Medicare is broken in the bush
A COUPLE of weeks ago, after seeing some last-minute patients, I did the marathon 5-hour flight from Emerald to Canberra; having worked the Monday public holiday, which was Labour Day in Queensland.
I was excited to be invited to the “Budget lock-up”, where I would get to see first-hand the deliberations of the Turnbull government regarding health.
I surrendered my iPhone, dare I tweet in the room, as Martin Bowles, Secretary for the Department of Health, gave his presentation, and I received in return over 50 pieces of paper and glossy A4 sheets espousing the magnificence of this well thought-out Budget.
As I flicked through the documents, I could see that much was on offer – an announcement for the Health Care Homes trials; the confirmation that remote doctors in training, from the Australian College of Rural and Remote Medicine, could access the same Medicare rebates as everyone else without the red tape; and that the failed Rural General Practice Grants Program would be revamped to improve infrastructure for training in the bush.
The Medicare Benefits Scheme (MBS) review was seeing some $5.1 million in savings, which I am told isn’t the point, through abolishing outdated procedures and items. There were some important programs for Aboriginal and Torres Strait Islander peoples, and an announcement of an item number for general practitioners to do retinal scans in rural and remote areas.
Buried deep in the folder was one piece of paper that told a different story. This was soon confirmed by the Secretary with his opening comment: “You aren’t going to be happy about some of this”.
And we weren’t.
We soon found out that primary care would be frozen out of any indexation of items for another 4 years, “saving” the Government nearly a billion dollars.
This was the pause on indexation of the MBS that stole the night. Any important investments mentioned in the Budget have since been smothered by an outcry from health-related groups.
In the days since the Budget much has been said.
Punters blame the “doctors’ union” – the Australian Medical Association – for self-interest and it being all about doctors’ income. Various politicians and commentators say that the freeze cannot be hurting because bulk-billing rates have never been higher.
The government has stated that GPs can choose to charge their patients. Angry consumers complain on forums that the gap they pay is already too great, creating some dissonance between narratives.
What is lost in the argy-bargy is a basic economic fact – rural general practice will be frozen out of any indexation for the next 4 years, on the back of 4 years in an already frozen wasteland.
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Within hours of the Budget, I was receiving messages of concern from doctors right across rural Australia. There was a common theme – rural general practice is not viable and it’s becoming worse. As the undeclared recession hits rural Australia, the capacity for patients to pay at all worsens and they can find themselves with widening gaps.
Rural practices don’t have large numbers of patients, competition and economies of scale that have seen the rise of corporate medicine and a focus on shareholder value. Rural practices don’t have a bevy of bulk-billing, after-hours junior doctors to manage their fatigue and burnout; it’s the same GP at 2 am as it is at 2 pm in many towns.
Within 300 kilometres of my practice there are marginal and non-viable small rural practices limping along, some on life support, in an effort to maintain some service to their patients. Doctors in other towns are closing their doors, or even working second jobs to stay afloat.
Practices are firing nursing staff, the backbone of rural health care, or restricting the services available to their people, creating greater challenges for rural people to access quality and affordable care. Every day, rural people pay a “rural GP tax” – a tank of fuel – to get in to a GP.
My practice is mixed billing. This allows us to look after kids, the aged, those on health care cards and those with chronic and complex illness; but we do that by charging a gap for other patients.
Many of my consultations are long. I and most of the clinicians in the practice run late, not because we’re inefficient, but because people are sicker and have often left their problems to fester for too long.
We do the best we can, but in the back of our minds is how long we can keep the doors open, pay the staff we need and offer the services we do. To criticise doctors for thinking of the bottom line, when failure means that rural people miss out, is disingenuous at best.
There is already a $2.1 billion difference in health spending between city and rural areas each year. Health outcomes across the board are poorer for rural people. Rural doctors, nurses, Aboriginal health services and other health professionals are at the mercy of government because we weigh heavily the social obligation to ensure that people can access health care when they are in need.
No one benefits from the freeze in the bush and no amount of selective programs will replace comprehensive care for country people. The health quality and equity gap will continue to widen for the 30% of Australians who live beyond the coastal fringe.
Medicare is a broken system. It fails the fairness test, it fails the equity test, it fails on delivering universal access to care, and it certainly fails to provide safe and sustainable services for rural Australians.
Unfreezing the MBS will be a hollow victory. We need and should be having a very different conversation.
That conversation was started by this current government with the Primary Health Care Advisory Group, the MBS review, the Private Health Insurance inquiry and a number of other reviews.
It’s a conversation that must continue regardless of who wins this election. The future of our health system depends on it, rural communities expect it, and the sick, the disadvantaged and the dying demand it.
Dr Ewen McPhee is a GP practising in Emerald in central Queensland. He is president of the Rural Doctors Association of Australia.
This story has been brought to you by the Emerald Chamber of Commerce Inc.
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