MedicarePlus, the federal government’s response to falling rates of GP bulk billing, passed through parliament in early March. In an attempt to give those on a low income a better deal, the new safety net pays 80 per cent of doctor’s bills, provides access to some dentistry and allied health services and offers differential incentives to encourage bulk billing in both cities and regions. Rather than easing the financial burden on average working families, closer examination reveals the policy leads to the creation of poverty traps.
Since 2001 the rates of bulk billing across the country have declined, but not uniformly. Such is the perverse nature of general practice that the highest rates of bulk billing and GPs per capita are in affluent suburbs. There is an ample supply of bulk billing GPs in those areas where people are most able to pay. Poorer communities and regional areas suffer the most on any barometer of affordability.
The fundamental problem with the decline in bulk billing rates lies with the Medical Benefits Schedule (MBS). Not only does it fail to keep pace with the real costs of medical practice, patients are only reimbursed to 85 per cent of the schedule fee. Patients are paying out of pocket fees regardless of their income. The strategy of a deliberately underpriced MBS to exert downward pressure and restrain doctor’s fees is failing. The upshot is that those on low incomes, including pensioners, are being charged to visit the GP rather than being bulk billed. Latest figures indicate that people are paying around $15 more on average for each visit to a GP.
The Government’s options were clear. Either re-invest substantially in the MBS so that most people will be bulk billed or pay very little for a GP service. Or, subsidise poorer people and those who most frequently use GPs. The Government chose the latter.
The decision was driven by expenditure concerns rather than sound public policy. The Government’s failure to keep Medicare in line with the costs of medical practice means that Medicare only covers some of the cost borne by individuals and will never provide full gap cover. For people with chronic illness and those living on, or around, average weekly earnings, this is significant.
There is ample research indicating that the introduction of fees discourages patients from accessing health care not only because of the cost, but the propensity of such costs to rise frequently.