Bulk billing $7.50 payment extended
The AMA has called on the Government to increase the Medicare rebate for all patients instead of providing incentives for some patients to be bulk billed. AMA President, Dr Bill Glasson made the demand after the Federal Government announced on Monday it would be providing an additional $2.50 incentive to doctors in limited cities and outer metropolitan areas for bulk billing children and concession card holders. This is an extension of the measure already in place in rural Australia and Tasmania. All other urban GPs continue to have access to a $5 incentive payment.

Dr Glasson said the AMA welcomes the fact that an extra $24 million is being put into the health system but remains totally opposed to geographically-based rebates. This incentive depends on a patient being bulk billed. "The AMA has consistently called for a significant increase in the Medicare patient rebate for all patients, no matter where they live," Dr Glasson said. "A person's health is not dictated by their postcode or their electorate. The Medicare rebate relates to the patient and the care they receive, not where the service was provided.

"The true value of a standard GP consultation is around $52.00, but the Medicare patient rebate is still just $25.70. I welcome the Government's admission that the MBS patient rebate is totally inadequate and I welcome their recognition of the impact of the doctor shortages on many communities, particularly in rural and outer urban areas. But a broader long-term solution for all patients is needed.

"As the cost of providing quality general practice continues to rise, any patient benefits stemming from the $7.50 incentive in certain areas will be eroded very quickly. The AMA recommends the Government invest strongly in the MBS to provide higher properly indexed rebates for all patients. We recommend Medicare policies that are based on individual patient need, not geography. And we urge an end to the fixation on bulk billing and short-term mechanisms to bribe doctors to bulk bill. The focus must be on quality, access, affordability and choice," Dr Glasson said.

Dr Glasson said the Government's claim that individual GPs stand to gain around $21,500 each from the bulk billing incentives is totally misleading. A recent Medical Observer poll on the original incentive found only around 15 per cent of GPs would come close to earning the Government's then estimate of $15,000 or more. Most GPs expected to earn around a third of that amount. And then they would have to deduct administration, staff and practice costs.

"But perhaps the most telling statistic from that poll is that only six per cent of doctors have recommenced bulk billing for concession card holders and children under 16 since the incentive was introduced in February," Dr Glasson said. "The bulk billing link is a furphy.

"We need more comprehensive reform of the MBS if we are going to see long term improvements in access and affordability of quality GP services for all patients," Dr Glasson said.

GPs in the following areas will be eligible for the increased incentive payment from 1 September: Australian Capital Territory; Beaudesert Shire Part A, QLD; Darwin City, NT; East Metropolitan (Perth), WA; Eastern Outer Melbourne, VIC; Frankston City, VIC; Gosford-Wyong, NSW; Greater Geelong City Part A, VIC; Greater Townsville (Townsville City, Thuringowa, Magnetic Island and Palm Island); Ipswich City, QLD; Litchfield Shire, NT; Melton-Wyndam, VIC; Mornington Peninsula Shire, VIC; Newcastle, NSW; Palmerston-East Arm, NT; Pine Rivers Shire, QLD; Queanbeyan, NSW; Southern Adelaide, SA; South Eastern Outer Melbourne, VIC; South West Metropolitan (Perth), WA; and Yarra Ranges Shire Part A, VIC.

Minister for Health, Tony Abbott said these areas were chosen using the following criteria:
· Outer suburban and semi- rural areas that are identified by the Department of Health and Ageing as areas of workforce shortage with lower bulk billing rates in the first quarter of 2004.
· Greater Townsville and Darwin because they are isolated cities.
· ACT and Queanbeyan, which have chronic workforce shortage problems.

"The limitations in this measure risk forcing out of general practice the many doctors out there doing it tough so they can continue to provide compassionate discounting to their needy patients," Dr Glasson said.