David Scrimgeour
The Coalition government is currently spending millions of dollars in an advertising campaign to convince the Australian people that the recent legislative changes with "strengthen" Medicare.
Not only is this a blatant waste of taxpayers money, it could also be considered false advertising — because the changes will not strengthen Medicare. The government is hoping to capitalise on the community confusion about what has changed.
The government proposed changes to Medicare in early 2003, in a package called "A Fairer Medicare" — a somewhat cynical title given that the plan was clearly to dismantle Medicare.
This package was so blatantly unfair that it was met with widespread opposition from the community and health professionals. The government subsequently came up with an alternative, called MedicarePlus, that it hoped would be more acceptable.
Some components of MedicarePlus — including a new Medicare item number to allow an extra $5 per consultation to doctors bulkbilling children and health care card-holders — were introduced without legislative change in 2004. The other proposed changes required legislation to be put through parliament.
To get it through the Senate, the government negotiated with the four independents, who agreed to pass the legislation with certain revisions. The revised MedicarePlus was passed by the Senate in March 2004. Below is a summary of the main changes it has brought in.
The 'safety net'
This is the main thrust of MedicarePlus, and despite being its main selling point, is also its main problem. It represents a change in the fundamental philosophy of Medicare. Medicare was supposed to be a universal health insurance system, which ensured that everybody in Australia had access to the same level of health care. Now there is an inbuilt expectation that costs of health care will be so prohibitive for some that a "safety net" is required.
The "safety net" is available to some families or individuals who have already spent $300 in out-of-pocket medical expenses in any one year, and to other families or individuals after a total of $700 has been spent. Once these thresholds have been reached, the safety net will pay 80% of further out-of-pocket expenses incurred outside hospital.
One of the problems of this system is that it relies on the individual to keep records of their costs. They are expected to request a receipt from the provider every time there is an out-of-pocket expense, and to keep these receipts to present to a Medicare office. Many people who would most benefit from the "safety net" are people who, for various reasons, are unlikely to keep the required documentation.
The "safety net" is also likely to lead to a further erosion in bulk-billing, particularly by specialists, as there will be an understanding that the government will help with the costs of out-of pocket expenses (i.e. gap payments) once a certain level is reached. Specialists will be encouraged to increase the level of gap payment, on the assumption that it will be beneficial for the patient (and the specialist's income) to reach the "safety-net" threshold.
Increased bulk-billing incentives to some areas
The original MedicarePlus included an extra $5 for GPs who bulk-bill concession-card holders and children. The initial evidence is that this has resulted in a slight increase in the rate of bulk-billing, but it is unlikely that this will be sustained.
Doctors who have already stopped bulk-billing usually charge a gap of more than $5, so they would lose income if they recommenced bulk-billing. The long-term effect of this initiative may be a slowing in the rate of decline of bulk-billing, but it is very unlikely to halt or reverse it.
The "incentive" has now been increased to $7.50 in regional and rural areas and all of Tasmania — a reflection of the horse-trading that the government had to do with the independent senators from Tasmania.
The introduction of "incentive" payments for some groups and areas not only makes Medicare more complex to administer, it also weakens the universality of Medicare.
Allied health services and dental health care
The recognition that certain allied health services, and dental services, should be reimbursable under Medicare is worthy of support. However, this will only be available for people with certain chronic conditions, whose GPs work in an accredited practice and undertake "Extended Care Plans" for such patients. The particularly weird aspect of this component is that the Medicare rebate will only be payable to the GP, not the allied health-care provider (AHP).
How this item will be organised remains unclear. The original announcement implied that GPs will be expected to act as brokers, having to negotiate a fee with the AHP, collect the Medicare fee and then pass this on to the AHP. GP groups are understandably unhappy about this requirement and have suggested an alternative, but which still involves a lot of red tape. Overall, it is unlikely that this component of MedicarePlus will be taken up in significant numbers except perhaps by GPs who work for health-care corporations that can negotiate arrangements with AHPs.
The complexity of this component indicates that the government has no real desire to widen access to Medicare-funded services. It was a poorly thought-through component that the government tacked on to the package to get the support of the independents, in order to change Medicare from a universal health insurance system to a welfare safety-net.
4. Other components which are unrelated to Medicare
These include: new medical school places; networked electronic medical records; and new criteria to determine whether a region classifies as regional, remote or metropolitan.
These components of the package are health-care innovations that the government was obviously planning to introduce, and which it decided could be included as part of the overall package. None of these components, however, are directly related to Medicare.
It is clear that the Coalition government wants Australia to have a health care system that is designed to minimise public spending and maximise profits for private corporations, rather then to improve the health of the Australian people. The US health care system, which is expensive, and inequitable and has worse outcomes than Australia — shows what will we could face if we do not defend Medicare, which Howard and Abbott are hell-bent on dismantling.
[David Scrimgeour is a member of the Socialist Alliance.]
From 91×ÔÅÄÂÛ̳ Weekly, June 23, 2004.
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