Medicare freeze continues to thaw – but not fast enough, RACGP says

Amanda Lyons

14/06/2018 2:40:09 PM

The indexation of consultation items is not high enough to cover the true costs or value of general practice care.

While the RACGP welcomes the end of the Medicare freeze, it believes the indexation is still not high enough to reflect the value of general practice.
While the RACGP welcomes the end of the Medicare freeze, it believes the indexation is still not high enough to reflect the value of general practice.

The Federal Government announced a gradual lifting of the five-year Medicare freeze as part of its 2017–18 budget, and from 1 July Medicare Benefits Schedule (MBS) group A1 – GP attendances or consultation items, which include the most commonly claimed items – will be indexed.
Listed below is the dollar value (before and after indexation) of the three most commonly used consultation items:

  • Item 23: $37.60 (previously $37.05)
  • Item 36: $72.80 (previously $71.70)
  • Item 44: $107.15 (previously $105.55)
The figures show the percentage value of the indexation sits at about 1.5%, lower than the approximately 2% average of the Consumer Price Index (CPI) over the past two years.
This lower rate has a significant financial impact: for example, if Item 23 had been indexed each year against an average CPI of around 2%, it would now be worth $40.10.
While the RACGP is pleased to see the Medicare freeze slowly lifted, it maintains that the indexation rates continue to not reflect the genuine value of general practice.
‘Medicare Benefits Schedule rebates need to recognise the real value of general practice, and the RACGP has called for an 18.5% increase of the Medicare rebate for GP attendances to bring us into line with other medical specialist attendance items,’ RACGP President Dr Bastian Seidel said in a message to RACGP members earlier this year.
Dr Seidel has also emphasised that investing in general practice services saves costs across the whole community.
‘If you see your GP early you’ll save the whole community money by staying out of hospital, and receive GP health services that can cost up to 10 times less,’ he said.
‘If we are serious about focusing on a preventive general practice healthcare, we need to end the inequality of general practice Medicare rebates compared to other clinical specialties.’

consultation-items MBS Medicare-Benefits-Schedule Medicare-indexation Medicare-rebates

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Michelle   15/06/2018 7:07:44 AM

I don't think bulk billing is a good idea for GP overall. In my opinion the whole concept devalues our service to the community. With the safety net in place those that need the medical services the most have capped fees. If we value ourselves and our own service, the community will too. I see the medicare rebate as a patient fee, not a doctors income

Richard Smith   15/06/2018 1:21:04 PM

When vocational registration and GP became specialists, there were high expectations that parity with other specialities would happen as a matter of course......
What did happen was that GPs needed to undertake more training and work within specified frameworks to ensure that they were at the standards required.
The Mental Health and Chronic Disease programs were funded at different levels and allied health personnel were partially funded to support these models of patient management.
Was this effective ?
Was it well funded ?
Does it work well ?
Is it sustainable ?
What was the patient's perspective ?
Could it be better ?
This may seem off-topic, but there are good reasons to discuss models of primary care funding.
The first is that systems that are well conceived, well implemented, properly funded and resourced, produce defined outcomes and satisfy consumers are VERY important.
These models are worthy of analysis, and research to ensure health dollars produce optimal measurable outcomes.
The concept that Medicare rebates underscore the quality and deliverables is not a sustainable one.
Change the discussion
The leading minds and voices of our College must set the agenda that was intended.
Provide quality care
Ensure adequate funding
Measure outcomes
Innovate and modify programs
Close the gaps
Collaborate with stakeholders and create a system which serves all Australians

Andrew Orr   15/06/2018 4:07:20 PM

A rational approach to universal insurance cover for primary care would see bulk billing only being made available to those in genuine need , i.e.,pensioners and children ( and perhaps valid full time students ) All other patient's fees could be variable at the GP's discretion, and that would include " rebate only" if circumstances are deemed appropriate , so that private / non bulk billed fees would remain subject to genuine market place competition. Universal bulk billing has seen the demise of a sense of value of the service to " consumers" and encourages fragmentation of quality care which works against key continuity of care. There is now a whole generation who have not experienced anything other than piecemeal care by a largely dispirited workforce , who no longer own their own practice of which to be proud to have built up and then to have to sell at the end of a working life. We have seen a " lose,lose,lose"outcome for patients, GPs,and the insurance system as a direct result of universal bulk billing.

Paul   15/06/2018 11:30:50 PM

Medicare is a poorly run, over bureaucratised government run agency. It looks backwards not forwards and is far to regulated and runs in a costly manner. Mostly it uses bully boy tactics and threats to control costs. The shareholders or voters should press the government for change. Other greedy craft groups should recognise times have changed and the value of one specialty is not 10x the value of another. The economic reality is that we must charge what we are worth and also cover often Govt or externally imposed spiralling costs. I know my goodwill and empathy remain but it is becoming really difficult to help patients. Prevention and spending time with patients has been overlooked far too long. Too much politicking and not enough rational evidence base advice from GP’s working in dysfunctional state and federal systems. Could rant for hours which is a worry

Dr Cameron Robert Gent   7/04/2019 3:17:14 PM

Interesting and good that the RACGP is seeking an 18.5% increase in GP attendance rebates for patients. Great if it can happen. Every bit helps.

However, when you look at the AMA chart of an Index comprising average weekly earnings and Consumer price index (70:30) reflecting the average cost structures in medical practices V Index of Medicare fees as determined by the Commonwealth Government since 1985, then in 2019 the rebate is 3600% less than where it would be. If the item 23, standard consult rebate had been indexed in the same way, the rebate would be $84.20.

And, as the government has said, both sides of politics, the rebate the government insurer (Medicare) pays the patient, was never meant to cover the full cost of the consultation. This means that the real cost of the consultation ( doing business) is well above $84.20.

No wonder times are tough for GPs.

Says it all really.