AMA's better way for co-pay

30 Pages·2014·0.63 MB·English

Download the Australian Medicine
app, free at your favourite app store
AMA’s better way
for co-pay
AMA plan protects
vulnerable, bolsters
general practice, p7
E 11 Co-payment’s Senate deadlock
D 12 Managed care health fund ‘endgame’
14 Senate urged to block uni fee deregulation
I
S
21 Health needs broad approach: Leeder
N
25 After hours care reviewed
I
26 Medicare to be outsourced
ISSUE 26.17 - SEPTEMBER 2 2014

In this issue
Managing Editor: John Flannery
Editor: Adrian Rollins News
7-20, 28
Production Coordinator: Kirsty Waterford
Contributors: Sanja Novakovic, Odette Visser
Regular features
Graphic Design: Streamline Creative, Canberra
Advertising enquiries 4 PRESIDENT’S MESSAGE 24 HEALTH ON THE HILL
Streamline Creative 6 SECRETARY GENERAL’S MESSAGE 29 OPINION
Tel: [phone]
21 PUBLIC HEALTH OPINION
Australian Medicine is the na tion al news publication of the
Australian Medical Association Limited. (ACN 008426793) 22 GENERAL PRACTICE
42 Macquarie St, Barton ACT 2600
23 DOCTORS IN TRAINING
Telephone: [phone]
Facsimile: [phone]
Web: www.ama.com.au
Email: [email protected]
Australian Medicine welcomes diversity of opinion on national health Cover: AMA Federal Council Members set a program of work at their first meeting in Canberra under new AMA constitutional arrangements.
issues. For this reason, published articles reflect the views of the
authors and do not represent the official policy of the AMA unless
stated. Contributions may be edited for clarity and length.
Acceptance of advertising material is at the absolute discretion of the
AMA LEADERSHIP TEAM
Editor and does not imply endorsement by the magazine or the AMA.
All material in Australian Medicine remains the copyright of the
AMA or the author and may not be reproduced without permission.
The material in Australian Medicine is for general information and
guidance only and is not intended as advice. No warranty is made as
to the accuracy or currency of the information. The AMA, its servants
and agents will not be liable for any claim, loss or damage arising out
of reliance on the information in Australian Medicine.
3 President Vice President
Associate Professor Dr Stephen Parnis
Brian Owler
Strengthening general For many people, the concept of universality
PRESIDENT’S
means that everyone has access to health care
MESSAGE
using Medicare bulk billing. However, universal
practice access to care is not the same as access that is
free of charge.
The AMA agrees that there is a role for free
medical care for some patients in our society,
The Government’s Budget proposal for a general $7 co-payment proposal is nothing more than particularly those for whom any sort of financial
practice co-payment has been universally an attempt to make the Budget bottom line ‘look barrier to care would deny or deter them from
condemned since it was announced, and better’. accessing health care. We know that almost 6 per
deservedly so. It is bad health policy. cent of adults already state that this is the case.
The pre-election commitment to not cut health was
At the request of the Prime Minister, the AMA always going to be a problem for the Government. So, why has the AMA suggested a co-payment for
BY AMA PRESIDENT developed an alternative co-payment model. Late patients who can afford to contribute?
So, taking $20 billion dollars out of health by 2020
last month, we released that proposal. It aims
ASSOCIATE PROFESSOR It is because if we continue to encourage a bulk
and putting it into the Medical Research Future
to protect vulnerable groups in our community
BRIAN OWLER billing culture in general practice for all patients,
Fund (MRFF) allows the Government to say that
while suggesting that, where people can afford to
the quality of general practice will suffer. Today,
contribute, they should do so. the money has been kept in health. It also, as the
bulk billing relies on a Medicare rebate whose
“ Finance Minister has finally articulated, means
For a one per The AMA proposes a co-payment of $6.15 for value has, in real terms, continually dwindled.
that the Government can make debt look better
concession card holders and those under 16
cent reduction because the MRFF will offset debt. Ingenious! Competitive pressures mean that GP consultation
years of age, which would be paid for by the
times are becoming shorter and doctors can only
in GP visits, a Government, and not from their own pocket. Only That is also the reason that the Government can’t
treat a single health issue at a time.
non-concession patients over 16 years of age accept the AMA’s proposal.
$7 co-payment
would be asked to make a co-payment of at least The long-term sustainability of our health care
As the AMA has repeatedly said, we cannot accept
on all patients $6.15. This amount was chosen on the basis system hinges on the ability of general practice to
a cut to the Medicare rebate. Consequently, our
seems like a that it is the current GP bulk billing incentive. The focus on prevention and manage chronic disease.
alternative co-payment proposal does not save
amount would be indexed.
very significant the Government the $3.5 billion it has budgeted to Managing the burden of chronic disease is the
The Government has argued that the co-payment come from the cut to Medicare rebates. Instead, it greatest challenge for Australia’s health care
impost on
should be a price signal to reduce unnecessary provides for only a very modest saving. system. A modest co-payment for those who can
society for visits to the doctor. However, as the Government afford to contribute will encourage the sort of
For the Opposition, this is an opportunity to
itself has modeled, this is likely to lead to just a 1
quality general practice that we need to see, and
a very, very capitalise on the Government’s intentions for
per cent reduction in GP visits in its first year, an
which is so important in keeping patients well and
modest return. It outcome that underlines the confused thinking Medicare – real or perceived. The Opposition
out of more expensive hospital care.
behind the co-payment proposal. has stated that it will never support any GP co-
simply does not
payment. It has attacked the Government for trying It’s an easy shot to paint the AMA and its members
A $7 co-payment on all patients seems like a
make sense ” to get rid of our universal health system. However, as only being interested in a ‘cash grab’, as the
very significant impost on society for a very, very
they ignore the fact that almost 20 per cent of GP Health Minister has done. In fact, the AMA has led
modest return. It simply does not make sense.
services are not bulk billed and instead attract a the debate in relation to concerns about vulnerable
What has become clear is that the Government’s significant co-payment. patients in our community. The AMA has been
MORE P5
44
INFORMATION FOR MEMBERS
Strengthening general
PRESIDENT’S
MESSAGE AMA Careers Advisory Service
practice
From graduates preparing their first resume to experienced doctors seeking
to carve out a new career path in the Commonwealth public service, the AMA
... FROM P4
Careers Advisory Service is been on hand to provide practical advice and
information.
consistent in its support for some co-payments, but also in its strong opposition to
the Government’s co-payment proposal. Since the Service was launched in their skills and expertise in jobs beyond
For many GPs, particularly those in suburban small practices or in regional areas, September, AMA Careers Consultant, medical practice. Among these have
their practices grapple with how to provide quality and comprehensive care for Kathryn Morgan, has handled dozens of been those looking for non-clinical roles
their patients in a competitive environment. If they don’t bulk bill, their patients go inquiries from members looking for help in Commonwealth and State public
up the road to the bulk billing clinic or they only attend when they have a serious and advice on advancing their careers, services that take advantage of their
problem that needs a longer consultation. This is why the AMA wants significant both within medicine and beyond. skills and experience.
new investment in general practice.
The Careers website, which is at: http:// The Service is constantly updating
While the AMA’s proposal does result in an increase of funding for general practice careers.ama.com.au/, gives members content on its website, including listings
of $580 million over three years (compared with the Government’s Budget ‘windfall’ access to both general and specific of career-related events being staged
of $480 million), it also protects vulnerable patients and children - and also excludes careers advice and information. In across the country, and uses feedback
out of clinic services such as visits to residential aged care facilities. addition to direct links to external from members to help add and develop
This investment is not a pay rise for GPs. It is an investment in more staff and websites and specific sources of resources.
better facilities in general practice to further improve the quality of care and meet information, the Service also offers Members are encouraged to visit the
growing demand for GP services. practical advice for medical professionals
website, if they haven’t done so already,
as their medical careers advance.
If practices are to gear up for the introduction of a co-payment next July, they will and we welcome feedback, which can be
need information and plenty of notice. The Government needs to put its model to The Careers Service provides information submitted via the online feedback form
Parliament for scrutiny and debate sooner rather than later. and support relevant to all stages of on the website.
If the Government’s co-payment is to be ditched completely, we will need an an individual’s career, from medical There will be further updates on
alternative plan to strengthen general practice. students looking for assistance preparing developments in the Careers Service
internship applications - particularly in coming months as we develop more
The AMA’s proposal does not make the Government’s debt level ‘look better’.
writing resumes and covering letters - ways to assist members along their
Rather, the AMA’s proposal is about sustaining the health care system through
through to doctors in training who want medical career path.
investing in general practice, while maintaining access to affordable health care
to brush up their interview skills to give
for everyone. If you or your colleagues would like to
them a competitive edge at all-important
This is a plan for a universal health care system that will serve the for community medical college interviews. convene a skills workshop facilitated by
much longer than the stressed current model. Kathryn, please contact her at:
But the Service is not only there for
This article was originally published in Fairfax newspapers – The Age, The Sydney Phone: [phone];
those in the early stages of their medical
Morning Herald, and The Canberra Times - on 28 August 2014 1300 884 196 (toll free)
careers. It has also helped qualified
medical professionals looking to apply Email: [email protected]
5 COMMENT
Nation’s diverse health needs The dinner was addressed by A/Professor
SECRETARY
GENERAL’S REPORT Owler, Minister for Health Peter Dutton, Shadow
Minister for Health Catherine King and Greens
underline high stakes in
health spokesman Senator Richard Di Natale.
The stakes are high in this session of

getting health policy right Parliament, with the Government keen to get its
Budget measures through.
Over the past couple of weeks I have been Public health issues were at the fore in many of
travelling with AMA President Associate our discussions – from management of chronic
“
Professor Brian Owler visiting members in disease to the impact of misuse of alcohol. The settings were as
BY AMA SECRETARY
different parts of Australia and hearing about
Public health experts pointed out that the life diverse as Amoonguna
GENERAL ANNE TRIMMER
their working lives, daily challenges and
expectancy gap will be addressed from a health
experiences as doctors. perspective in line with the Close the Gap near Alice Springs and
These visits highlight the many differences in initiatives, but that the social determinants of
Bathurst Island north of
health will be the factors that impede achieving
members’ practices, and in the needs of their
the targets – housing and employment.
patients. They also highlighted the commitment Darwin ”
invested by doctors in ensuring the right care Work is underway on shaping the National

is given when needed. The settings were as Alcohol Summit which the AMA will host in late
diverse as Amoonguna near Alice Springs and October at Parliament House in Canberra.
Bathurst Island north of Darwin.
The Summit will address multiple domains For those commentators willing to consider the
I was very impressed with the energy of the which look in detail at the impact of alcohol detail, the AMA’s proposal for an alternative
trainee doctors we met in the Northern Territory. misuse – domestic violence, in association with approach to the co-payment has attracted some
sport, by teenagers, in Indigenous communities, thoughtful responses.
Many of the trainees had spent time working
and street violence.
in Indigenous health centres in different The AMA Board spent two days at the end of
communities. They reflected on the changes The objective is to agree on a National Alcohol the month in a strategic planning meeting to
in training for GP registrars as a result of the Strategy to replace the now defunct plan set the direction of the company for the coming
developed some years ago.
Budget and the possible impact on the GP period.
pipeline into some of the tougher areas. Many Last week, the AMA hosted its annual
The decisions taken at the meeting will help
said that they would not have gone down Parliamentary Dinner. It provided an opportunity
determine priorities for investment and activity
the general practice path if they have not for members of Federal Council, the State AMA
on behalf of AMA’s members, and opportunities
had the chance of being part of it in the pre- CEOs, and colleagues from other health-related
to grow membership for the future.
vocational period. We need to ensure that these interest groups to meet with politicians from all
opportunities remain, even if in a different form. political persuasions. I will report more in a future column.
COMMENT
6
$6.15 co-payment an AMA co-payment:
NEWS
how it would work
investment in quality care: AMA
• no cut to Medicare rebate
• practitioners free to set own fee
• $6.15 co-payment would apply to most GP
services
• Govt would pay co-payment on behalf of children
younger than 16 years and concession card
holders
• co-payment would not apply to:
> residential aged care and home visits
> chronic disease management services
> health assessments
> mental health treatment items
• two-year delay on co-payment for pathology
AMA President A/Professor Brian Owler and AMA Council of General Practice Chair Dr Brian Morton present the AMA’s alternative GP co-payment
and diagnostic imaging services, pending
proposal to the national media. AMA House, Canberra, 21 August
consultation and review
Children and concession card holders would be exempted Under the AMA’s plan, the co-payment would not apply
from paying a co-payment for GP services under to residential aged care and home visits, chronic disease • the inclusion of the co-payment in Medicare
an alternative model put by the AMA to the Federal management services, health assessments and mental Safety Net calculations
Government and publicly released late last month. health treatment items, while child immunisation would
• A1 rebates for general patients linked to the
be covered under the blanket exemption from the co-
In a plan designed to protect vulnerable patients while application of the co-payment
payment for children younger than 16 years.
injecting much-needed funds into general practice and
putting a value on quality primary health care, the AMA In addition, the AMA has called for a two-year delay on the
has proposed that a $6.15 co-payment apply to most GP Government’s proposal to impose co-payments for pathology COMMENT
services, with Government paying the fee on behalf of and diagnostic imaging services, pending detailed consultations
children younger than 16 years and concession card holders. and assessments with professional and consumer groups.
7
MORE P8
$6.15 co-payment an investment practice, according to Government modelling.
NEWS
A/Professor Owler said the much-needed injection of funds
could relieve some of the competitive pressure on GPs to
in quality care: AMA
bulk bill and cut consultation times.
“If we continue to go down the path that we are, with 81
or 82 per cent of GP services being bulk billed, then what
... FROM P7 will happen is that we have this competition where the bulk
billing signs do go up, and people are forced to bulk bill on
AMA President Associate Professor Brian Owler said Instead, he said, through its co-payment model, the AMA
the basis of competition,” he said.
the Association’s model, which was presented to the sought to address what it saw as a secular decline in
Government in late July, was underpinned by two important support for general practice that was undercutting quality “At the end of the day, that’s a bad thing for patients,
principles – protecting vulnerable patients and supporting health care and would eventually increase the incidence because [it means] those practices are essentially just bulk
quality general practice. and severity of preventable disease and exacerbate the billing and they have to adjust, eventually, the amount of
pressure on the health system. time that they spend with patients, [which means] they can’t
A/Professor Owler said the Government’s $7 co-payment
do the prevention, [the] chronic disease management.
plan had failed dismally on both counts – it would fall At the heart of these concerns is the long-term
disproportionately heavily on the sickest and most deterioration in the value of Medicare rebates for GP “What we want to do is actually give them a break from
vulnerable, and the $5 cut to Medicare rebates it involved services. that bulk billing competition, allow them to actually charge
would make many general practices, particularly those in a fee that recognises more of the services that they are
A/Professor Owler said Medicare rebates had increased
disadvantaged areas, unviable. providing, and actually allows them to do the important
by an average 2.48 per cent a year in the past 30 years,
work of prevention and chronic disease management that
The Government has failed to articulate and clear and completely outstripped by growth in the costs of providing
actually we want our GPs to do for the sustainability of the
internally-consistent rationale for its proposed $7 co- quality medical care such as rents, training, staff costs,
health care system.”
payment, which would apply to all GP, pathology and insurance, and equipment, and had been frozen for the
diagnostic imaging patients. past two years. In its model, the AMA has effectively re-badged the $6.15
bulk billing incentive for metropolitan GP services ($9.25 in
The plan has been alternately presented by the
He said the erosion in the value of Medicare rebates had
rural and regional areas) as a direct co-payment to GPs.
Government as a way to ration access to health care by
been exacerbated by the surge in bulk billing, to the extent
sending a ‘price signal’ to patients, as a means to support that more than four out of every five patients seen by the The AMA proposal includes a hefty incentive for GPs to
medical research (co-payment revenue is to be directed to
nation’s GPs are bulk billed. charge the co-payment.
a Medical Research Future Fund) and as a way to improve
Commonwealth finances by helping defray the rising cost “The Medicare Benefit Schedule does not represent Where they charge the schedule fee plus the co-payment,
of Medicare. the true quality of quality primary health care,” the AMA GPs will receive the full A1 schedule rebate (currently
President said. “It does not value the vital role of general $37.05 for a level B consultation), plus the co-payment (for
But A/Professor Owler said the AMA proposal would
practice in the health system.” a total payment of $43.20).
provide the Government with only modest savings, of
around $66 million – a fraction of the $3.5 billion claimed Under the AMA proposal, GPs would receive the $6.15 But if a GP decides to waive or reduce the co-payment,
by the Government under its proposal. co-payment, injecting an extra $580 million into general they would only be eligible for the A2 level schedule rebate
8
MORE P9
$6.15 co-payment Grassroots lobbyist
NEWS
an investment in
quality care: AMA
... FROM P8
(currently $21 for a level B consultation), meaning they would
receive just $26.15 – a stiff $17.05 financial penalty.
A/Professor Owler said that there would inevitably be patients
who were older than 16 years and did not hold a concession
card but who had a reduced capacity to pay, such as low
income families or those with complex and chronic conditions.
He said people in these circumstances were known to their GP,
and under the AMA model the family doctor would continue to
look after them as happened under current arrangements.
The AMA President said the AMA was open to suggestions
A rural voice: Kempsey GP Dr Colin Farquharson at AMA House, Canberra late last month
on ways to improve its co-payment model, not least from the
Indigenous community.
AMA member, Dr Colin Farquharson, a GP from the Hon Luke Hartsuyker MP, and the Member for
“The AMA model is an attempt to support quality general Kempsey, NSW, was visiting Canberra recently and Lyne, Dr David Gillespie MP.
practice,” he said. “It aims to allow GPs the opportunities to paid a visit to AMA House.
He says that many of his patients are elderly, poor,
spend more time with patients to provide preventative health
care and chronic disease management, and to place a value on Dr Farquharson has been in regular contact or Indigenous, and that they would be hit hardest
the valuable service they provide. with the Federal AMA since the May Budget to by the proposed co-payment.
share his thoughts on the terrible impact the
“The focus is on the quality of the services, and this benefits the Colin also does visits to residential aged care
Government’s proposed GP co-payment model
GP, the patient, and the broader health system. patients, and says collecting the co-payment would
would have on his practice and his patients.
be unworkable and totally inappropriate.
“The AMA model is all about maximising the benefits of high- Colin has become a busy grassroots lobbyist
quality primary care and general practice, keeping people well, on the issue by raising his concerns with local Dr Farquharson and his rural practice exemplify
keeping people out of more expensive hospital care.”
Coalition politicians, including the Assistant the need for the AMA’s ongoing campaign against
Adrian Rollins Minister for Employment and Member for Cowper, the Government’s proposals.
COMMENT
COMMENT
9
INFORMATION FOR MEMBERS
AMA’s co-payment proposal:
NEWS
Essential GP tools at the
the reaction
click of a button
The AMA Council of General • checklists and
Prime Minister Tony Abbott: Royal Australian College of General
Practice has developed a questionnaires in PDF
Practitioners:
The system is becoming unsustainable. It is vital that resource that brings together format, available for
we try to ensure that there are sensible price signals The AMA’s alternate model is on the right track, in one place all the forms, printing;
in the system. And if it’s right and proper to have however [the RACGP] is still concerned about the guidelines, practice tools,
• commonly used forms in
a modest co-payment for the PBS, why not have a risks posed to vulnerable populations. information and resources
printable PDF format;
modest co-payment for Medicare? used by general practitioners
Mental Health Australia CEO Frank • clinical and administrative
in their daily work.
Treasurer Joe Hockey: Quinlan: guidelines; and
The GP Desktop Practice
I am glad that they [the AMA] do support the AMA’s proposal to exempt people treated under Support Toolkit, which is free • information and other
concept of the co-payment. I think that is hugely mental illness Medicare items from GP co payments to members, has links to resources.
important. If we want to have a sustainable “is an important first step in encouraging people around 300 commonly used In addition, there is a
Medicare system we are asking Australians to make concerned about their mental health to see a GP, but administrative and diagnostic State/Territory tab, with
a contribution along the way because, ultimately, protections must go further”. tools, saving GPs time spent information and forms
nothing can be for free. fishing around trying to locate specific to each jurisdiction,
Australian Healthcare and Hospitals
them. such as WorkCover and S8
Health Minister Peter Dutton: Association: prescribing.
The Toolkit can be
The current proposal put forward by the AMA with The co-payment policy proposal released by the downloaded from the AMA The information and links in
regards to the $7 co-pay will result in a windfall AMA goes some way to addressing the inequities of website (http://ama.com.au/ the Toolkit will be regularly
for doctors while wiping out 97 per cent of the the Government’s policy, but it still falls a long way node/7733) to a GP’s desktop updated, and its scope will be
Government’s estimated savings. short. computer as a separate file, expanded as new information
and resources become
and is not linked to vendor-
Consumers Health Forum CEO
Opposition leader Bill Shorten: available.
specific practice management
Adam Stankevicius:
Labor will not accept Tony Abbott’s GP tax in any software. Members are invited
form. A co-payment would erect a barrier to primary to suggest additional
The Toolkit is divided into five
health care for many thousands of families and information, tools and
categories, presented as easy
Palmer United Party leader Clive individuals who would not qualify for concessions. resources to be added to
to use tabs, including:
The Federal Government, and now the AMA, are the Toolkit. Please send
Palmer:
proposing a new impost on health consumers before • online practice tools that suggestions, including any
Who cares [about the AMA proposal]? We won’t investigating other ways to make health care in can be accessed and/or links, to generalpractice@
accept any co-pay, doesn’t matter what they say. Australia more cost effective. completed online; ama.com.au COMMENT
10
COMMENT