Landmark Medicare review pushes changes to fee-for-service system, safety net, GP-patient relationship

Sweeping reforms to Medicare are needed to streamline fees and help patients, according to the biggest review since its creation.

A safety net designed to cut costs for sick Australians is being rorted by some doctors who are instead jacking up their fees, according to the most comprehensive review of Medicare since its inception.

The landmark report, which includes more than 1400 recommendations, warns patients are frustrated by soaring out-of-pocket costs and confusing information on fees and treatment options.

Health Minister Greg Hunt is now considering the findings, including a push for an independent fee complaints tribunal to protect patients against costly charges.

Health Minister Greg Hunt MP. Picture: Wayne Taylor

As Medicare spending soars towards $30bn, the five-year investigation led by hundreds of experts across dozens of specialities also recommends a shake-up of the doctor-patient relationship.

Under the changes, Australians with chronic and complex needs could voluntarily enrol with their GP, who would receive a quarterly taxpayer-funded payment.

It would cover the costs of doctors providing proactive and comprehensive care, such as reminding patients when they are due for tests, providing advice over email or the phone, and issuing referrals and repeat prescriptions without appointments.

Medicare’s fee-for-service system would also be overhauled to allow patients to pay a streamlined price for treatment for a specific medical issue, instead of coughing up separate fees to each specialist involved in their care.

The report also called on the government to reform the extended Medicare safety net, which covers 80 per cent of out-of-pocket costs once patients have paid more than $2169 in a year.

It said the safety net was “not meeting its original objectives” and had caused “unintended and negative consequences”, including providers inflating fees so patients reached the threshold.

The landmark report into Medicare has made 1400 recommendations. Picture: AAP

The report warned safety net support was “distributed towards consumers residing in wealthier and metropolitan areas of Australia and does not effectively reduce cost pressures on those in most financial need”.

While many of the taskforce’s recommendations have been implemented during its work since 2015, it called for more changes to modernise Medicare after the biggest review since 1984.

“Consumers consistently raised the challenges encountered in navigating a complex, and at times fragmented, health system, with care being delivered by a multitude of service providers and funded by different levels of government,” the report concluded.

“Consumers also expressed concerns about increasing out-of-pocket expenses and the lack of transparent information on fees, treatment options, risks and outcomes.”

It said Medicare’s fee-for-service model was not always appropriate, and should be complemented by options allowing patients to enrol with their GPs for continuous care, and pay “bundled” or “case-based” charges for particular issues.

A spokesman for Mr Hunt said the government would “consider, consult and respond as we have done throughout the course of the review”.

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