General Practitioners Remuneration

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

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.

Purpose of health policy or idea

• Note: as there are no formal policy proposals on the table as yet, this information is preliminary and conjectural.
• The main objective of the policy is to ensure that low income individuals and families are not denied access to GP services because of out-of-pocket costs.
• The characteristics of the policy are not yet clear but they may include an income-related means test to ensure access and allowing doctors to charge a co-payment and then bill Medicare (the Australian universal health care scheme) for the remainder of the cost of the consultation.
• It has been suggested that incentives will be offered to doctors who bulk-bill low-income patients (ie do not charge the patient but agree to receive only the government re-imbursement) and/or tie incentive practice payments (paid by the Commonwealth government to GP practices for technology and nursing costs) to doctors undertaking to bulk-bill low-income families.

Main points

Main objectives

to reduce inequity of access to GP services by making care free at the point of delivery for low-income patients.

Type of incentives

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

Groups affected

GPs, Patients, Some specialists/diagnostic services which also bulk-bill

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

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.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

The ideas being speculated about are not new:

• Incentives for GPs to change behaviour are well entrenched in the system
• Many GPs charge above the rate of re-imbursement or above the recommended fee
• Means testing is a common means of allocating benefits but a major reversal of the principles of Medicare.

Stakeholder positions

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.

Influences in policy making and legislation

This remains to be seen

Adoption and implementation

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.

Expected outcome

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.

References

Sources of Information

No formal policy proposals as yet

Author/s and/or contributors to this survey

Marion Haas, Jane Hall, Elizabeth Savage

Empfohlene Zitierweise für diesen Online-Artikel:

Marion Haas, Jane Hall, Elizabeth Savage. "General Practitioners Remuneration". Health Policy Monitor, May 2003. Available at http://www.hpm.org/survey/au/a1/4