- by Anna Pha
- The Guardian
- Issue #2036
Photo: Anna Pha
Since its introduction in 1984, Australia’s national health insurance scheme, Medicare, has been under constant attack from the privateers. Medicare is an anathema to their profit-driven philosophy of user pays. Private health insurance funds have long sought to get their hands on Medicare.
The Medicare Schedule of rebates encourages short, fast through-put consultations as doctors’ rebates have been frozen or failed to keep up with rising costs for decades.
Bulkbilling has been undermined by stealth as more and more GPs charge fees leaving patients out of pocket by $30, $40, $50, or much more in many instances. It is almost impossible to get into remaining bulkbilling practices in some suburbs and regional and rural Australia.
General practice is the bricks and mortar of the health system, where preventative care, education and early detection can result in better outcomes for patients, avoid hospitalisations while making huge savings for the public purse.
Health care has increasingly been turned into a commodity – provided for profit – with ability to pay a major determinant in access and outcomes for patients.
A new, highly profitable industry of online prescription services has emerged where companies such as InstantScripts (see Dingo Bytes) and Prime Medic offer prescriptions online from registered doctors.
Scripts are available by completing an online questionnaire and not speaking face-to-face with a doctor, with bulkbilling an option. Telehealth consultations are also offered.
Prime Medic, for example, offers online prescriptions; medical certificates; specialist, pathology, and radiology referrals.
Its website boasts 50,000 plus “weekly visitors” and ninety-two plus doctors. When contacted by the Guardian, Prime Medic clarified that the 50,000 plus referred to the number of people who used the service in a week. It did not mean they just visited the website.
Simple arithmetic suggests that each doctor is providing scripts, referrals and other services for around 500 customers per week or 100 a day over a five-day week! No wonder the company and doctors can afford to bulkbill. So much for knowing patients or continuity of care!
Proposals for pharmacists to be able to issue scripts keep surfacing, with claims about relieving the pressure on GPs to free them up for patients with chronic conditions.
What we see emerging is a second-class health stream for people on lower incomes and with chronic health conditions. Research has established that those in the lower socio-economic brackets are more likely to have multiple chronic diseases than wealthier Australians.
REVIEW OF MEDICARE
In July, the Labor government established the Strengthening Medicare Taskforce which is due to report by the end of the year. Its stated focus is on “improving primary health care in Australia,” with particular reference to improving patient access to general practice; GP-led multidisciplinary team care; making primary care more affordable for patients; improving prevention and management of ongoing and chronic conditions; and reducing pressure on hospitals.
At the same time the government is seeking to contain spending on healthcare.
Last week the Grattan Institute thinktank published recommendations for a “new Medicare.” To understand where the Grattan Institute is coming from it is worth looking at some of its financial supporters. They include Medibank Private, several banks, a law firm, BHP, an investment fund, Wesfarmers, and various philanthropic foundations. Its board members include directors from NAB, BHP, HSBC, and CSL.
The report points to some of the problems relating to Medicare – lack of accessibility to GPs and specialists for poorer Australians; GPs “struggling to meet increasingly complex demand in the system does not support them.”
It says that “… general practice needs to be a team sport, with many clinicians working under the leadership of the GP to provide more and better care … To accelerate change, 1000 more clinicians, such as nurses and physiotherapists, should be employed in general practices serving the communities with the biggest gaps in care.” Team-based care is highly desirable.
But it then proposes a model where GPs can combine appointment fees with a flexible budget for each patient that is based on their level of need. GPs would be able to opt in to such a system. The allocation of a specific budget for each patient would lay the foundations for the entry of private health insurance (PHI) funds – the privatisation of Medicare.
Medicare would allocate a specific amount to a PHI fund for each patient. The concept is similar to the privatised NDIS model where each participant is ostensibly assessed according to needs, a dollar allocation made for services which are contracted out to the private or not-for-profit sector. In the case of healthcare, it would be for PHI funds.
Once the PHI sector got its grubby hands on Medicare the outcome would be disastrous both cost-wise and in meeting the needs of patients. It would add an additional layer of profits and fail to restore universal bulkbilling.
It is worth noting that the Grattan Institute does not push for universal bulkbilling but makes constant references to patient fees throughout its report.
The Communist Party of Australia believes that universal access to medical care is fundamental to building a healthy society. It calls for a nationalised health system under local control, with high quality and “free” at point of delivery care, according to need rather than the ability to pay.
In particular, it supports team-based care focused on early intervention and providing care in the community and in the home. Improvement of the public system in outer suburban, rural and remote areas is needed, with measures put in place to ensure the health system caters first and foremost for working families and the sick and the elderly in these communities.