The future of primary health care is at the forefront of community debate in the lead-up to the next federal election. This issue has only become of real concern to politicians over the last 7–8 months.
During this time we have seen the release of the federal government’s Fairer Medicare Package, the Labor Party’s own Medicare Package, the revised Fairer Medicare package called MedicarePlus and now a community debate about the future of Medicare and primary health care services throughout Australia.
MedicarePlus is based on an assumption that most Australians should not only pay for the health care services through their taxes, but also at the point of delivery, in the form of an upfront fee to their general practitioner (GP).
It is acknowledged by politicians of all parties, the broader community and health economists that implementation of MedicarePlus will see decreased bulk billing rates.
The Australian Medical Association acknowledges that the extra $5 rebate to doctors for seeing patients with a health care card or those under 16 years is not enough to meet the practice costs of most GPs and will not encourage doctors to bulk bill. GPs will not return to bulk billing if it means charging less than they are at present. MedicarePlus offers no encouragement to GPs to achieve an optimal bulk billing rate. The package does not address the fundamental inadequacy of the amount of the rebate shortfall. This can only result in a decline in bulk billing and an increase in upfront fees.
The Minister for Health, Tony Abbott, has indicated that the Commonwealth government does not believe in universal access to bulk billing. MedicarePlus provides significant disincentives for people to use primary health care services. Establishing safety nets once people have reached either $500 or $1000 annually will still mean that those on low incomes will have to think twice before seeing a GP. Given that those who have the lowest incomes also have the worst health, it makes little sense to impose any obstacle to securing basic health care services.
The average out-of-pocket expense for attending a GP across Australia is over $13 per visit. In order to get to the $500 safety net or the $1000 safety net a person would have to visit the GP on about 40 occasions. It would also require the person to keep very clear records so that they could determine when they had reached the safety net.
The government’s