DUTTON FAILS TO REJECT THE DISMANTLING OF MEDICARE

The Doctors Reform Society  is shocked to hear that the Health Minister Mr Dutton sees no problem with the trialling of private health insurance (PHI) covering  copayments for GPs, said Dr Con Costa, President, Doctors Reform Society. Copayments will increase, the rich will pay via their insurance, taxpayers will pay more through the PHI rebate, and those 55% of Australians who can’t afford PHI will miss out.

This proposal is about introducing queue jumping into GPs waiting rooms, said Dr Costa. We already have such unfair treatment for hospital care as patients wait years for elective surgery. Now it will be ‘Do you have private insurance so we can see you immediately?’, in GP waiting rooms.

This will two tier our GP services  as well as our hospital care, said Dr Tim Woodruff.  It is a clear sign that Mr Dutton approves of the destruction of Medicare as a system of universal access to affordable care for all Australians.

It is also clear that controlling health costs is not a concern as this Americanisation of our health system is a sure way to send health costs through the roof whilst providing less health care

Adding private health insurance to GP services is just another nail in the coffin of Medicare

Please explain Mr Dutton

Dr Con Costa    Dr Tim Woodruff  

President   Vice President      

Doctors Reform Society      Ph 0401042619

Ph 0418400309

https://twitter.com/drsreform

http://www.facebook.com/DoctorsReformSociety

http://drs.org.au

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Local Brisbane GP and Vice President of the Doctors Reform Society, Dr Tracy Schrader, has called on Dr Bill Glasson, LNP candidate for the seat of Griffith, to a debate on his support for mandatory copayments on GP visits.

“This will be the end of Medicare” said Dr Schrader.

“The government and Dr Glasson believing a $6 copayment is affordable are living in a different world. These costs add up and most of my patients have difficulties already affording medication and other care. This will be another deterrent in seeking care.” concluded Dr Schrader. “This won’t just stop at $6 either. These fees escalate.”

“Price signals do not work in health care. This is not cups of coffee or luxury items you’re dealing with here. This is people’s lives and health. People don’t need to be hit with a financial hammer when seeking care. Preventative care, screening and chronic illness management will all be impacted,” Dr Schrader said “and down the line more illness that could have been dealt with more efficiently in the primary care setting.”

“Who determines what’s ‘affordable’ or who’s the ‘most vulnerable’? Most of us are all vulnerable in different ways at some time. Isn’t the taxation office the best place to determine who should pay what and not the doctor’s surgery where we sometimes do feel vulnerable? Free at the point of service is a fundamental principle of universal health care and Medicare. This will only create bureaucratic chaos and won’t save money. It will be more costs for the sick and less well-off and less tax for the wealthy.” said Dr Schrader. “Yes, Dr Glasson, if you can afford to pay you should pay – through your taxes.”

“Doctors’ fees always blow out after the introduction of copayments. Bulk billing has been a cost constraint on doctors’ fees. Compare the cost to see a GP ($36/$72) with the fees private specialists charge often around $300 plus. Dr Glasson as a private ophthalmologist should be well aware of this. It is the thin edge of the wedge. The death of Medicare Dr Glasson claims to support.” said Dr Schrader.

“Is Dr Glasson also supportive of the proposal of extending the copayment to public hospital emergency departments to “stop the rush of Medicare patients to the state hospital ‘free’ ED”?” asked Dr Schrader.  “Introducing a copayment in emergency departments would create an administrative nightmare. The practicalities are almost unthinkable. Who collects and when? Would you be sent a bill if unable to pay at the time? Would debt collectors be sent after people unable to pay? Remember back in the early seventies before Medibank/Medicare, failure to pay medical bills was the main reason for imprisonment for debt in South Australia. And then there’s interference with administrating care. The so-called frontline services the government proclaims to want to protect.”

“Dr Glasson is the endorsed LNP candidate for the Griffith by-election. He and the government have to come out and tell the Australian people exactly where they stand on this. Medicare is an issue at the heart of the Australian people. Why wasn’t such an important policy issue raised prior to the last federal election? Is it bad policy on the run or is there more to it?” said Dr Schrader. “I call on Dr Glasson to a public debate on this issue so the people of Griffith have the opportunity to make an informed decision prior to the by-election.”

(Dr Tracy Schrader lives in the seat of Griffith)

Dr Tracy Schrader 

Dr Con Costa 

Dr Tim Woodruff

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Ex AMA President and federal by election candidate for Griffith out of step with GPs, his own organisation (AMA) and with Australia’s patients say DRS

Ex AMA president and federal by election candidate Bill Glasson’s support for copayment is not unexpected said Dr Con Costa, National president of the DRS.  The AMA was one of the most ferocious opponent of the introduction of bulk billing when Medicare was first introduced as Medibank. However, unlike the AMA which has moved on, Dr Glasson seems to be continuing the war on Medicare, bulk billing and Australia’s patients.

Contrary to Dr Glasson’s press statement – GP visits are not “free”.  They are paid for by all Australians through their taxes and the Medicare levy.  They are low cost because of the economic downward pressure on doctors fees caused by bulk billing – and this is what some doctors, especially specialist doctors cannot tolerate, said Dr Costa.  No charge at point of seeing the GP is an integral part of Medicare – and high levels of bulk billing keep costs down.

When Medibank, later Medicare, was introduced it led to doctors moving away from just the affluent areas of our cities.  For the first time women who are the principal care givers, and their families had access to doctors – as well as preventive screening which, before bulk billing, was the prerogative only of richer women. Now Dr Glasson wants to take us back to the bad old days before Medicare, said Dr Tracy Schrader, Brisbane GP and national vice President of the DRS.

Dr Glasson wants to go back to the pre Medicare system where doctors are concentrated in the more affluent suburbs of our cities – and can charge their private patients while the rest of us line up at the casualty or ED, or attend the doctor as a charity case, said Dr Schrader. 

Introducing copayments or up front fees for the GP will dissuade many women from attending the doctor early in their families illness of for preventive screening.  It will result in much greater costs for the health system overall and most of the costs shifted from “open ended” federal funding to “closed” or limited state funding.  Thus more people will be lining up for less care.

The big losers will be the patients in outer suburban and rural areas – those same people that benefitted from Medicare when it was introduced – as well as our public hospitals which will become clogged up with GP type patients.

If Dr Glasson believes that a copayment is affordable to most Australians then we ask whether he is opposed to the suggestion of the copayment being extended to Public Hospital ED departments to “stop the rush of Medicare patients to the state hospital ‘free’ ED”.

Dr Glasson, an ophthalmologist, should be well aware of the high and often unaffordable cost for Australians to see a specialist. He is out of step with Australia’s GPs many of whom are concerned:

1. many of their more needy patients wont be able to see them for chronic and complex illness

2. the bureaucratic nightmare of policing complex new rules and collecting payments

3. will probably stop bulk billing if copayments introduced. 

4. and with his own organisation (the AMA) which has expressed concerns about the negative impact of a copayment – and also its negative effect of the state public hospital system.

Brisbane based GP DRS national vice President Tracy Schrader called on Mr Glasson to debate the Copayment issue.  He is running for federal office and people have a right to know exactly where he stands on important issues such as equitable access to health  care, driving our high out of pocket costs even higher, and driving up the overall costs of the health system by white anting Medicare, said Dr Schrader.

Sydney Brisbane  Melbourne

Dr con costa  Dr Tracy Schrader  Dr Tim Woodruff

National President  Vice President  0401042619

0418400309 Ph 0408 892 610 

(02) 97978710

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Proposal for Copayment for hospital ED wont work and confirms that there is serious concern about GP copayments acting as a disincetive to GP visits

The DRS today called on Health Minister Peter Dutton to rule out changes to Medicare including copayments for GP visits and charges for attending the ED department.  This is getting sillier and sillier said DRS spokesperson Dr Con Costa.  First they say they will introduce a charge to see the family GP, and that it is only a small charge that won’t dissuade people from seeing a GP.  Next they are saying that charges should be introduced to state public hospitals to prevent an influx of GP patients who can’t afford to pay the copayment.  Which one is it?

 The report by Terry Barnes, former health adviser to PM Mr Abbott includes – “We think that $5 or $6 would not be enough to deter people from going to the doctors if they absolutely need to,” he said.

“We’re saying this is quite reasonable to keep the whole system going.

This is sending a price signal to people, there’s no doubt about that… the level of co-payment we’re suggesting is equivalent to a hamburger and fries or a schooner of beer, it’s not a great deal.”

Mr Barnes further promotes the idea of a similar charge to stop people from going instead to the ED departments of their local public hospital. 

Health Minister Peter Dutton has not ruled out a fee for patients visiting their doctors, saying in a statement the Government “won’t be commenting on speculation around what the Commission of Audit may or may not recommend”.

This is truly the silly season said Dr Costa. 
Proponents of the GP copayment are admitting that such a copayment would be a disincentive for people seeing their family GP and lead to a run on hospital ED’s as people seek to avoid the copayment.   This alone would be a strong argument against a copayment ie it would be a disincentive for people attending a regular GP early in an illness or for routine preventive screening.  – and our public hospitals are  already overcrowded with more serious type emergency cases.  The last thing the ED doctors need is an influx of refugee patients from GPs.

Secondly the introduction of a copayment for the GP is cost shifting from federal to state government budgets – and so the states are being encouraged into  a tit for tat retaliation ie the states who would be forced to introduce charges in the emergency departments of public hospitals – thus making it difficult for people to access emergency care.

It is not just a question of attempted cost shifting by the federal government. Our hospital EDs cannot take over the role of the family GP.  ED cannot provide immunisation or preventive women’s health checks or monitor diabetes or high blood pressure patients.  There would be no continuity and no cumulative memory if people are driven to seek their routine medical care in the hospital ED.  It would also be a very expensive and inefficient way to run a health system, said Dr Costa.

There is only one fair and realistic way to save money in the health system said Dr Con Costa.  We must provide community based care based on early prevention and good management of chronic or advanced illness – in the community where it is more appropriately managed and at much lower cost than hospital care.  We have a broken system where most GPs are seeing patients only in their surgeries yet those with complex illness in the community – the elderly in nursing homes, the dying who are in desperate need of palliative care or those who are too sick to get to the doctors office, are simply going without care or end up yo yo ing back and forth to the public hospital EDs in an ambulance.

It is a crazy and heartless statement to portray these patients as needing a price signal to deter them from seeing their GP too often.  These patients often do not have a GP or a so seriously under serviced that they have no alternative but to call an ambulance and sometimes on a weekly basis.  Why blame the patients when the problem could so easily be fixed with better community based care instead of more expensive hospital based involvement.

We now seem to have a federal government which feels that the simple solution is to make everyone pay for their medical care individually ie not through national health insurance/ Medicare.

Eroding bulk billing with up front charges/ copayments forces our patients into rear guard measures including avoiding going to the doctor or seeking community based care – until late in the illness when it is much harder to treat.  Instead they present inappropriately to the ED department or simply call an ambulance at great cost to the system – and will create a bureaucratic nightmare for doctors who have to collect the fees as well as encouraging doctors to stop bulk billing.  Encouraging a user pays system will make all of those in residential aged care or needing care in the home, worse off.  A GP copayment would hit mainly women who are often the principal carers as well as women again missing out on preventive health checks – especially women in outer suburban areas.

Eroding bulk billing will worsen access to timely and cheap GP care and will further aggravate a situation where many Australians find it difficult to access a family GP and are forced to use the public hospitals for routine medical care.  Charging at the hospital ED is impractical.  Our EDs will end up choked with more patients and the public hospital administration burdened with a bureaucratic nightmare of debt collection.  What is next in the silly season – means testing of public hospitals? asked Dr Costa.

Dr Con Costa   Dr Tim Woodruff

President   Vice President 

0418400309  or (02) 97978710   Ph 0401042619

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PM Tony Abbott and his health minister Ms Ley have been keen to present the demise of the Medicare Copayment as a victory for common sense and that “the government is listening” said Dr Con Costa National President of the DRS.  The public would be naive to accept Mr abbotts assertion that the attacks on Medicare bulk billing have been withdrawn.  We need to be very clear that Mr Abbotts abandoning his $5 copayment policy does not mean the end of extra copayments to see the GP – because the federal governments freezing of medicare rebates for 4 years will force the end of bulk billing for many patients

A 4 year freeze on The Medicare rebate present the likelihood of most GPs returning to charging rather than bulk billing.  And the commonest private charge to see a GP starts from $60 and goes upwards to the AMA recommended fee of $75, or more.  Based on these figures alone, many australians would face a copayment of $25 if their GP stops bulk billing, or up to $40 or more to see a GP.  And thus a lot more than the $5 copayment proposal.
As was stated at the hearings of the Senate subcommittee into Health, the greatest threat to the viability of bulk billing and the Medicare system, is the 4  year freeze on the medicare bulk billing rebate.  And the proposed 4 year freeze, which is much more destructive that the $5 copayment, remains in place.  It presents a clear signal to the electorate and to doctors, that bulk billing is finished and that doctors need to start charging patients.  A 4 year freeze on the rebate will force GPs to charge copayments sooner or later.  No business can withstand such a prolonged freeze in prices – and as an ex health Minister, Mr Abbott would well know this.

The 4 year freeze on an already minimal Medicare rebate of $36 (around half of the private billing doctors charge of $75) will force doctors to put patients through quicker and sicker, but more probably many GPs will gradually start to abandon bulk billing and a resultant $40 copayment for patients.  Doctors have already lost confidence and any doctor who can charge a $65 or $75 fee will quickly do so ie not wait around for 4 years.

While the 4 year freeze on the medicare rebate remains in place, PM Mr Abbott and Health Minister Ley are being dishonest with the Australian people in presenting the reversal of Medicare Copayment policy.The 4 year freeze on the Medicare rebate will lead to Copayments much higher than $5 – and commonly they will be upwards of $40, said Dr Costa

WHAT HAS OUR COUNTRY COME TO?

Below is reportedly the Xray of the forearm of an 11 year old boy in the care of the Australian Government as a refugee on Nauru. It shows he has 2 broken bones. It is claimed that this happened 4 weeks ago and as yet has not been treated to address the obvious deformity. Without treatment he will have lifelong deformity and decreased use. Such fractures would normally be sorted out within 2 weeks with adequate medical care.

An 11 year old did not choose to come by boat to Australia. An 11 year old is not to blame for anything his parents may have decided. This 11 year old could be the son of any one of us if we were unlucky enough to be born in a war torn county and tortured and hounded into taking the huge risk of becoming a boat person refugee.

This blameless child is being punished by the Australian Government for being born into a family of refugees. Proper medical care is being denied by leaders who proclaim their Christianity in one of the richest countries in the world.

If a doctor consciously denies adequate care for no reason other than the child’s family background (refugee on Nauru), that doctor could be at serious risk of being struck off the register.   But a politician?

The Government, Opposition, and indeed all Australians should hang their heads in shame. This is child abuse.

NEW COPAYMENT KICK IN GUTS FOR WORKING AUSTRALIANS

The announcement that the proposed $7 GP copayment will be replaced by a $5 rebate cut to GPs when they see non pensioners and concession card holders is a kick in the guts to working Australians, said Dr Tim Woodruff of the Doctors Reform Society.

This is clearly aimed at keeping patients away from the doctor, said Dr Woodruff. This is forcing working Australians to pay twice for health care (once through taxes and then through the copayment) or not see the doctor. We doctors do not want patients to avoid seeing us with what to them might appear to be minor complaints but are really signs of serious disease, said Dr Woodruff. But this appears to be what rich politicians from the Government want.

This puts the pressure on doctors to decide who are the ‘deserving poor’ and forces doctors to cross subsidise care if they do want to bulk bill a non pensioner.

The $5 copayment may not seem like much to a rich politician but multiple $5 do mean a lot to a low income worker. In addition, many doctors will move from bulk billing to charging more than $5 as they recoup the costs of charging copayments.

This decision will please doctors who want to charge copayments but will antagonise those who want to make sure any patient who thinks they should get their problems sorted should be very welcome. It is not a way to give a fair go to all Australians. It is a way to slowly destroy Medicare as we know it.

Dr Con Costa    Dr Tim Woodruff  

President   Vice President      

Doctors Reform Society      Ph 0401042619

Ph 0418400309

https://twitter.com/drsreform

http://www.facebook.com/DoctorsReformSociety

http://drs.org.au

]]

“The Opposition’s rejection of changes to the Private Health Insurance (PHI) rebate is a sad confirmation that neither of the major political parties accept that this $3 billion per year subsidy of the private health industry is both inequitable and inefficient,” said Dr Tim Woodruff, President, Doctors Reform Society

“The rich are being asked by the Rudd Government to pay for the luxury of a short waiting time for surgery or for their private maternity services,” said Dr Woodruff. “How can Mr Turnbull object to that when over half of all Australians must wait for the underfunded public system for their care?”

“But whilst the Rudd Government has announced changes to the PHI rebate, it will do little more than save $500 million per year,” said Dr Woodruff. “It will not affect the growth of the private hospital sector which is dragging specialists out of the under-resourced public sector. Nor will these savings be earmarked to rebuild and properly finance the struggling public sector.”

“So the majority of Australians, the 56% of Australians who can’t afford PHI, will continue to be ignored by both major parties as both parties commit to private affluence and public squalor.”

“As for raising revenue from increasing tax on cigarettes by 3 cents; if it reduces smoking it won’t raise revenue, if it doesn’t then it’s simply a tax on people with an addiction; hardly a health measure.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“Instead of announcing bold new funding initiatives to meet the historical federal commitment to 50% funding of the public hospitals – (federal share of funding has been lagging dramatically since the times of the Howard government and their push for hospital privatisation) – the Rudd Government has simply frittered around at the edges of the wasteful PHI rebate,” said Dr Tim Woodruff, President, Doctors Reform Society. Even then, any meagre savings from some minor reductions to the PHI rebate ($500 million out of the wasteful $3 billion annually) will not be going to the cash strapped public hospitals.”

“Addressing the worst inequities of the Private Health Insurance (PHI) rebate and the Medicare Safety Net are welcome,” said Dr Woodruff, “but the PHI rebate was a waste of money in the good times. It is now simply obscene.”

Our public hospitals have always carried the burden for major illness and injury for ALL Australians – regardless of ability to pay. How many of our sick children are treated in private hospitals?? Yet this government seems determined to hang them out to dry while continuing privatisation via public subsidies to the failed private health insurance industry.

“Where is the immediate investment in the desperate public hospital and health system to guard against the increased demand for public services which are likely as we move further into recession and un and under-employment deepens?,” asked Dr Woodruff. .”Much of the ‘new’ money for hospitals had been promised already, and most will not be available for several years despite it being obvious that it’s needed now to address the 2 year waits for elective services and the days long wait in emergency departments which our public patients endure.”

“Money has quite rightly been found for pensioners, but many pensioners will find copayments and private hospital charges will quickly eliminate these benefits as they struggle to choose between an under-resourced public health system and the expensive expanding publicly subsidised private health industry.”

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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“The DRS supports the National Health and Hospitals Reform Commission’s criticism of the current method of payment of GPs,” said Dr Tim Woodruff, President, Doctors Reform Society. “Paying doctors on a walk in walk out basis is only useful for a minority of illness in primary care. It discourages professionalism, encourages doctors to work alone rather than with health teams, and in a perfunctory manner i.e. time is money and an emphasis on quick consultations and fast throughput,” said Dr Woodruff.

“Fee for service (FFS) is not a good way to pay for the doctor to manage chronic illness or community care such as house visits and taking care of the elderly, seriously ill, those with disability or mental illness or those needing home care, palliative care etc.”

“In addition, FFS means patients who live in areas of workforce shortage, who are usually the most needy, get less care than those who live in richer urban areas, because funding goes to doctors, not to areas of need”

“We support calls for a mixed payment system for GPs that could combine FFS for acute care and part salary and part incentive payments for meeting broad targets and voluntary enrolments etc. It is crucial however, that incentive payments have no negative effects such as disadvantaging doctors working in areas of increased health burden, or encouraging doctors to cherry pick patiens with certain diseases.”

“However, we would stress that the important aim should be to get away from wholesale dependence on FFS payments,” said Dr Woodruff. “This would encourage doctors’ professionalism and a team approach to primary care, but it also must be done in a way which does not lead to frustratingly complicated and regulated payment systems.”

“But while reform of the system itself is important, it must be recognised that reform costs money but it is an investment in the future and in the midst of our current economic crisis it is crucial to make that investment,” said Dr Woodruff. “The current health system is under funded and under strain. Prime Minister Rudd’s promise to fund the system properly if elected should be implemented immediately and even while reform is being discussed. Otherwise doctors and patients may not take the reform process seriously or get the wrong idea – that the federal government’s reform process is really about privatising the health system or introducing US style managed care. And this would be the wrong signal to be giving at this time”. said Dr Woodruff.

Dr Tim Woodruff
President
Doctors Reform Society

Dr Con Costa
Vice President
Doctors Reform Society

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