gp copayment

Disclosure: I'm a GP so read into this whatever bias / vested interest you think I may have.



For me the devil is in the detail with this scheme. It could be good or it could be bad. This is the most decriptive detail I've seen so far:

"Where does the copayment of around $7 go? Under Peter Dutton’s plan, the Medicare rebate paid to the GP would fall by some $5 to offset the new copayment. So that would be a saving to the federal budget of some $600-700 million a year.

But the GP would get to keep the other $2. This is partly designed to win over GP support for the change; it’s also the government’s hope and expectation that, with more money for GPs, they will use some of it towards the really big area of potential gain, managing chronic diseases more actively. "

Read more: http://www.theage.com.au/comment/joe-hockey-waves-goodbye-to-the-medicare-kingswood-20140509-zr89z.html



Now there are some details the journalist misses and the media will probably mess this up next week also.

CURRENTLY

Bulk Billing a standard consult to a concession card holder in an outer metro area:
- Item 23: $36.60 (standard consult)
- Item 10991: $10.65 (bulk billing incentive for card holders and children under 16). 10990 is used for inner metro and is a bit less
- Total: $47.25

Bulk Billing a standard consult to a non-concession card holder:
- Item 23: $36.60 (standard consult)
- Item 10991: N/A
- Total: $36.60



Under the NEW scheme if I read this correctly:

Bulk Billing a standard consult to anyone
- Item 23: $31.60 (standard consult)
- Item 10991: N/A - consult not bulk billed
- Copayment: $7
- Total: $38.60


So what effect?
a) Practices who bulk bill everybody could conceivably continue to bulk bill. However they will be taking a 15% hair cut. These practices usually have a short consult, high turn over model. If they further shorten the consults, quality could suffer further.

b) Practices who bulk bill everybody could start charging a copayment. Strong possibility that copayment will be more than $7.
Reasons:
- patient behaviour: people save up more problems rather than doing them one at a time. Consultations take longer.
- admin: more resources to process payment
- reduced income. Doctors $9 worse off when bulk billing children and card holders (even with copayment)
- Rebates have not increased for 18 months. A freeze in rebates could see copayments continue to rise.

c) Practices who use mixed billing (bulk bill card holders & kids / privately bill others)
- minimal change for private patients other than their rebate is $5 less
- Strong possibility that copayment will be more than $7 for card holders (see above)
- greater motivation to some services outside the medicare system (eg online / phone consults - see below)
- strong case to continue bulk billing kids who rarely take long. I'd advocate for this in my practice even if pensioners had a $20 gap.

d) Practices who privately bill all patients
- minimal change for private patients other than their rebate is $5 less
- greater motivation to some services outside the medicare system (eg online / phone consults - see below)


Special considerations:
- unclear what will be done for patients who find it very difficult to make a copayment (eg a nursing home patient with dementia). Will doctors treat them - yes! Will doctors be happy to increase their case load of such patients - probably not. I suspect there may be some other payment to take on vunerable chronically ill patients.
- There is no medicare rebate for consults which are not "in person". Phone consults would be a more efficient way to do some things but without a rebate they rarely happen. With larger gaps, practices will start setting up the infrastructure for this and using more novel approaches.

Overal Impression
- good for the government / tax payer. Less rebate per consult PLUS fewer consults. I think this will save more than budget estimates.
- neutral for most GPs - but practices will change how they operate / charge
- modest out of pocket changes for patients (but will be more than spruiked by the govt)
- some consideration needed for special cases but over should work well. Assuming this happens, I'd give this the thumbs up