True drivers of Medicare gaps revealed in new campaign

The Australian Medical Association has launched a new campaign highlighting the true drivers of Medicare gaps across the healthcare system.  

AMA President Dr Danielle McMullen said the AMA’s The Medicare Gap seeks to help patients understand the patchwork and piecemeal nature of Medicare funding for general practice, specialist consultations, and surgery.  

“Doctors have become a handy target for some people in discussions about the cost of healthcare,” Dr McMullen said. “But the reality is that the system is failing us, including in general practice, with a woefully out-of-date rebate structure that does not support GPs to provide the care they need to provide to patients.  

“We need to modernise Medicare with a new, 7-tier rebate structure to adequately care for today’s patients, who need more time with their GP, and we need funding and reform to provide a true medical home for patients, where they can get after-hours care with their regular practice.” 

The Medicare Gap also highlights the truth about the cost of specialist consultations. 

“Sadly, what’s been missing from the ongoing debate about specialist fees is a clear explanation about why the gaps are so much higher for specialist consultations relative to say, GP consultations or surgeries and procedures,” Dr McMullen said.  

“This is a policy area that’s been forgotten by successive governments. There’s been no top-up funding after years and years of freezes in rebates, no investment plans, and no signs of reform. Our campaign highlights just how far behind reality Medicare specialist consultation funding has fallen.  

“In stark terms, Medicare funds about 89 per cent of general practice, and Medicare and Medicare-supported private health insurance provides about 80 per cent of private health funding. But for specialist consultations outside the hospital, it’s at best 53 per cent.”  

Dr McMullen said there were also a myriad of reasons for the gaps in coverage experienced by patients with private health insurance. 

“Our Uncovering the Gaps in Private Health resource highlights the many permutations and combinations that can lead to a gap. Every insurer has a different rebate, despite being labelled with the same government-endorsed gold, silver or bronze stamp.   

“As we show, a $7 dollar fee variation can lead to an $863 increase in the out-of-pocket cost for a patient, and huge windfall for the insurer. Doctors need dozens of different fees for the same service, as insurers can’t agree on a single rebate. Meanwhile the Medicare rebate never varies. No wonder everyone’s confused.” 

Dr McMullen said despite the complexity, wild variation in costs and the patchwork quilt of funding band-aids, there was one common issue across all areas of medical care — the dire need to top up Medicare rebates.  

“Rather than continue to add more complexity, additional programs and more ribbon cutting outside new models of care, let’s do the right thing and fix the root cause of the problem, a lack of investment in patient rebates.”