All of the media statements are somewhat vague on exactly how this whole co-payment scheme is supposed to work – I suppose because the actual sources are purposefully vague.
Like many GPs we bulkbill a sizeable proportion of our patients and these changes will be game changers for us – I would hate to think how it will affect the large Bulkbilling emporiums
So lets look at what we do know of the current suggestions:
- The non-concession patient will pay $ 15 per visit for the first 15 visits and $ 7.50 per visit after that.
- Concession card holders/pensioners pay less
- GPs CANNOT waive this out of pocket payment nor can patients insure against it
OK – so let’s look at the current situation that is in place:
- We can charge a patient whatever we like in addition to a rebate – most privately billing Practices would charge around $ 70 for a non-concessional standard 5-15min visit
- If we bulkbill a pensioner, child or concession card holder we get a bulkbilling incentive payment in addition to the current rebate
- Medicare Rebates have not increased since November 2012 – bulkbilling income has therefore been static since then (unless you churn patients through at a faster rate)
Next let’s look at the elephants in the room – the unknown factors:
- Most important unknown – is this co-payment part of the rebate or in addition to the rebate
- What are we supposed to do with a patient who has NO money and we are told that we cannot legally waive the co-payment? See them for free ? How can we force generations of patients who are used to the option of bulkbilling to suddenly always pay an amount? What about nursing home visits and how does this affect Veterans
- What happens to the bulk billing incentive payment ?- that is currently worth $9.10 per consult
- How does this affect the annual indexation of the Medicare Rebate ?- as mentioned this has not been indexed since 2012.
Taking into consideration all of the above lets consider a few possible scenarios
(from best to worse):
The co-payment is on top of the current rebate and the Bulkbilling incentive stays put
GPs will have a have a massive increase in their income for bulk billed services in the first year – for a standard consult is is currently $36 (Vocationally Registered GP) or $21 (non-VR) plus the incentive of $9.10. If the co-payment is added to this we get as much as $ 15 more per visit
The very strong assumption with this scenario is however that there will be no annual indexation of rebates for at least 3-4 years so the added benefit for GPs will very quickly level off – this however still remains the best scenario from the GPs perspective
The Co-payment is on top of the current rebate but we lose the incentive:
The only visit where the proposed co-payment is more than the existing bulkbilling incentive is the $15 for the first 15 non-concessional visits (and would not have qualified for the incentive anyway) – these patients however do not make up most of the GP visits so in practice GPs will actually face a reduction in their income for patients who have some sort of concession that rtiggered payment of the incentive
The co-payment makes out part of the rebate
This is the worst case scenario (and one I am cynically thinking may be very likely).
The current bulkbilling income for a standard VR consult is as mentioned around $45 for a patient on a concession card and $36 for a non concessional patient. Non – VR is would be $ 30 and $ 21 respectively
If the incentive remains in place the Government would save up to $ 15 per visit however if they get rid of the incentive they no longer have that expense AND save the money from the patient paying a co-payment.
a Significant drop in income to a bulkbilling clinic would be the end result
This will have a HUGE implication for practices who survive on rapid throughput bulkbilled consults – one can have a debate on the quality of the services these places provide but the fact of the matter is that there are people who cannot afford to go elsewhere and they will now HAVE to go elsewhere – until a fee at the Emergency Department closes all avenues for them
The fate of GP medicine in Australia is about to change and it is most likely going to be a very bad change for GPs – especially those of us who own our own Practices.
The final straw is off course the fact that most GPs would also fall in the income bracket that would puts them in line for most of the other proposals in the Commision of Audit – we will pay more for our Private insurance, more tax, work longer and have less concessions on our retirement savings