24 November 2003

Senate Inquiry into Medicare

The key elements of the government's proposals are a system of incentive payments for practices that agree to bulk-bill all concession card holding patients and the capacity for participating practices to receive rebates for all their patients directly from the HIC.

At a philosophical level, the government package amounts to a decisive step away from the principle of universality that has underpinned Medicare since its inception. The Committee does not accept the government's argument that, because everyone continues to be eligible to be bulk-billed and receives the same rebate, universality is preserved. This argument is disingenuous and ignores the reality of the incentive system the government seeks to put in place. In practice, a GP will receive more public money to treat a concession card holder than they will for treating a nonconcessional patient. The fact that the incentive payment has a different label to the rebate payment is of minimal practical significance, particularly given the direct rebate of funds to the practice. A Fairer Medicare is about a return to a welfare system.

At a practical level, the policy is focused on 'guaranteeing' bulk-billing of concessional patients in a way that is quite simply unnecessary, since the majority of these people are in all likelihood already bulk-billed. The Committee is inclined to agree that the package essentially focuses on a solution to a problem that does not exist.

Far more serious though, are the practical ramifications of the proposals. If put into effect, the scheme will trigger a fall in bulk-billing for all those who are not concession cardholders. Inevitable problems arise at the boundaries of entitlement, and many Australians in genuine need of bulk-billing will fall just outside the threshold of concessional status including many working families and those with chronic illnesses. These people will face both more gap payments, and overall, a rise in the level of such payments.

The report was written before we got the Medicare Plus proposals. Savings to the budget are not necessarily savings to the economy. The Abbot proposals, while a lot better than 'A fairer medicare', still try and solve the fall in bulk-billing by addressing bulk-billing of concession holders when the problem is almost certainly falling bulk-billing for non-concessional patients. 'Disingenuous' is a kind expression for the government's action.

Link runs to a largish PDF.

No comments: