Issue 22 / 14 June 2016

THERE’S a flotilla of ice-breaking campaigns to thaw the Ley-Turnbull Medicare rebate freeze. Plenty has been said about the consequences for patients and practices.

Given our Health Minister’s love of freezing, I propose five areas that are more amenable to lifelong ice.

Australian Health Practitioner Regulation Agency (AHPRA)

Unlike Medicare rebates, AHPRA fees continue to rise without any apparent need, return on investment or benefit to doctors. AHPRA charges fees approaching those of colleges and professional associations – however, we cannot see where the money goes.

AHPRA’s intrusion into our daily practice appears to be headed for deeper waters with the issues of recredentialling and declaration of all legal settlements their next targets. Before AHPRA rolls out such programs, it would be useful to see evidence of its utility.

It is little wonder that the Health Professionals Australia Reform Association has formed.

Medical schools

There are simply too many medical schools and too many medical students in Australia; graduate numbers have more than doubled over the last two decades. Training and jobs are in short supply for young doctors. Many practising doctors are underemployed.

Every week I am receiving letters from new specialists seeking my GP referrals. When I started in general practice 20 years ago, I would be lucky to get a couple such letters per year. This is a reflection not only of numbers, but also that the new specialists aren’t getting enough work.

With so many students and junior doctors, one has to be concerned about clinical experience becoming diluted and as a result, standards may drop. Conclusion: the Australian public will suffer.

No longer does a medical degree equip us to practise independently. Let’s hope fellowships of the colleges don’t follow suit. 

Private health funds

Since private health funds have listed on the stock market, there has been a clear tendency towards managed care. Even a casual glance across the Pacific Ocean will tell us that is dangerous territory.

Rather than redistributing contributions for the sick and needy, many funds now have to factor profits and expensive executive salaries. To do this, the funds need to drive down patient services and doctors’ incomes – it’s pretty simple, really.

It makes me very nervous seeing the Royal Australasian College of Surgeons co-branding with Medibank Private. This may need more than a freeze – it may need a burial and funeral too!

Primary health networks (PHNs)

I doubt anyone knows the exact figure; however, PHNs suck up a good percentage of the primary care budget in Australia. This could be in patients’ rebates. Need we say more?

Now in their third iteration (divisions of general practice, Medicare Locals prior), I still see them as solutions in search of problems.

The expensive offices, computers, corporate uniforms, cars and conferences are all very visible. The better patient care and access to services is not so visible. 

Wherever I mix with GPs – both in rural and urban areas – the consensus appears to be one of frustration about the PHNs’ lack of engagement and top-down approach. There appears to be a lot of administrative personnel and not much clinical personnel. Instead of helping GPs, the PHNs appear to be creating more paperwork for GPs.

Practice costs and red tape

The rebate stays flat, but staff wages, insurances, AHPRA and college fees and consumables all continue to rise. It is little wonder fewer young doctors opt for practice ownership. Wouldn’t it be interesting to see the reaction to a 5-year freeze of nurses’ wages or hospital administration wages? Or that of politicians…

So there you have it, Minister! Five better things to freeze! Would you like cubes or crushed?!

Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.

4 thoughts on “Rebate freeze: losing our autonomy

  1. hester wilson says:

    I don’t agree with some of what you’ve written, but I loved your comment about PHNs, ‘solutions in search of problems’ made me laugh, it is so true, What is it that PHNs do?

  2. Jeffery Hunt says:

    Great article. I agree that AHPRA and the colleges are part of the problem. Professionalism cannot be regulated.

    It is unfortunate that Dr’s have abdicated our role in leading our profession, allowing regulatory bodies and colleges to set the agenda of medical care.

    The initiatives that are proposed to improve patient outcomes all appear to focus on budget costs and balance sheets at the expense of patient care. Reinforcing a soloed approach to delivery of care. Each silo vigorously protecting it’s piece of the pie at the expense professionalism.


  3. Dr Louis Fenelon says:

    Thumbs up for the article apart from a couple of points.  

    Australia’s private health funds don’t have to campaign too hard to reduce their exposure, because if Medicare doesn’t cover something, nor do they. Therefore to make a big deal of the Americanisation of the private funds sort of misses the point that they don’t have to worry about that stuff yet.

    I’d also like to speak for the real autonomy of Australia’s medical practitioners. Labelling doctors without college qualifications or other professional backing as lacking standards is both disturbing and inaccurate. “No longer does a medical degree equip us to practise independently. Let’s hope fellowships of the colleges don’t follow suit.” I am sorry, but doctors as individuals provide the colleges and our profession with the public standing needed to lobby against  governments and bureaucrats who wouldn’t know direct patient care if they fell over it. Doctors junior and senior learn to set the standards of our profession. The doctor patient relationship cannot be dictated, bought or subscribed to.

    Respectfully, this argument should include parasites from within. The RACGP, AMA and other professional bodies must be included when discussing redirection of health funding. Their interests are not our patients, but their own status. Indirect health dollars go from us to them, making us their tool$ while the system pays for our “autonomy”.

  4. D Mark Allison says:

    I agree with all the points made by Dr Iannuzzi especially regarding the publically listed health funds. In the USA when the health funds morphed into managed care organizations CEO salaries went from hundreds of thousands a year, generous in their own right to up to $16m, and this was nearly 20 years ago.

    One thing that Dr Iannuzzi has overlooked is that the contract is between the doctor and the patient and bulk billing leads to overuse of services by both the profession and the public. A gap and thus a price signal is no bad thing and helps prevent over use. Even if one accepts the rebate as full payment the actions necessary to get the money from Medicare bring it home to the patients that their treatment is their concern. 

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