The Guardian July 12, 2000


Medicare under attack again

by Kerry Ans

The Australian Medical Association (AMA), a medical lobby group which in 
the past has mainly looked after the interests of high income specialists, 
is stepping up its attack on the Medicare system.

Last week it called for the means testing of Medicare rebates for general 
practitioner (GP) visits. Dr Kerryn Phelps, President of the AMA, claimed 
that bulk-billing is failing its customers.

Her argument is that the low rebate paid by the Federal Government to GPs 
who bulk-bill puts pressure on those GPs to churn patients through, thus 
lowering the quality of care.

Dr Phelps suggests that the Government has three choices in solving the 
quality of care problem. Means testing Medicare is one option; increasing 
the GP patient rebate from $22.50 to $44 is the second; doing nothing and 
eliminating bulk billing by attrition because GPs will refuse to provide 
access to it is the third.

Given that in some lower income areas of Australia, GPs rely very heavily 
on the Medicare rebate for their income, the third option is not realistic 
and the fact that it is being put forward by Dr Phelps has put many GPs at 
odds with the AMA.

The second option is preferable, from the point of view of retaining 
Medicare. The level of rebate  which has been virtually frozen for the 
last 10 years  should reflect a reasonable rate of income for GPs.

While publicly ruling out the call to means test Medicare rebates, the 
Howard Government continues to undermine the public system, via its 30 
percent rebate on private health insurance and the Lifetime Health Cover 
system.

In electoral terms, the Government can't be seen to be attacking Medicare, 
but it is doing so by stealth.

Good for patients and doctors

Suburban and rural GPs have been picking up the gaps in public health 
provision over the past decade. The rundown of public infrastructure and 
loss of funding for many community health facilities has put additional 
strain on GPs.

More funding for the public system would help them access the services they 
require for their patients. A fair remuneration for GPs as a part of 
Medicare provides the basis for a good health system for both patients and 
GPs.

The AMA could make a considerable contribution to public health services if 
it campaigned for the Federal Government to lift rebates paid to GPs 
through Medicare to the $44 level which is put forward as one of the AMA's 
options, rather than speculating that Medicare is "on the way out".

Medicare as a universal health system is highly popular with the Australian 
people and is supported by 78 percent of doctors according to a recent 
survey of GPs.

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