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How this GP illustrated Medicare’s four-decade slide
While the rebate freeze put the spotlight on the value of GP services recently, Dr Christian Allen has gone a step further and compared MBS items since 1984.
Dr Christian Allen believes the system cannot continue in the same direction.
The pressures on Medicare are well known. Most obviously, GPs across the country felt the impact of the six-year freeze on Medicare Benefits Schedule (MBS) rebates.
One Gold Coast doctor, however, decided to take the longer view and try to work out a truer value of rebates since 1984, the year Medicare was introduced .
Dr Christian Allen, who became an RACGP Fellow in the past year, took two common MBS item numbers – 23 and 110 – and dug through the archives to compare the inflation-adjusted value of rebates from their inception until now.
‘What I was seeing seemed to imply that funding had gone up steadily over time, but also that the gap in terms of what patients needed to pay to fill the gap between the rebate and a suggested fee was steadily widening, particularly after the Medicare freeze,’ Dr Allen told newsGP.
‘But I also thought it was odd that even though the gap was widening, it wasn’t really compared to what people were paying back in the day.’
He has set out to put that right by going through MBS books and finding historical equivalents (equating the old item 5 for item 23, for example) then putting the values through an inflation calculator to cross-check with the modern day.
Few GPs will be surprised that the trend is steadily downward.
The work suggests that the current $39.75 patient rebate for item 23 – a consultation lasting less than 20 minutes – has declined in value in real terms by more than a fifth since it began.
The fall has been even greater for item 110 – a professional attendance at consulting rooms or a hospital by a consultant physician – with Dr Allen’s calculations putting its current value of $161.90 as more than a third down on its equivalent real value 38 years ago.
‘I wanted to make people aware that [with] these numbers, even if tomorrow the health minister comes out and says, “Look, we’re going to bump up item 23 by 20%” … that’s all well and good as a one-off,’ he said.
‘But unless you change the trajectory of this graph … it’s a bit meaningless.’
He has been sharing the results – recently signing up to Twitter – to draw attention to the disparity.
‘This to me would be almost the equivalent of the nudge letter, but [in] reverse towards the Government saying, “Hey, I’m just nudging you and letting you know that we’re aware you’re not really paying your fair share”,’ Dr Allen said.
Given more time, he would like to do a more detailed trawl through the MBS to see if any items follow a different pattern.
‘From what I can see … most of it is fairly similar,’ he said. ‘It starts off a lot higher in the 80s, and it tends to trend downwards.
‘Over time, I can’t think of any particular item off the top of my head [which] would buck that trend.’
Dr Allen, who first studied business before swapping to biomedical science then medicine, said he noticed a substantial difference when swapping from hospital work to general practice, noting that hospital interns can earn more than GP registrars.
‘It is definitely eye-opening,’ he said.
‘A lot of this stuff is more real than when you’re in the hospital and you’re earning a steady paycheque.
‘[In hospitals] you don’t really consider the cost of consumables if you make any decision, or if you decide to send a patient for a test, you don’t think about the cost.’
In the Gold Coast practice where he works, Dr Allen says prices are not going up this year, despite the impact of inflation.
‘Staff are saying, “that’s eating into our profits by 5 or 6%, how are we going to be able to continue to bulk-bill the pensioners?”,’ he said.
‘There isn’t really an answer for it.
‘Realistically, and we’ve probably seen it more with the rural practices, doctors either leave the town, or the practice closes. Some of the bigger chains where they purely bulk bill, they can’t survive.
‘The realisation that this can’t continue indefinitely is very much coming.’
He hopes the
Strengthening Medicare Taskforce will improve things and says the calculations on his graph are all the more relevant given the rapid current inflation.
The graph’s trajectory will show no sign of changing direction this year, however, with MBS indexation
confirmed at 1.6%, compared with a
Consumer Price Index of 6.1% over the 12 months to the end of June.
‘In the same way that as soon as the interest rates rise the banks are happy to pass on the costs, we’re going to have to, as a collective, move towards that unfortunately,’ Dr Allen said.
‘Either we have to pass on the cost, or the public needs to pass on their concerns to the Health Minister and try to rise the rebate in line with inflation at the very least.’
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