Experts yesterday praised the Government's revamped Medicare package as a big improvement on its unpopular predecessor and predicted it should hold bulk-billing rates steady.
The package scored the qualified support of John Deeble, the architect of the Medicare system and a strong critic of the Government's earlier proposal.
Professor Deeble said the $2.4 billion plan was "obviously better" than the $917 million A Fairer Medicare package, but said the Government was still undermining the system as a universal scheme.
"The overt shift to a welfare system has gone... but not the covert shift," he said.
Professor Deeble said the Government's costings suggested bulk-billing for children and concession card holders would settle at about 78 per cent.
The Government will give doctors an extra $5 for each child and concession patient they bulk-bill.
But Professor Deeble said bulk-billing for other patients could continue to slide, meaning the overall rate would probably hold steady at about the 67 per cent that it is now.
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Canberra University health economist Ian McAuley said it was unlikely that the Government would lift the bulk-billing rate back to its 80 per cent high of the mid-1990s. "The bulk-billing rate took a long time to get to that level, and it's unravelled very quickly," he said.
Professor McAuley said the best option would have been to increase the Medicare rebate across the board, to maintain the universality of the system. "This is targetted assistance, which is consistent with this Government trying to convert Medicare into a welfare program," he said.
University of Technology Sydney health economist Jane Hall said this was not a health care revolution.
More-radical changes could have included putting more doctors on salaries, instead of paying them as a small business for each patient they see.
"We're clearly going down the user-pays path," Professor Hall said. "The safety-net provisions are a way of ameliorating that for people who are less well-off."
She said that providing more doctors - a key part of the Government's plan - should encourage competition to bulk-bill.
Professor McAuley said the Government would struggle to meet its ambitious task of boosting doctor numbers by the equivalent of 1500 full-time doctors and 1600 practice nurses.
"I'd like to know where they're going to get them," he said.
He was sceptical of the Government's plan to recruit about 725 overseas-trained doctors and to use more young GPs supervised by experienced doctors.
However, he praised Mr Abbott for dropping an earlier proposal to introduce private health insurance to cover high doctors' bills, saying this would effectively be a green light for doctors to put fees up.
Doctor shortage sparks training concerns
The Central Queensland Rural Division of General Practice says Australia
is taking advantage of other countries because it has not trained enough doctors to meet its own needs.
Medical director Dr Ross Woodward says the Federal Government will have to look overseas in order to secure an extra 1,500 doctors by 2006 to 2007.
Dr Woodward says the Government has been too shortsighted to train enough doctors and is now reaping the benefits of other countries' training.
"There's also the question of standards for those doctors," he said.
"There are excellent overseas trained doctors and there are doctors trained overseas who do not meet Australian standards but are still allowed to practice in this country because of the extreme shortage of the workforce.
"So this is one area that has to be addressed in bringing in these new doctors."
Easy visas raised for Iraqi doctors
By Michelle Grattan
November 23, 2003
Australian Health Minister Tony Abbott has held out the prospect of the Government making it easier for refugee Iraqi doctors living in Australia
to become permanent residents.
Mr Abbott told The Sunday Age that if these doctors were qualified to work in Australia
and the country needed doctors, it would be silly not to make the most of their abilities.
He was commenting on a call by the medical director of the Latrobe Regional Hospital, Peter Sloan, for a streamlined system to allow the doctors to obtain permanent residency.
The hospital, in Traralgon, has nine Iraqi doctors. One has permanent residency, four are on temporary protection visas (TPV) and another four are New Zealand
citizens who have come to Australia
under the open-door arrangements between the two countries.
The doctor with a permanent visa obtained it only by leaving the country and going to Malaysia to apply for sponsored migration. The other four were at various stages of investigating this option. One was expected to go overseas soon, as part of the process. His migrant application would be sponsored by the hospital.
A Government source said the Immigration Department facilitated the process. Unless they tookthis course, the doctors faced being left in limbo, unable to be reunited with their families or to travel overseas.
The general processing of Iraqis on TPV for new visas, temporary or permanent, has been deferred because of what the Immigration Department said was the difficulty in getting information about the human rights situation in Iraq. They have been given extensions of their visas rather than final determinations.
"These guys got temporary protection visas. They waited three years, then they've waited another couple - and it's still a contorted process," Dr Sloan said.
"If doctoring was this complicated everyone would be dead."
He said the Iraqis and the many other foreign doctors at the hospital were filling a hole left by Australia
's failure to train enough doctors.
The MedicarePlus changes announced by Mr Abbott last week provide for an increase in the number of overseas trained doctors by the equivalent of 725 full-time positions.
Mr Abbott said measures to boost the number of overseas doctors included judicious recruitment abroad, streamlining entry and qualification procedures, and assistance to competent foreign doctors living in Australia
to meet the necessary practice qualifications.
"If we have a doctor shortage it makes no sense not to make maximum use of the doctors we have here (so long as they met Australian qualifications)," Mr Abbot said.
One doctor seeking permanent residency is Salwa Al-suhaily, from the Swan Hill hospital, who came from Iraq in a boat with her two children in 2000 and has just completed the work for her general medical registration in Australia
. She practised medicine in Iraq for about 14 years.
The local medical centre wants her to work there as a GP and was willing to sponsor her as a skilled migrant.
Dr Al-suhaily, whose husband was still in Iraq, said that country was even more dangerous than before. She said Swan Hill was nice, quiet and safe and the people were friendly.
The federal Liberal Party has realised that being too blatant about dismantling Medicare is electorally dangerous. After widespread negative reactions to its fraudulently named “Fairer Medicare” package, on November 18 the Coalition government presented a new package which is also intended to deceive the public by using a misleading title: “Medicare Plus”.
As the government intends, at first sight this new package may appear more palatable. However, closer inspection reveals that it is still intent on dismantling Medicare.
New health minister Tony Abbott claims that the government is committed to Medicare, and that Medicare Plus will “strengthen Medicare for the future”. This package will not strengthen Medicare — it is a step towards its destruction.
Medicare is an internationally respected universal health insurance system, funded by progressive taxation — which means people pay what they can afford for health care which is accessible to everybody. This is what the Australian people have demonstrated they value, at the polling booths and in opinion polls, during the past two decades. It is what PM John Howard and Abbott are determined to destroy.
By re-jigging Medicare as a “safety-net” instead of a universal health insurance system, Howard and Abbott are intent on setting up a two-tier health system, in which the majority of people will be expected to rely on private health insurance, and the “deserving poor” will get some protection from catastrophic medical bills. This is not good health policy.
The original “Fairer Medicare” package included an incentive to doctors to bulk-bill concession-card holders, of $1 per consultation. In Medicare Plus, the government has increased the incentive to $5 per consultation, and has widened the incentive to include children as well as concession-card holders.
Non-bulk-billing GPs, however, generally charge a gap of $10-$20 (specialists usually charge much more), and so the $5 incentive would amount to a loss of income. Abbott has stressed that the decision to bulk-bill is a matter for “the doctor and the patient” (although the decision is the doctor’s and the patient has no say in it).
It is unlikely that most doctors would accept the “incentive”: even the government admits that no more than 50% of doctors are likely to take the option. This initiative is not likely, therefore, to significantly affect bulk-billing rates.
The government is attempting to soften the attack on Medicare by adding a safety net. For concession-card holders and families who receive Family Tax Benefit (A), if out-of-pocket non-hospital medical expenses exceed $500, 80% of their further costs will be covered by the government. For all others, the 80% kicks in after $1000 spent on medical expenses. This initiative will only benefit a small minority of Australians, about 200,000 people. It may however be a windfall for high-charging medical specialists such as radiologists, and could act as a disincentive for such doctors to bulk-bill.
The Medicare Plus package also includes a component to increase the numbers of doctors and practice nurses, especially in under-resourced areas. Such efforts are needed, but it is important to realise that this has nothing to do with Medicare.
The government’s methods are also questionable: having reduced the supply of doctors by restricting provider numbers, it is now attempting to redress the problem by poaching overseas-trained doctors — particularly from Third World countries, which, after paying for the training of their doctors, can ill afford to lose them.
Australia
can afford to provide high-quality primary health care to all. We do not want a US model of health care, which allows access to the best medical care that money can buy for those able to buy it, and the devil take the hindmost. The irony is that such systems are ultimately more expensive — the US health system costs 15% of GDP compared to 9% in Australia
(already up from 8% since Howard took office). But this is the direction in which Howard and Abbott want to take us. The Australian people must show that they will not stand for it.
We all know too well the issue of doctor’s shortages in country Western Australia
so when a GP stays in the job for 30 years in a regional town, it’s something to talk about.
Dr Tony Lee has been Boyup Brook’s resident doctor since the 1970's but after three decades he’s hanging up the stethoscope and moving on.
Tony was born in Malaysia to Chinese parents who worked in a small store from morning to night. His dad ploughed his energy into educating his eleven children to ensure they didn’t end up following in his footsteps.
It worked two are lawyers, two are doctors, one’s an accountant and one’s a physiotherapist.
Caroline Hillman spoke to Tony, who’s just retired and asked him where he began his life practising as a doctor.
"I was qualified in London University in 1960 and I worked there for a couple of years, as they called it the houseman, you are not allowed to go into general practise straight away, you have to work under a sort of supervision if you like for a couple of years", says Dr Tony Lee.
"Then went back to work in Singapore and there I worked for about ten years and got married in the mean time, we had two children in Singapore and then we moved on to Western Australia
.
"The AMA were trying to recruit people for the country areas then, and a visiting lecturer... said yes Western Australia
is fine you come along. The secretary actually of the AMA put me in contact with the various shires who were looking for doctors.
"Then chose out of three we chose Boyup Brook we were renting a shire house and worked in the hospital, eventually we got our own house and then eventually we bought a farm actually. We lived in the farmhouse, the farm was a working farm growing some grain and some sheep and worked from there for the last thirty years.
"We were coming initially for a trial for a year or so. Thats the main thing, the main attraction. if people are trying to attract people from overseas the main attraction is offer a lifestyle of mateship and what you see is what you get. Not the airs and the graces.
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