21 January 2004

Rebate may not help bulk-billing

The federal government's $935 million GP rebate scheme was unlikely to improve bulk-billing and could see the bulk-billing level slip to 60 per cent, health experts said.

Health academics, appearing before a Senate committee examining the government's revamped $2.4 billion Medicare Plus package, agreed the $5 rebate would do little.

The rebate is an incentive for GPs to bulk-bill children and the poor and is a key component of Medicare Plus.

Professor Jane Hall, from the Centre for Health Economics Research and Evaluation, said the rebate may halt the decline in bulk-billing - which is at 14-year lows of 67 per cent - but would not reverse the trend.

Australian National University professor John Deeble, the architect of Medicare, predicted bulk-billing levels would stabilise around 60 per cent with the introduction of the rebate.

'The $5 is not going to lure back people who have reduced or ceased bulk-billing but I think it would hold the proportion up,' he said.

Academics pointed to doctor shortages rather than increased costs as the driver for falling bulk-billing.

'What seemed to be driving down the rates of bulk-billing was the fall in supply,' Canberra University health economist Ian McAuley said.

Prof Hall agreed doctor numbers were to blame but he was doubtful increasing the supply was the answer.

The Senate committee already concluded that special arrangements for concessional bulkbilling are an answer to a nonexistent problem because the vast majority of concession cardholders are already bulkbilled. The real answer is to restore the bukbilling fee to its 1996 level (adjusted for inflation). Even a $5 increase in the bulkbilling fees would be better than what the government is proposing.

On another issue, I blogged a few days ago about the need to include at least concessional dental services in Medicare. I had missed the fact that we already pay massive subsidies for dental care through the private insurance rebate. If we already have an anticoncessional dental service, the ALP would do well to transfer the anticoncessional dental expenditure to concessional dental expenditure.

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