Policies, based only on financial considerations, that discourage people from seeking treatment at the earliest (and therefore cheapest) opportunity are knee-jerk reactions at a momentary point in time with no thought for the future or the non-financial impact of those policies. Research shows such short-term “savings” actually result in higher costs and sicker people in the long-term.

Medical Knowledge/Continuing Professional Development

Doctors hold our health in the palm of their hands. Yes, we, the patients, certainly have a major part to play in caring for our own health, but the reality is the doctors decide what tests to run, what medications to prescribe and whether we need to see a specialist or a surgeon.

In order for doctors to care for us in the best way possible, they can’t be consulting all the time. We expect the medical profession to keep up-to-date with advances in the field. Again I will use my own case as an example. The RF (Rheumatoid Factor) test had been the stock standard test for Rheumatoid Arthritis (RA) for many years, well over half a century. Unfortunately, specificity is not very good: IgM RF, the isotype most typically detected, is seen not only in RA but also in various other conditions. Also, some RA patients never test RF positive. There is a new (relatively speaking in research to commercially available terms) blood test, the anti-CCP with much higher specificity and in many cases earlier detection of RA. Earlier detection leads to earlier treatment resulting in better outcomes.

As a patient, you expect your doctor to know about new tests. Continuing Professional Development (CPD) takes time (up to 50 hours a year is specified in some cases) and effort and can be costly. Certainly my general practitioner may be able to learn about a new blood test from a medical journal or a medical association newsletter, but these cost. Journal subscriptions and association memberships don’t come free. There is the time required to read the information, absorb it, understand it. This is all non-revenue generating time.

What of our surgeons? New surgical techniques are constantly being developed. We can have laparoscopic hysterectomies these days, a far cry from the full abdominal cut. We want our surgeons to know the least invasive techniques, don’t we? Learning these may be a bit more time-consuming and/or expensive than reading a journal article about a new blood test.

Remember the days of “exploratory surgery”? My mother had some of that. Now with modern imaging techniques, one rarely hears the term. Yet without knowledge of these advances, our doctors would still be recommending exploratory surgery.

Doctors are no different to the rest of us. They have families, mortgages and household bills. They like to go to their children’s sports events and school concerts. Date nights with their spouse are important, just as for all of us. Doctors are normal people with normal lives. They are entitled to time off.

Yes, there are some doctors who are very rich. So are some plumbers and electricians. Most are not. Many have the added responsibility of running a business: it isn’t just the medical knowledge.

If we arbitrarily cut the gross revenue of our doctors, yet the running costs of their businesses and their family lives continue to increase in line with the overall economy, what might suffer? I suggest it might be the extra CPD most doctors do to stay abreast and that impacts on all of us. Or the study diligence will suffer, perhaps, without them even realising. My profession also requires CPD but I can tell you right now if the kids need help with homework, or the dinner needs cooking or the pantry needs restocking, my professional journal can sit untouched. They’ll do the legal requirement, of course, but is that enough to be the best when medical advances are frequent and across the breadth of medical knowledge. Will they be forced to attend cheaper courses or conferences for a lesser value learning experience?

NB: There is no intention to imply doctors would deliberately compromise their CPD.

Apart from CPD, cost pressures may force staff reductions in a practice. One nurse instead of two, or one less receptionist. How will this impact on you? Will medical practices close and the doctors change professions?

If the doctors do, as they have said they will have no option but to do, pass the cost of the lost revenue on to the patients, then we have the potential for the second consideration.

Treatment Delay versus Early Intervention

I think we all know these days that the earlier a medical condition is detected and treatment begun the better the prognosis for the patient. Breast cancer, colon cancer, rheumatoid arthritis – the list goes on. In every case you will find the words “early detection”. When the costs of a medical consultation or tests or prescriptions become a barrier to seeking medical advice, the condition worsens. Once the patient is forced through deteriorating health to finally seek treatment they may be unable to continue to work, they may die much earlier, they may need much longer and more expensive treatment. All of this is an unnecessary financial burden to the health system and consequently to the community. Not to mention the cost to children who lose parents too early or the spouse who loses a partner.

The following is about the USA experience. Is this really what we want for Australia?

The National Council on Aging found that 25 percent of people with chronic diseases delay or skip medical treatment because of costs. Families U.S.A. has also studied the effect of high deductibles and copayments on utilization. According to Kathleen Stoll, director of health policy, the danger lies in “small medical problems becoming large medical problems, one of the many high-deductible pitfalls that consumers need to watch out for.”

Source: http://www.managedcaremag.com/archives/1001/1001.downstream.html

Here is a similar study involving children in the Philippines.

In relation to maternal health, the United Nations says:

It is often said that maternal mortality is overwhelmingly due to a number of interrelated delays which ultimately prevent a pregnant women accessing the health care she needs. Each delay is closely related to services, goods, facilities and conditions which are important elements of the right to health (see Box 4).

Source: http://www.unfpa.org/sites/default/files/pub-pdf/reducing_mm.pdf Page 8

Is this what we want for Australia? The word cost is up there in the top left-hand square.

What other non-financial impacts can you contribute to the discussion? I am sure there are many, many more.

Have you, or anyone you know, already ever delayed seeing a doctor due to the cost or fear of the cost of any treatment? Please share your experience.

This was an edited version of How Medicare Rebate cuts may impact the patient, other than cost from Robyn’s website Love versus Goliath : A Partner Visa Journey.

Should I just put a down payment on my coffin now, Scott Morrison?

Different political persuasion, this government, but essentially the same beast. This isn’t just about the unemployed or low-income earners. ANYONE can suddenly discover they are unwell. ANYONE! It happened to me, it can happen to you too.

I am writing from my personal perspective to illustrate the potential scope of proposed changes to Medicare and the looming doom is a worry. I am gainfully, at the moment anyway, employed. I do earn a reasonable salary. I also have four children at home who strangely are not partial to starving so I can have blood tests. I consider myself “typical”. Not rich by any means, but not on social welfare either. If it is going to be tougher for me, I can only imagine how much tougher for those really struggling financially.

Although it has taken me some time to adjust to the idea I am not well, I’m not. At the moment I am seeing three medical specialists, a general practitioner, a physiotherapist and have just finished a series of support sessions from a psychologist. I’ve had countless blood tests, faeces tests, urine tests, x-rays, a whole body nuclear bone scan, CT scans, ultrasounds, cortisone shots and a nuclear thyroid scan. I’ve also paid a $500 hospital admission co-payment. All since October 2014. I have medications to keep me functioning so I can keep working: these cost money. Not all the blood tests have any rebate available at all, 100% out-of-pocket. If I don’t keep working I become a “burden to the taxpayer”, do I not? Yet make no mistake, if I can’t afford my treatment, I will be unable to work.

The doctors, general practitioners and specialists, impacted by these changes are NOT employed by the government. They run small businesses, like so many Australians. They have the same business expenses to pay has anyone else.

The first change to our Medicare system that was suggested was a $7 co-payment. I thought it a ridiculous proposal and said so in no uncertain terms. The general backlash seemed to have chastened the government somewhat and a slight variation with a $5 figure was bandied about but thankfully the opposition aren’t buying it.

The latest is:

From 19 January 2015, the Government has cut Medicare rebates by $20 for GP consultations that take less than 10 minutes.

Today, the standard GP consultation has a Medicare rebate of $37.05. More than 25% of these consultations last less than 10 minutes. The Government will reduce the rebates for these services to $16.95 by restricting:

• Level A consultations (MBS item 3) to consultations lasting less than 10 minutes; and
• Level B consultations (MBS item 23) to consultations that last between 10 and 20 minutes.\

Source: AMA

 

I’ll admit personally I am not quite as worried about the standard GP consultations as I am about the specialists. THEY COST! BIG TIME! I don’t believe only general practitioner rebates are being slashed, do you? No, I didn’t think so.

Those of us with chronic conditions and multiple medical providers will suffer. I recently joked about my version of MAS*H – staying reasonably healthy could send me broke, literally.

I walked into an imaging provider with NO idea how much I would be charged. The medical system is like that, if you don’t have a Health Care Card there is this assumption you have the cash. I was charged $951. Bang, just like that. Now, because as a family we had already hit the Safety Net, I got $885 back, but I had to actually have the $951 in the first place. I stole from the rent money, what else could I do? At least the rebate arrived in my account within twenty-four hours. I actually do not know what would have happened if I had stood at the counter and said, “I can’t pay”.

I have two bills here, as yet unpaid, for three blood tests for which there is no rebate at all. Total $140 but the electricity bill took priority. My last two prescriptions were $26.99 and $36.70 respectively and that is for a month. I spend about $100 a month on prescriptions which I well know is MUCH less that many other people with chronic medial conditions.

My initial consultation with my gastroenterologist was $190: not nearly as steep as the initial consultation for the rheumatologist of $320.00. The endocrinologist was an initial consultant of $304.35.

As just one example, the Scheduled Fee for the rheumatologist item number is $263.90. The rebate of $224.35 falls far short of the actual cost to me, unless the patient/family has hit the Safety Net. You can argue all you like that specialists should charge the scheduled fee, but those scheduled fees won’t be updated again for YEARS (see below).

You don’t have to be a maths major to work out the patient needs to juggle the finances to ensure they can see the doctors required to keep the patient in good enough health to keep working. What choice do I have? Forego treatment and end up on the DSP? If I “went public” how long would I wait before I was diagnosed and treated, too unwell to perform my job?

From July 1, 2015 the standard consultations will be cut by a further $5 for non-concessional patients. The doctor will receive a rebate of $11.95 for a non-concessional patient for a consultation of less than ten minutes. You will pay the difference. I don’t know what your doctor charges, but $70 perhaps? $75 or $80? Don’t get too many viruses.

“What it will mean is that GPs are forced to pass these changes on to their patients in terms of costs,” he said.

A/Professor Owler said experienced GPs were often able to conduct an examination, take a history, prescribe and management plan and counsel a patient within eight or nine minutes, but such efficiency would be punished under the Government’s changes.

“Why that consultation should be worth on $11 now, compared to the $37 that it was worth last week, is certainly not something the AMA supports,” he said. “That is an enormous burden on practices which, at the end of the day, are small businesses.”

In addition to the reclassification of consultations, the Government also plans a $5 cut to the Medicare rebate, which A/Professor Owler said practices would have no choice but to pass on to their patients.

Source: AMA

 

How much will be cut from other item numbers, such as those claimed when I see my specialists? No-one is talking about that yet and despite diligent research, I’d uncovered nothing and asked the AMA directly.

There is another kicker in all this. From the same AMA link as above:

The Government has extended its freeze on indexation of Medicare rebates until July 2018.

As with all small businesses, the costs of providing medical care go up each year. Costs to run medical practice include wages for receptionists and nurses, rent, medical equipment, cleaning, electricity, computers and insurance. All these costs must be met by the single fee the doctor charges the patient for their care.

Medicare rebates have been frozen since 1 November 2012 for GP* and specialist consultations and operations and will not be increased until 1 July 2018.

Medicare rebates for pathology and diagnostic imaging services have not increased for more than 15 years.

If you are a business person, can you honestly say you haven’t increased any of your selling prices since November 2012? I didn’t think so. So the doctors still have to face the cost of living increases the rest of us face in their lives.

If you work for a medical practice and you want to buy a car, for example, can you go to the bank and ask for a cheaper interest rate because the medical practice can’t afford to pay you an increase like the rest of the population got? Unlikely. The discretionary spending power of the workers in the health industry will be reduced with the resultant negative impact on the economy.

Before you dismiss the cuts in rebates as “not something you have to worry about”, think very carefully. Next week, even tomorrow, you might feel a little off-colour. Then a bit worse. Then you have some blood tests: then … welcome to my world, my friend.

Heaven help your finances if anyone else in your family gets sick as well, short-term or long-term.

Save Medicare. Support our brilliant medical profession. Download or share the RACGP poster: Targeted.

It is worth reminding the government the objectives of the Liberal Party (on page 3) state:

(j) in which social provision is made for the aged, the invalid, the widowed,
the sick, the unemployed and their children;

(k) in which adequate medical services are within the reach of all;

The aim of this article is to enable the “average Australian” to consider what these changes may mean to them. The poorest don’t have the political clout – the rest of us do. If using myself as an illustration achieves this objective, I’m happy to be the guinea-pig! For a medical practitioner’s perspective, you might like to visit New year, same approach: implications of the Fed Govt’s confidence trick on Medicare.

I also care about our environment, so while you are here, may I tempt you to kindly click on Today’s Neros fiddle while our planet burns. We might need our health system even more!

This was an edited version of You’ve been targeted: supporting the AMA and RACGP from Robyn’s website Love versus Goliath : A Partner Visa Journey.