaceutical Benefits Scheme grew an average of a measly 1.2% each year. In fact, in 2012-13 the PBS expenditure decreased by 2.1%

The AMA lists quite a number of criticisms of the government’s plan. Here are just a few:

The most obvious is that it unfairly targets the most vulnerable, but it also is far too complicated in its application and would place cost, admin and time burdens on practices. There is also the cumulative effects to consider. In the first three years, the government scheme (this analysis includes the $5 cut to Medicare rebates) would cost patients $3.5 billion. Changes to the PBS would mean $1.3 billion in costs to patients over the first four years. Overall, government changes to Medicare and PBS (as per AMA’s assessment re the government's policy in September 2014) would place a burden of $8.4 billion onto patients in the first four years. (Rough calculations showed if the $5 rebate cut was offset by a $7 co-payment, the difference would mean an additional cost on patients of $1.4 billion.)

In regard to aged care, it is well known that patient numbers are steadily increasing and, in living longer (though no one’s sure about Joe’s optimistic 150 years), residential aged care facilities are dealing with an increase in older patients. 

The AMA says the average number of GP visits for residents is 15 a year, adding this is not frequent enough to properly manage those with complex needs. And while Medicare rebates are payable to those GPs providing services to aged care facilities, the AMA’s submission believes “the current rebates are inadequate to cover the real costs of providing services.” The AMA also recommends recognising the aged care sector as a part of the health system. 

Along with an increasing numbers of elderly requiring care from GPs for their complex needs, the AMA notes that patients with chronic conditions make up more than a third of all problems managed. These area require changes to the structure of the Medicare system which currently assumes “one size fits all” and fails to target further resources toward patients with higher needs.

Here’s something else to worry about. 

Our medical workforce numbers won't be sufficient to meet future needs. “Australia’s medical workforce planning capacity has been significantly diminished as a direct result of the 2014/15 Budget.” Plus, the AMA sees the workforce shortages in regional and rural areas as “a major health issue” (and supports the implementation of regional training networks).

Some further info: Govt spent $286 per person for GP visits in 2012-13. “GPs provide all the care needed for 90% of the problems they encounter. … Services provided by GPs provide very good value for money and are an efficient means of utilising scarce health dollars.”

Whatever the government chooses to do this week regarding their crusy co-payment barnacle, it cannot whine about lack of an alternative plan.