Frosty reception for budget cuts

An extended freeze on the Medicare rebate and fears the budget axe will also fall on pathology bulk billing incentive payments have been roundly condemned by Australian clinicians.

Specialists fear the moves will severely impact those patients with chronic diseases, although there remains a high level of confusion over how the potential cuts to pathology incentives will play out.

And Pathology Australia has already warned that pathology companies could not absorb these cuts – saying services will close and patient co-payments must be introduced to meet the funding shortfall.

Speaking on ABC Radio, AMA president Professor Brian Owler said it was “really an attempt of the Government to introduce further co-payments by stealth and to drive down the bulk billing rate.”

“It’s about actually saying the doctor is now a villain, he’s the one or she’s the one, that’s passing the cost onto you, but of course this is driven by the Medicare rebate,” he said.

“Now we know also, that one of the problems, particularly in primary care and general practice is that you have financial barriers to care. It does impede people from accessing that care, and people can end up sicker, and more likely to end up with problems that land them in emergency departments.”

Extending the rebate freeze even further out to 2020 was also a bit loss for patients, Professor Owler said.

“And that result is that it is money that’s taken away from patients because this is the patients’ rebate and I think that’s something that’s often lost on people is that this is not about the doctor’s income, this is about the amount that the patient gets back from the Government for medical services,” he said.

“And when the rebate is frozen it means that as the cost for the doctor, whether they’re a GP or specialist, keeps going up for employing staff and having premises et cetera, then they have to pass that cost on to the patient and so the patient is the one that keeps paying more and more out of their own pocket and at the end of the day we’re going to see the erosion of Australia’s very good Medicare system.”

Rheumatologist, clinical epidemiologist and recently appointed President of the ARA Professor Rachelle Buchbinder said she had spoken with the ARA board about the proposed budget cuts.

She said she and her colleagues were concerned there would be adverse consequences for patients with chronic disease and the flow on from this might be to further increase health inequality.

“The pathology co-payment may lead to some patients not having tests (for either diagnosis or monitoring) and this might be a particular problem for the safe use of medicines that require blood test monitoring,” she told the limbic.

She used the example of routine monitoring of the safety of some drugs used to treat arthritis like methotrexate and the biologic drugs.

“To obtain further prescriptions of biologic drugs, in addition requires six-monthly blood tests which are then used to decide if the patient is responding to the treatment – this is a PBS requirement,” she said.

“Similarly for a condition like gout, we would monitor the serum level of uric acid to see if the target level has been reached and then maintained”.

“The Medicare rebate freeze will also inevitably lead to increased gaps for patients. While inflation, wage growth and interest rates are low, some private specialists may choose to absorb some costs increases in the short term, but eventually we will see gap increases.”

Professor Buchbinder said this may lead to problems like longer waiting times and missed diagnoses as patients deferred initial visits or follow ups, due to financial pressures.

“Having the two combined is a double jeopardy for those who get their care in the private sector, compounding the access issues faced by those who live in rural and remote Australia,” she said.

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