The end of bulk billing: no more free GP visits

[MichaelP]

The new revised copayment system just announced by Tony Abbott will force GPs to stop bulk billing for the average punter. The changes mean that GPs will only be able to bulk bill pensioners and children and people on benefits. The policy is being misleadingly sold as an 'optional' $5 co-payment to be imposed at the discretion of the GP. The reality is that GPs will have no option but to charge a fee - they would go out of business with the $5 cut in the rebate. And if they are going to charge a fee, most GPs will now charge what they have always claimed to be the 'real' fee for their services - the AMA recommended fee of around $75. You will get $31 of that back. In other words, a visit to the GP will likely cost you $44 from 2015. Oh and this policy also hits you if your GP already charges a fee and doesn't bulk bill - the $5 fee cut means you will get $5 less back when you claim a rebate from Medicare.

 

This new policy fundamentally changes the Australian Medicare system. It will no longer be a universal primary healthcare system, but a two tier system with a cheap-as-chips service for the old, unemployed and people on low incomes. In other words, it will become like the US Medicaid system. The next step will be legislation to allow private health insurers to offer GP policies - this is already starting with Medibank in Queensland offering their members 'GP Plus Care'. Australians can expect to be paying a lot more of their family budget on healthcare fees as a result of this.

[Quoll]

Well it was always meant to be a co-pay system but the Bulk Billing juggernaut got speedy wheels with competition from big conglomerate practices (and no one I know is as hell bent on finding a BB practice as the new Pom incomers!). In Canberra it's largely irrelevant anyway as there aren't many BB practices and those there are don't always have the best of reps. I'm glad to see it return to what it should always have been - bulk billing for the disadvantaged and a part user pays for the rest. A totally free universal health care program like the NHS would need a total revamp and higher contributions across the board. I would like to see some capping on the fees that doctors can charge though - some specialists have obscene fees.

[Guest Guest66881]

Well it was always meant to be a co-pay system but the Bulk Billing juggernaut got speedy wheels with competition from big conglomerate practices (and no one I know is as hell bent on finding a BB practice as the new Pom incomers!). In Canberra it's largely irrelevant anyway as there aren't many BB practices and those there are don't always have the best of reps. I'm glad to see it return to what it should always have been - bulk billing for the disadvantaged and a part user pays for the rest. A totally free universal health care program like the NHS would need a total revamp and higher contributions across the board. I would like to see some capping on the fees that doctors can charge though - some specialists have obscene fees.

 

 

Is that because that fits into your lifestyle?

 

Bulk billing will never go away, larger practices will use it as a ways to gain public enrolment to that practice, and as for bulk billed means a crappy service utter rubbish.

I have used both and systems here and found both to be very good, no different than the NHS other than some med costs, but we live here and some things are that way so we just suck it up and get on with it.

[foolboy]

This really sucks. I have to go to my GP at least once a month sometimes more and my GP usually BB me to help me out. I don't have a health care card ( apparently I'm not sick enough ) so now he will have to charge me or take a $5-00 cut in his pay. What really annoys me is that kids don't get charged. I'm already paying for their childcare, private health insurance, private school fees and 50 % of their parents get more in rebates than they pay in tax. If you are thinking of coming to Australia don't bother if you are single and sick or at least delay coming until this fool is kicked out.

[MichaelP]

The corporate medical centres have never been a big influence on bulk billing rates. Even the biggest chain, Primary Health, only have 70 clinics (there are 25,000 GPs in Australia). With bulk billing confined to pensioners and kids you will see GPs start to charge everyone else the same obscene fees as specialists. The health minister keeps saying that Australians see the GP for free. Oh no they don't. As well as paying the Medicare levy, there are already a lot of costs in seeing the GP. My recent visit with my son for his asthma ended up costing us nearly $100 just for the prescriptions. Thankfully that was a one-off. I pity those with chronic conditions like diabetes who need to see a doctor regularly. And the idea of charging people a fee to "make them appreciate it" is just nuts. I've worked in a family practice and believe me people don't come in to see the GP just for a chat or with a sniffle. Just the opposite - far too many people avoid seeing the doctor until their condition gets really bad - and ends up costing the hospital and taxpayer a lot more to fix. Blokes are particularly bad in this respect. Putting a 'price signal' on GP visits is really bad policy. It should be the other way round - we need to be building up GP and giving them more funds for more staff to keep people out of the hugely expensive hospitals.

[foolboy]

You are so right Michaelp GP's are the people who keep the health system going and making them the badguys is a really low act by the government. Like I said before my doctor often doesn't charge me which I really appreciate unlike most specialist who charge you like a wounded bull. I don;t mind paying my way but living with any kind of chronic illness is a very expensive life adding to this is centrelink who often don't recognise serious illnesses any longer. I live with 4 separate conditions but none are apparently serious enough to qualify for a pension but I still have to live with the 4 different conditions. This government just doesn't seem to get it.

[Quoll]

Is that because that fits into your lifestyle?

 

Bulk billing will never go away, larger practices will use it as a ways to gain public enrolment to that practice, and as for bulk billed means a crappy service utter rubbish.

I have used both and systems here and found both to be very good, no different than the NHS other than some med costs, but we live here and some things are that way so we just suck it up and get on with it.

 

Nope, I guess it was more because I was there when it started and it was never meant to be universally free, it was designed as a copay system. If you want universally free then there needs to be a total re-start but just tinkering is going to result in an even bigger mess - if the electorate wants a totally free system then it needs to begin again. Bulk billing got popular with the mega practices to enrol people in and then keep on churning them through and through - sometimes when repeat visits werent justified clinically or ethically just to get the money coming in. The big practices are more common in the places that people want to live - the nice places. Unfortunately, the areas where bulk billing is perhaps more necessary - the impoverished country towns - the conglomerates arent interested because there isnt the number of clients to support them so the smaller GP practices have to do it all and from what I can gather (friends in small rural GP practices) they struggle to make ends meet.

 

I dont think anyone is seeing the GPs as the bad guys here.

[Jacaranda]

Ok so what if you have/had private health insurance.How much is that per month for example and if you had it,how much would you then pay out of your own pocket for a visit to the doc's,specialists or whatever?

[Petals]

What is bulk billing my docs have not heard of it, always have to co payment even though I have health care care :laugh:

[Skani]

Ok so what if you have/had private health insurance.How much is that per month for example and if you had it,how much would you then pay out of your own pocket for a visit to the doc's,specialists or whatever?

 

Private health insurance doesn't cover GP consultations. I don't think any of them cover the 'gap' - ie. what you have to pay after the Medicare refund - for specialists either, but I could be corrected on that.

[Freckleface]

As Quoll already mentioned Medicare was designed as a co-payment system. Bulk billing was supposed to be there as a safety net for the poor - those unable to pay their own way.

 

I don't think people who can afford to migrate should be attempting to access bulk billing after stepping off the plane.

[scuffythetugboat]

Well it was always meant to be a co-pay system but the Bulk Billing juggernaut got speedy wheels with competition from big conglomerate practices (and no one I know is as hell bent on finding a BB practice as the new Pom incomers!). In Canberra it's largely irrelevant anyway as there aren't many BB practices and those there are don't always have the best of reps. I'm glad to see it return to what it should always have been - bulk billing for the disadvantaged and a part user pays for the rest. A totally free universal health care program like the NHS would need a total revamp and higher contributions across the board. I would like to see some capping on the fees that doctors can charge though - some specialists have obscene fees.

 

Not all specialists in my case. My GP charges me $65 for a short consultation, sometimes only 2 minutes, I also have to see an ENT specialist regularly and he charges me $80 per visit and I'm in there for a minimum of 10 minutes at a time.

[scuffythetugboat]

As Quoll already mentioned Medicare was designed as a co-payment system. Bulk billing was supposed to be there as a safety net for the poor - those unable to pay their own way.

 

I don't think people who can afford to migrate should be attempting to access bulk billing after stepping off the plane.

 

 

I disagree. I was around when Medicare was introduced and it was introduced as universal healthcare for Australians and Permanent Residents.

[Peach]

As Quoll already mentioned Medicare was designed as a co-payment system. Bulk billing was supposed to be there as a safety net for the poor - those unable to pay their own way.

 

I don't think people who can afford to migrate should be attempting to access bulk billing after stepping off the plane.

 

Bulk billing isn't just a reserve for the poor, http://www.familycare.com.au/ (bulk billed) and http://www.westbelconnenhealth.coop/ (annual fee per family, then bulk billed) are two examples of cheap accessible healthcare.

[Freckleface]

I disagree. I was around when Medicare was introduced and it was introduced as universal healthcare for Australians and Permanent Residents.

 

 

Yes a poor choice of words - I should have said since 1978 rather than designed.

 

In 1978 medical benefits were reduced to 75 per cent of the Schedule fee and bulk billing was restricted to holders of Pensioner Health Benefits cards, and those deemed by the doctor to be, in the Minister's words, 'socially disadvantaged'.

[fish.01]

Yes a poor choice of words - I should have said since 1978 rather than designed.

 

In 1978 medical benefits were reduced to 75 per cent of the Schedule fee and bulk billing was restricted to holders of Pensioner Health Benefits cards, and those deemed by the doctor to be, in the Minister's words, 'socially disadvantaged'.

 

 

And those 1978 amendments to the original Medicare charter were chucked out and a return to the original Medicare occurred in 1984:

 

"[h=3]Medicare from 1984 Onwards[/h]The major changes introduced by the Fraser Government were largely rejected by the Hawke Labor Government, which returned to the original Medibank model. Although the financing arrangements were different, and there was a name change from Medibank to Medicare, little else differed from the original. Medicare as we know it came into operation on 1 February 1984, following the passage in September 1983 of the Health Legislation Amendment Act 1983, including amendments to the Health Insurance Act 1973, the National Health Act 1953 and the Health Insurance Commission Act 1973. It differed from the original Medibank program only in matters of detail.

Dr Blewett in his Second Reading Speech in September 1983, described the legislation as 'a major social reform' that would 'embody a health insurance system that is simple, fair and affordable'. He also emphasised the 'universality of cover' as being 'desirable from an equity point of view' and 'in terms of efficiency and reduced administrative costs'."

 

http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/medicare

[Guest Dave53]

As I understand it , and I will stand corrected if wrong , is the Medicare rebate for a GP consultation being cut from around $32 to about $12 too and will be capped for 4 years ? ... If this is the case then it will cost the patient the $5 co payment + the extra $20 in rebate differential ... As I say I may be wrong , however , I'm sure it was posted in the SMH this week ... So we may be up for an additional $25 or so ! ...

 

Dave C

[Harpodom]

As I understand it , and I will stand corrected if wrong , is the Medicare rebate for a GP consultation being cut from around $32 to about $12 too and will be capped for 4 years ? ... If this is the case then it will cost the patient the $5 co payment + the extra $20 in rebate differential ... As I say I may be wrong , however , I'm sure it was posted in the SMH this week ... So we may be up for an additional $25 or so ! ...

 

Dave C

 

No, the rebate will be cut by $5 for a standard consult (to about $28). The govt will also expect the GP to spend a minimum 10 minutes (rather than the current 5) to get that rebate. But yes, the rebate is locked until 2018. GPs have been crying out for years for a lift in medicare rebates which have been effectively static.

 

Needless to say, GPs are furious. They have been against any co payment model since it was first proposed at the start of the year.

 

This 'plan B' was crafted on the hoof, there was no consultation with GPs before this amended model. The govt thinks it is a master stroke because it makes the GP the bad guy for charging the co payment.

 

Interestingly, specialists are completely off the hook. Why? Primary Care needs proper funding to make it sustainable in the future. This govt couldn't give a $hit about the future of Primary Care. Inevitably these changes will lead to junior doctors avoiding general practice as a career and in 5-10 years, Primary Care will be in deep $hit.

 

The greatest fallacy of this policy is that the savings won't be going back to the treasury, they're earmarked for a medical research fund that no one asked for.

[Skani]

As I understand it , and I will stand corrected if wrong , is the Medicare rebate for a GP consultation being cut from around $32 to about $12 too and will be capped for 4 years ? ...

 

 

 

Yes, for GP visits of less than 10 minutes, the Medicare rebate will be cut from $37.05 to only $11.95. For visits of 10 - 20 minutes the rebate will be cut to $32.05.

(I'm not sure what happens for visits longer than 20 minutes).

 

You are right about the capping for 4 years.

Shall we now see politicians' salaries frozen for 4 years? That's fair....:rolleyes:

[Guest Dave53]

I'm confused now ! .. Two differing responses . If indeed Skani is correct ,then simple maths puts us even more out of pocket , to the sum of just short of $30 per GP visit ..

Dave C

[Harpodom]

I'm confused now ! .. Two differing responses ..

 

Dave C

 

We're both correct. :wink:

 

A standard consult (level B: rebate $28-33 according to before/after the cut) currently is anything from 5-20 mins. Less than 5 mins and its a level A (rebate about $12). More than 20 mins and its a level C (about $70).

 

The govt in their wisdom will be moving the goalposts to make a level A up to 10 minutes, level B 10-20 minutes, level C will remain the same.

 

What this will mean in reality is GPs (not being completely daft) will stretch out a 6 minute consult to a 10 minute one, not in the interests of the patient, just to make it worth getting out of bed in the morning. Wouldn't you if the difference was between $12 and $28?

[Ozmaniac]

As I understand it , and I will stand corrected if wrong , is the Medicare rebate for a GP consultation being cut from around $32 to about $12 too and will be capped for 4 years ? ... If this is the case then it will cost the patient the $5 co payment + the extra $20 in rebate differential ... As I say I may be wrong , however , I'm sure it was posted in the SMH this week ... So we may be up for an additional $25 or so ! ...

 

Dave C

Bulk billing doctors currently make what they feel is an acceptable income by seeing large numbers of patients for very short consultations of under 10 minutes (usually well under). Under the new measures, if the doctor spends 10 minutes or longer with the patient, the Medicare rebate will be cut from the current $37.05 to $32.05 (i.e. the 'new' $5 co-payment as advertised). However, the rate for a shorter consultation will only be $11.95.

 

With a greatly reduced rebate for very short consultations, far fewer practices will continue to bulk bill all comers. IMO, a good outcome.

[Harpodom]

Bulk billing doctors currently make what they feel is an acceptable income by seeing large numbers of patients for very short consultations of under 10 minutes (usually well under). Under the new measures, if the doctor spends 10 minutes or longer with the patient, the Medicare rebate will be cut from the current $37.05 to $32.05 (i.e. the 'new' $5 co-payment as advertised). However, the rate for a shorter consultation will only be $11.95.

 

With a greatly reduced rebate for very short consultations, far fewer practices will continue to bulk bill all comers. IMO, a good outcome.

 

Why?

[Skani]

I'm confused now ! ..

 

I think that's part of the government strategy ...confuse the punters enough ...and they won't have a clue what we're up to! :wink:

 

This may be the article you saw in the SMH. At the bottom there's a "What it will mean..." explanation.

But your head will probably hurt even more....:rolleyes:

 

http://www.smh.com.au/federal-politics/political-news/copayment-will-hit-bulk-billing-ama-predicts-20141210-124e1n.html

[Ozmaniac]

I'm very definitely not a supporter of this current government but believe reduced bulk billing is a good outcome for two reasons.

 

1. Far too many people go to the doctor when they don't need to. They get a simple cold or their child has a temperature .5 degree above normal and no other symptoms, and they're off to the doctor. If it costs them something, they will (hopefully) think more carefully about whether or not they really need to see a doctor. Fewer visits means lower costs to Medicare and we all benefit.

 

2. Doctors in bulk billing practices don't spend enough time with most patients because their income relies on seeing large numbers of patients. Currently, if the patient walks out with a scrip after a 3 minute visit, they seem to think they're achieved something and they're satisfied. If the doctor has to spend 10+ minutes for the same return per patient, the additional time may allow them to actually give some informed and considered advice instead of hurriedly writing a scrip and shoving them out the door for the next patient, an outcome which may even also have an additional effect on reducing over prescribing of antibiotics and other drugs.