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Tag Archives: Sussan Ley

Sussan Ley updates the nation on Medicare

As any regular reader of my work is aware, I have been very vocal about the various changes to Medicare proposed by the LNP government. A list of past articles is provided at the end of this article should you have missed out. I also appeared on the ABC News supporting the RACGP in their “You’ve Been Targeted” campaign.

Earlier this week I wondered what was happening. Minister Ley had promised to consult with doctors before making any changes. I’d suggested Ley not forget about the most important demographic: the patients. I Googled and didn’t find much. I checked Ley’s Twitter feed and found the odd tweet about consulting with doctors.

https://twitter.com/MalBrough_MP/status/563504992078688257

Meeting with doctors and

more doctors.

Where are the meetings with PATIENTS? This one, maybe?

Possibly, but they look suspiciously like more medicos to me. I was becoming a little depressed. Yesterday Ley finally held a press conference. The full transcript is available: Update on nationwide Medicare policy consultation.

Craig Laundy: It’s great to have the Health Minister, the Honorable Sussan Ley and my good friend the Member for Lyne Dr David Gillespie here in Reid for an afternoon of consulting with local GPs so without further ado Sussan welcome.

Not one word about PATIENTS! More doctors! Yes, doctors are voters, just like you or I. Yes, doctors pay the Medicare levy just like you or I. Yes, doctors have a vital voice in any changes to Medicare. You and I have a far greater voice and we must not let Ley forget that.

I’ve just come from breakfast this morning on the Central Coast. There were 40 doctors and lots of different views in the room and the same for last night and I’m on my way to another part of the country to do something similar.

Still no mention of PATIENTS. *sigh*

…accept that unless you’re in a vulnerable category maybe those services don’t come absolutely for free and that where there is an ability to pay that you value the high quality service that you receive that you do indeed pay something. When I look at the number of bulk-billed consultations across the country 76 per cent of all episodes of care are bulk-billed to non-concessional patients.

No, Ley, any bulk-billed service to a non-concessional patient is certainly not for “absolutely free” as most non-concessional patients are working and paying the Medicare Levy! Or are the children of people paying the Medicare Levy. That’s not “free”, we pay an insurance premium. I’ve heard it said there are medical practices that bulk-bill 100% of their consultations. I’ve yet to actually attend one, but I have no doubt there are some. There are also practices that bulk-bill only those holding a Health Care Card.

The practice I go to has a policy of bulk-billing walk-ins (see first available doctor) between 7 am and 6 pm. Appointments are not bulk-billed, nor are consultations after 6 pm or on weekends or public holidays. I think there are many practices with similar policies. How often am I a walk-in? Not too often. I work full-time and also have medical conditions which I prefer to have overseen by a regular doctor. Consequently most of my consultations are either by appointment or outside of the bulk-bill hours, even if I am walking in with a child that needs a stitch in a toe – no appointment, but 8 pm at night. $90 payment, $49 rebate. My co-payment is already $41, thank you very much. The average patient contribution for out-of-hospital services for patients who pay is $51 (including specialists visits).

My GP visit

I wanted to see proof of this 76%. I thought the annual report might be a good place to start, but as Medicare has been absorbed into the Department of Human Services, there doesn’t seem to be much Medicare detail in that report. The Department of Human Services ended the 2013-14 year with an operating SURPLUS.

In 2013–14 the department administered an estimated $159.2 billion in payments or around 38 per cent of government outlays. Financial performance targets were met, for the most part, and the department reported an operating surplus of $132.6 million after adjustment for unfunded depreciation and the revaluation of assets. This compares with a deficit of $7.7 million in 2012–13.

Source: Department of Human Services Annual Report

That doesn’t tell me anything about bulk-billing though, interesting as the information may be. Further research found bulk-billing statistics. Click the image to go to the full table. According to the Medicare statistics, 77.2% of consultations were bulk-billed for the 2013-14 year, but there are vast differences across services. GP visits are bulk-billed 82.2% of the time, whereas specialists a mere 29.2%. No clear differentiation is given in the report between concessional and non-concessional patients, so are we to assume only 1.2% of consultations were for concessional patients?

Clearly doctors in Canberra don’t believe in bulk-billing politicians.

I am struggling to believe the rate is this high. If you want to delve into the full statistics yourself, the spreadsheet available is very useful.

Why is the rate of bulk-billing so high? Based on my own personal experience and that of friends, family and co-workers, my guess would have been less than 50%. The history of Medicare may have something to do with it. I found this interesting snippet. Read very carefully.

Levels of bulk billing for unreferred GP attendances have been declining in recent years after reaching a high of 79.7 per cent in1996-97. By the December quarter 2002 bulk billing for unreferred GP attendances had declined to 68.8 per cent, but by June 2004 this had improved to 70.2 percent.

Source: APH

The decline in bulk-billing had been viewed as a negative! Incentives of $7.50 to encourage doctors to bulk-bill were introduced in 2004.

From 1 May a $7.50 incentive paid to GPs for bulk-billed GP consultations with concession card holders and children under 16 in non-metropolitan areas (RRMAs 3-7) and Tasmania introduced. This incentive replaces the earlier $5 incentive in these areas.

As of 1 September eligibility for the $7.50 incentive payment to GPs extended to eligible urban areas and large regional centres.

Clearly bulk-billing was encouraged in more ways than one.

Between 1992 and 2003 the Scheduled Fee rose 26%. The CPI rose 31%. Doctors were taking a pay cut.

Interestingly, during the 2004 election campaign, the Coalition proposed to increase the rebate to 100% of the scheduled fee. Different captain at the same helm eleven (eleventy?) years later wants to cut the rebate.

Proposals for changes to Medicare were announced by the Coalition during the 2004 election campaign. These include from 1 January 2005 increasing the Medicare rebate for all GP services to 100 per cent of the Schedule fee…

Source: APH Library Archive

When did the big clinics emerge? Edelsten opened the first after Medicare came into being in 1984. We now have very professional corporate medical businesses, minus the chandeliers and gawdy trimmings.

Reading through the history, it is clear Medicare has been tweaked many times over the years. The practice of medicine has evolved. We no longer visit our local family doctor in the front room of his residence as in days gone by. The economies of scale from multi-disciplinary and multi-doctor practices would, I think, be necessary in circumstances where fee increases were running well behind CPI increases AND bulk-billing was being encouraged.

The HICAPS system has been a great innovation. The doctor gets paid at the time of service and the patient receives the rebate overnight in their bank account. As noted in the past, I’ve actually received the rebate credit before the payment debit hit my bank account. For patients this saves considerable time. In the last twelve months I’ve only visited one medical provider (and we know I’ve visited a few) that had not yet moved to HICAPS. Gone are the days of lining up in a Medicare office to claim medical bills.

The medical profession was initially resistant to Medicare. The medical profession today is a very different beast to the medical profession of forty years ago. Many practitioners are not as politically right wing as their predecessors. Free university education saw many from different backgrounds obtain degrees.

Forty years is a long time. You may be reading this on a smartphone. Medicare was launched three years before Telstra launched the first mass mobile network in Australia.The phone cost $5,200. Technology, medicine, society: all have changed.

How much revenue does the Medicare Levy raise? That seems to be the greatest secret, as despite considerable research, I can’t find the answer. The spreadsheet I referred to above analyses the costs of Medicare to the nth degree, sliced and diced to within an inch of the core and tells me the benefits paid were $19.1 billion. Not a revenue number in sight. Nor, for that matter the infrastructure, staff and other costs (such as HICAPS).

Was Medicare ever intended to be completely self-funding?

The objectives of the original Medibank were summarised by R. B. Scotton (1977) as universal in coverage, equitable in distribution of costs, and administratively simple to manage.

That statement doesn’t really specify self-funding. As it turns out, the original funding bills weren’t passed and the funding came from general revenue. The levy came later.

“Equitable in distribution of costs” doesn’t mean the same thing as self-funding. In any case, what was appropriate forty years ago may not be appropriate today – and that could be either way. How do we assess “equitable”? These are social questions, not medical questions, yet I see Ley focussing on the medical profession and not the people.

To be continued . . .

Previous Medicare related articles by the author:

This is a slightly edited version of the article originally published on Love versus Goliath

Lucy Who?

One could be forgiven for not knowing who Lucy Wicks is – even her electorate had never heard of her before she was parachuted into the seat of Robertson in a captain’s pick by Tony Abbott, bypassing the pre-selection process, much to the chagrin of the local Liberal Party membership:

“NSW State Executive of the Liberal Party have endorsed Lucy Wicks as the Candidate for Robertson. No preselection was held and the executive of the Robertson Federal Electorate Conference was not notified, only told that this was under consideration today. Nominations for Robertson have been open for 5 months, Lucy Wicks being a member of that State Executive that delayed nominations”.

The comments from local Liberals were scathing, as the above link testifies. A poster with the aptly-named persona of Back Room Deals summed up the sentiment thus:

“Lucy Wicks lives in Warringah, Tony Abbott’s electorate . . . hmm. Wicks nominated on Thursday and was rushed through NRC. Then the vote went to State Executive on Friday. The problem is that our leadership has shown no integrity in this issue. To fix the problem in Dobell, a problem of their own making, they take away the democratic rights of Robertson branch members. We will not stand for these tactics, there are 10 branches in Robertson . . . 10 branches with hundreds of unpaid foot soldiers who will walk away, let Head Office pay for the lot come the Election”.

Lucy then called in the big guns, hosting a morning tea at which Bronwyn Bishop spoke. This was the reaction from someone who attended that function:

“Lucy Wicks was totally uninspiring and seemed like an impressionable kid that didn’t have a brain between her ears. The helpers there all seemed like young Liberals that were nice, but really, did nothing to add any degree of credibility at all. Dressed like they came off a refugee boat. Doesn’t some-one give them a dress code at all? As for Bronwyn, she was the main star and Lucy apart from telling us she worked in a factory in the Central Coast really had nothing to say. And it showed. Bronwyn did all the talking and Lucy shut up which is just as well I think”.

Even though there was a 0.1 per cent swing against the Liberal Party, there was an even larger swing against the Labor sitting member, Deborah O’Neill, who in my mind was a hard-working MP who ably represented her constituents. 21.8 per cent of the vote went to the minor parties and Independents. Hardly a resounding victory for the Coalition.

So it was with interest that I watched Lucy ask her first question in Parliament:

“My question is to the Assistant Minister for Education. I remind the minister that childcare groups and parents in my electorate of Robertson have told me of the burden that the previous government childcare rules and regulations placed on costs for centres and parents. Will the minister tell the House how the Government plans to fix the red-tape mess and reduce costs?”

Up bounced Christopher Pyne’s sidekick, Sussan Ley, who seems to have learned her oratory skills from her Minister, to tell us that axing the carbon tax and cutting red tape would fix all the woes of the childcare system. Her proof of this was a couple of anecdotal stories about turning the lights off for an hour and eating individual cupcakes.

Perhaps Ms Ley is unaware of what her colleague in the NSW State Parliament is doing:

Community preschools across the state could be sent broke under changes to state-government funding for three-year-olds as daily fees nearly double for parents of the younger children.

The sector is warning many community centres will be forced to close under a new model that slashes funds for the age group in a bid to get more four- and five-year-olds into classes before they start kindergarten.

In what has been slammed as a further blow to the chronically underfunded sector in NSW, the Community Child Care Co-Operative claims one in three centres could be forced out of business if parents switch their children from preschool to cheaper long day care.

The report, by UNSW professor Deborah Brennan, said the state government would need to “substantially increase” investment in early education to meet its commitments as community preschools had been underfunded for “decades” compared to those in other states.

Ms Ley also failed to mention that the Coalition have cut $300 million from the Early Years Quality Fund:

A $300 million funding boost aimed at improving the wages of 30,000 childcare workers looks increasingly likely to be axed as the federal government continues to sit on the Labor-approved initiative.

The money was to be spent in 1100 childcare centres to bolster the meagre $19-an-hour wages of certificate III childcare workers by $3 an hour and early-childhood teachers by $6 an hour. The starting wage for a university-educated early childhood teacher is $42,000 a year.

The government wrote to childcare centres who had accepted the funding soon after winning office, revoking the conditional funding offers and advising it was reviewing the $300 million Early Years Quality Fund (EYQF).

Ms Ley did not specify what “red tape” would be removed, and when Graeme Perrett asked “What—you’re going to have free-range kids in the childcare centres!”, he was promptly ejected by our fearless arbiter, Bronwyn Bishop.

The National Quality Standard for Education and Care Services can be found in Schedule One which appears at the end of the Regulations.

Having glanced through them, I am not sure which of these guidelines could be dumped, and how that would improve the quality of the service. But then again, quality of education isn’t a goal of this government.

So it is with a great deal of trepidation that I reiterate the question asked by Lucy Who and could we please have some detail to your answer rather than “axe the tax and cut red tape” slogans.

“Will the minister tell the House how the government plans to fix the red-tape mess and reduce costs?”

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