‘Opt-in’ in plan to guarantee doctors offer bulk billing amid Medicare collapse
Top health policy experts have put forward a radical plan to guarantee access to bulk billing for the neediest patients.
Top health policy experts have put forward a radical plan to guarantee access to bulk billing for the neediest patients, proposing the Commonwealth restrict access to some Medicare billing items only to GP practices that opt in to a voluntary scheme while others are forced to bill wholly privately.
Health law professor Fiona McDonald and prominent health economist Stephen Duckett have proposed the reform in a paper which argues the constitutional restriction on civil conscription that prohibits the federal government from forcing doctors to become professional officers of the commonwealth has been interpreted too widely by the executive.
The High Court’s interpretation of the civil conscription section 51(xxiiiA) of the Constitution has narrowed over the past 40 years such that more direct regulation by the commonwealth of the medical profession and access to Medicare is legally permissible and arguably essential as bulk billing rates continue to plummet and evidence grows the poorest patients are deferring medical care.
Bulk-billing rates have plunged almost 10 per cent in recent months to 80.5 per cent, with many patients struggling to pay rising gap fees and medical practices being pushed to the wall amid a steady erosion of rebates.
At least one-third of patients are charged gap fees averaging $40 for every doctors’ visit. Many practices are now bulk billing even pensioners and children, and the Medicare rebate for standard consultations stands at just $39.75.
The new paper published in the Federal Law Review, authored by Professor Duckett, QUT’s Australian Centre for Health Law Research co-director Fiona McDonald and Grattan Institute researcher Emma Campbell, proposes a “participating provider” scheme in which the federal government would restrict access to some or all Medicare items to GP practices which voluntarily opt in and in exchange for agreeing to bulk-bill all patients.
Doctors who do not opt in would still be able to practice medicine outside the scheme but would rely solely on patient out-of-pocket payments.
“What we’ve said is maybe we should change the basis of Medicare so that if doctors want to participate in Medicare, they sign up for bulk billing, so people know that if they front up to a particular doctor they will be bulk billed,” Professor Duckett told The Weekend Australian.
“There is a quid pro quo to that. We say that you need to increase the average rebate because GPs now are underemunerated relative to other specialists, and so what I’ve suggested elsewhere is there ought to be an independent fee tribunal to set the fees so they are not politically determined.”
The shake-up of bulk billing came after the government-commissioned Pradeep Philip review of Medicare compliance this week found the system is vulnerable to fraud and is bleeding between $1.5bn and $3bn a year due to structural flaws that were resulting in widespread billing errors and a lack of effective controls.
In the review, Dr Philip noted that the pressing need to provide complex care amid growing chronic disease was being hampered by a dysfunctional and outdated Medicare system.
Professor Duckett and his co-authors also suggested that the commonwealth should more actively intervene in the market to guarantee access to GPs and affordable care in regional and rural Australia by limiting the number of new doctor provider numbers on issue to specific geographies or specialities.
That would mean GPs who choose to practise in wealthy locations in the big cities may not have access to Medicare rebates, while the number of GPs in the bush who could fully bulk-bill would be boosted.
The paper also suggested that large pathology and radiology companies, many of which are listed on the stock exchange, be removed entirely from the Medicare schedule or be forced to tender to provide services.
More Coverage
After a double tragedy, Sarah Wheeler found purpose in grief
Driven by sorrow but also determination, Sarah Wheeler embarked on a charity horseback ride 290 days ago. On Saturday, she returns home.
Family earns top farming honour
A South Australian family who have greatly increased production within their dairy herd through innovation and sustainability measures have been judged Australia’s best farmers.