General Practice and the "Rebate Freeze"
General Practice is on the brink of massive changes that will fundamentally change the way healthcare is delivered to our community. Government policy, funding changes, training and workforce issues, and the changing roles of other health care providers are just some of the factors that are changing the primary healthcare landscape.
This was exemplified in the May 2014 federal budget, with the announcement of a $7 GP co-payment. By December 2014, this had changed into what became known as the "$5 GP Co-payment". This included three different changes to the Medicare system:
1. a $20 cut to Medicare rebates for GP consultations of between 5 & 10 minutes from 19 Jan 2015
2. a $5 cut to the Medicare rebate for non-concessional patients from 1 July 2015
3. a freeze on Medicare rebates from 1 November 2012 to 1 July 2018
Once these changes were combined, for many patients this would have turned in to a "$25 GP-Copayment".
At the same time, the Federal Government was also in the process of setting up Primary Health Care Networks around the country, after declaring that, "General practice will be at the centre of this model...Improved primary health care is fundamental to achieving better health outcomes across Australia. A strong primary health care system helps to contain costs because health problems are treated before they need more expensive hospital treatment". In other words, they agreed that, "investing in a strong primary care system provides better health outcomes for less money".
And yet, the 19th of January change to 5-10 minute GP consultation rebates alone was expected to take $500 million out of General Practice in 2015. This is before taking into consideration the other changes, which would have seen a bulk-billed non-concessional rebate for a consultation of less than 10 minutes frozen at $11.95 until July 2018.
Whilst the argument was made that the new rebate levels will discourage poor quality "six-minute-medicine", if the intention was truly to encourage longer, higher quality consultations, a cost-neutral policy would have been proposed. But the focus was clearly on short-term budget saving by taking funds out of General Practices.
Following an unprecedented response from GPs, their patients, the AMA, the RACGP and the HGPA, the federal government was forced to listen. On the 15th of January, 2015, they abandoned the $20 cut to GP consultations. On the 3rd of March, they also dropped the $5 cut to the Medicare rebate.
Even with just the rebate freeze remaining, to remain viable, GPs will be forced to pass on the cost of the cut-backs to patients, including concession holders. This represents a "co-payment by stealth". Trying to keep their businesses afloat will be a major distraction for GPs, and will leave them unable to devote their energies to improving "...primary health care...to [achieve] better health outcomes across Australia".
The Government can't have it both ways. They can either invest in General Practice and efficiently improve the health of the nation; or they can disinvest in General Practice for short-term politically expedient goals, and jeopardise the health of our patients and their families.
The fundamental problem with the "GP Co-payment" has been a lack of consultation. To develop the detail of any health reform that affects primary care, broad consultation and feedback from experienced grassroots General Practitioners should be combined with the input of organisations such as the Australian Primary Health Care Research Institute. The result would be a valuable resource that would inform important and necessary changes to our primary health care system.
We are encouraged that the federal government has said that it will engage with health professionals and patients to review the Medicare Benefits Schedule, and investigate options for health funding models. Yet shortly after announcing a consultative review of the MBS, in the May 2015 federal budget the government cut a MBS item (the Health Kids Check) - without consulting grass-roots GPs.
The Hunter General Practitioners Association will staunchly oppose any health reforms that we believe will be harmful to our patients. At the same time, we stand willing and able to engage with Government, help develop proposals that have the ability to change systems for the benefit of our patients, where appropriate trial these proposals locally, and help scale up successful solutions for wider implementation.
We want a health system that works for our patients. Watch the videos at the bottom of this page to see how this could happen - and how it is happening in the Hunter New England region.
HPGA witnessing to the Senate Select Committee on Health, 5th February 2015
We want a health system that works for our patients. Watch the video to see how this could happen.
Dr Graham McGeoch and Carolyn Gullery presenting evidence to the Senate Select Committee on Health, 14th April 2015. They discuss the health system in Canterbury, New Zealand, and the consulting work they have been doing with HealthPathways and the Hunter Alliance in our region.
Department of Health info
1. The DOH transcript of the Minister for Health cancelling Level A/B Medicare rebate changes (15/1/15)
2. The DOH press release announcing they will consult on Medicare reform
3. The Federal Minister for Health's announcement of a MBS Review Taskforce and a Primary Health Care Advisory Group
Hunter GP resources
1. "An open letter to the Minister for Health" - by Dr David Smith
2. An Excel spreadsheet to help practices to assess the financial impact of the Medicare changes - by Dr Peter Hopkins.
3. HGPA submission to the Senate Select Committee on Health
4. HGPA supplementary submission to the Senate Select Committee on Health
5. Dr Colin Pearce submission to the Senate Select Committee on Health
6. Dr Richard Terry submission to the Senate Select Committee on Health
7. Dr Fiona Van Leeuwen speaking to ABC 1233 Local Radio about witnessing to the Senate Select Committee on Health, 5th February 2015
8. Transcript of the HGPA witnessing to the Senate Select Committee on Health, Canberra, 5th February 2015
9. Transcript excerpts referencing HGPA - from the Senate Select Committee on Health, Canberra, 5th February 2015
10. HGPA feedback on the RACGP draft discussion paper "Working towards a sustainable healthcare system - February 2015"
11. Transcript of the HGPA witnessing to the Senate Select Committee on Health, Gosford, 11th March 2015
12. Dr Steve De Lyall speaking to ABC Local Radio about the threat to GP Access After Hours (starting at 12 min 22 seconds), 14th May 2015
13. Federal Election 2016 - Prescription Pad flyers. For printing on the back of PBS prescription paper.
The RACGP submission to the Senate Select Committee on Health can be downloaded from here:
A link to the RACGP "You've been targeted" campaign is here. Includes downloadable posters and banners.
AMA practice resources
The AMA submission to the Senate Select Committee on health can be downloaded from here:
A link to the AMA Medicare rebate freeze page is here. It includes downloadable posters and template letters to patients about increased medical fees.