|Implemented in this survey?|
As preliminary information a new proposal has been released to ensure that low income families and individuals in Australian are not denied access to general practitioners? services. This is achieved by making available free-for-charge health services at the point of delivery for low income patients. The proposal has been controversial because it has the potential to change the nature of Medicare.
to reduce inequity of access to GP services by making care free at the point of delivery for low-income patients.
additional financial incentives to doctors to bulk-bill low-income patients and/or tie incentive payments already received (ie practice payments) to undertaking to bulk-bill low income
GPs, Patients, Some specialists/diagnostic services which also bulk-bill
|Medienpräsenz||sehr gering||sehr hoch|
One of the aims of Medicare is to provide equity of access to necessary medical services. Although this government publicly supports Medicare, some have argued that its support is reluctant as its
ideology would favour a "user-pays" system. However, Medicare is a very popular system with voters and a previous attempt by a former government to introduce a co-payment was not successful.
GPs are funded from the general tax base but operate as private small businesses, charging patients on a fee-for-service basis
Since the inception of Medicare, many GPs (particularly in cities where competition is greatest) have chosen to "bulk-bill" ie have patients assign their entitlement to a Medicare benefit for a consultation to the GP.
Over time, the proportion of GP income from fee-for-service has been reduced as payments such as incentives for immunisation, practice payments for using new technology and employing nurses and funding support for Divisions of General Practice.
Nonetheless, the proportion of services being bulk-billed has fallen from a high of 80.6% in 1996/97 to 69.6% in September 2002. The issue has received a great deal of media coverage and the Commonwealth government has announced that it intends to respond in the near future with a series of policies.
|Implemented in this survey?|
The ideas being speculated about are not new:
The ideas being considered are controversial because they are seen to have the potential to change the nature of Medicare (as it is applied to GP services in particular).
Because the debate is being conducted in the media, the Commonwealth and State governments and opposition political parties, doctors' organisations and patients' groups are currently heavily involved.
The media has reviewed the history of bulk-billing, recent falls in the level and geographical nature of bulk-billing and the effects on out-of-pocket costs, utilisation and access. The potential impact on hospital emergency department services has also been discussed.
Until the policy is announced, it is not possible to provide answers to the other questions.
This remains to be seen
Although it is not possible to be certain about who will be involved, in the past, doctors' organisations such as the Australian Medical Association, the Australian Division of GPs and the Rural
Doctors Association have been invited to discuss proposals with government ministers and bureaucrats.
Financial incentives paid directly to doctors or practices will be required to facilitate the implementation of any policy.
It is unlikely that opponents will be appeased as any changes to the way in which bulk-billing occurs will be seen as compromising the objective of equity of access to GP services, facilitating the introduction of a "2-tiered" system of health care in Australia and allowing doctors freedom to charge high up-front fees, resulting in larger out-of-pocket costs to patients.
Opponents of the proposed policy may be of the opinion that it will succeed in its (implicit) objective of undermining the principles of Medicare.
Proponents of the proposed policy may consider that it has achieved its aims if GPs' incomes are maintained or increased.
The government will consider that its objectives have been achieved if low-income patients are bulk-billed for GP services.
The costs to the Commonwealth are likely to rise but it remains to be seen to what extent patients will also bear increased out-of-pocket costs.
If the policy objectives remain focussed on low-income patients, it seems likely that inequities in the system will increase as the number of doctors in outer metropolitan areas and regional and rural Australia continues to fall as will the rate of bulk-billing.
This may also increase the pressure on emergency services in hospitals as more GP-type patients attempt to access their services (which are free at the point of delivery).
There is also potential for the policy to discourage patients from consulting their GPs, thus presenting as sicker and therefore requiring longer or more costly treatments.
Finally, if fewer people have a regular GP, the continuity of care (for post-acute care or care for chronic conditions) may be compromised.
No formal policy proposals as yet
Marion Haas, Jane Hall, Elizabeth Savage