Hospital overload ‘fuelled by GP rebate’

A too low Medicare rebate is prompting tens of thousands of people each year to flood emergency departments.

NSW Health Minister Brad Hazzard. Picture: AAP

The Medicare rebate for GP consultatio­ns is too low, prompting tens of thousands of people each year to flood emergency department­s and discouraging young doctors from training in general practice.

That’s the view of NSW Health Minister Brad Hazzard, who says health systems around the nation need a “complete restructure”, starting with adjustments to ­Medicare. “Every state and territory jurisdiction is facing increased pressure on emergency departments,” he said. “Obviously one of the major contributing factors is the lack of a reasonable increase in Medicare rebates for general practitioners­. There is inadequate ­recom­pense for GPs.

“Many of them are now charging a gap fee, which for an average consultation can range from $30 to $100. That is contributing to a substantial increase in people presentin­g to emergency departments with issues that clearly aren’t emergencies.”

The Medicare rebate for stand­ard GP consultations lasting less than 20 minutes is $38.20. For longer consultations up to 40 minutes­, the rebate is $73.95.

The Australian Medical Assoc­iation has issued a fresh warning that public hospitals are “stretched to the max” with big increases in presentations to emergency departments and ballooning waiting lists for elect­ive surgery.

Mr Hazzard said emergency departments of hospitals across NSW were being inundated, and in regional areas many patients presented to hospital because they were unable to access GPs.

“We are being slammed at major hospitals in Sydney by increasi­ng numbers of patients coming to our emergency depart­ments when they should have been going on any objective criteri­a to their local GP.

“We need to look really closely at why that is occurring but I suspec­t at least a substantial number are doing it because they get the service at taxpayers’ expense.

“Full marks to our emergency department staff at our major hospita­ls because generally they have been copping it big-time but have been working in a way that is quite unbelievable and achieving very good outcomes. It’s a very tough gig, and it can’t continue the way it is. It is not feasible.”

The federal government ended a freeze on Medicare rebates for GP services last year, allowing annuall­y indexed increases in Medicare Benefits Schedule fees to resume. It provided $187m to increas­e patient rebates for 176 GP service items on the MBS, including chronic disease management plans and mental health services.

Medicare funding by the feder­al government is set to increase to $30.7bn by 2022-23.

However, some doctors groups believe rebates for standard consulta­tions are still too low, prompting patients to seek treatment at hospital.

Nationally, the number of patient­s presenting at emergency departments at public hospitals has increased by almost one million since 2014-15. In the past year, 30 per cent of patients waited more than four hours to be seen.

NSW hospitals treated almost three million cases at emergency departments in 2018-19.

The AMA is calling for a renewe­d focus on primary care and preventive health to ease the pressure on hospitals. The call comes as state and territor­y ministers negotiate a new National Health Reform Agreement with the federal government.

One issue of intensive government focus in recent months has been the shortage of GPs in many regional towns, as well as in some city areas. There was a 30 per cent vacancy rate in GP training positions nationally in the past year.

“What I’m seeing is young doctors being more attracted to going into specialised practices, and a lot of that is because they know they’ll be expected to work under enormous pressure in a GP practice for what they consider in­adequate recompense,” Mr Hazzard said.

“My sympathies are with the GPs on that. And when you move into regional areas, there is a complete lack in many areas of GPs and we absolutely have to look at making regional or rural practice more attractive.”

The Australian has reported on an initiative backed by the federal government to formally recognise “rural generalist” as a distinct medical specialty.