Expect to be $30 out of pocket when you next visit your doctor because non-bulk billing doctors will increase their standard consultation rates of $62 to $64 as of November 1, in line with the recommendation by the Australian Medical Association.

The Medicare rebate will cover just half the cost of the bill, which is a far cry from the 85 per cent promised by the Hawke government when Medicare began.

Yet increasing the rebate would not put an end to the problem of achieving quality primary health care, according to Vice President of the Doctors Reform Society, Dr. Con Costa,.

“The problem is in the way doctors in practices are paid,” he said.

“They are paid on piece work which means that the more patients they see, the more money they will make.”

Costa believes that this is a very expensive way to run the health system. “The trick to seeing a patient quickly is to send them away for a blood test or expensive X-ray even though it is not necessary. Patients often go home unhappy and frustrated because they don’t get heard,” he said.

Mother of two, Crysy Mylonas does not believe her son is getting the good quality health care he deserves, despite forking out an arm and leg for his appointments.

“My little boy has been seeing a specialist for his bowel but the consultations are not worth sitting down for they are so quick,” she said.

“All they do is put him on the bed, touch his tummy and say they will continue to see him in three months. When you leave and pay $180 you wonder why.”

Helen Kontogiannis, also a mother of two young children adds that the November doctor fee increase will make it hard for already struggling families.

“With a lot of people making it by from pay check to pay check, an increase in doctor’s fees is the last thing someone needs when their child is already sick,” she says.

Both Kontogiannis and Mylonas add that they have noticed a decline in doctors offering bulk billing services, which further makes it difficult for families to afford much needed medical attention.

Australian Medical Association President, Dr. Andrew Pesce attributes the decreasing numbers of bulk billing doctors to the meagre rebate that they are paid.

The Government’s schedule fee, which is paid to the GP for a 20-minute consultation currently stands at $33.55, barely $20 more than it was when Medicare started in 1984.

However increasing the schedule fee will not necessarily encourage more doctors to bulk bill or spend quality time with the patient, says Costa.

“Even if they increased the doctor’s schedule fee to $60, a doctor who is more business minded will still try to get through as many patients as quickly as possible to maximise income.”

Costa underscores that the only solution really is to modify the way doctors are paid to encourage them to spend more time with those who need it.

“One way of doing this is to put doctors on a salary according to the number of patients enrolled. That way they would stop flicking patients so quickly and spend more time with the needy,” he explains.

He envisages this model to be similar to that already in Britain, in which there would be no up front costs to the patient.

Instead, the doctors would be paid by the Government, the money of which would come from taxes.

However it seems unlikely that this proposal will be accepted by the Federal Government.

Professor Mark Harris, Chair of the Expert Committee on Primary Care, which was part of the Government’s National Health and Hospitals Reform Commission (NHHRC) allegedly said at a lecture Costa attended last week that the commission was prohibited from suggesting reforms concerning the current payment method of doctors.

“Not only that, but the Commission also insisted that private health insurance should be part of the reforms, which most doctors will agree will further increase medical costs,” says Costa, who deems these decisions as politically motivated.

The NHHRC, which finalised its report to the Government on June 30 appeared to advocate the creation of new private insurance plans that would somehow operate within Medicare.

Under the Medicare Select plan, Australians would automatically belong to a government operated health and hospital plan, but if they were to pay more, they could select to move to another plan, which could be operated by a not-for-profit or private enterprise.

“This fragmentation of Medicare will not only drive up costs but take the responsibility away from the Government and into the hands of private insurance funds. The rich will benefit whilst the poor will be left with the basics.”

Dr Pesce suspects there are significant risks in private insurers entering the market, and compares the system to that of the two tiered health system in the United States.
The Federal Government is conducting public consultation about the NHHRC proposed health reforms until December this year when it will decide what health reforms it will employ.

“The consultation process appears to be hijacked by hospital specialists… Consumers need to make their voices felt as their health system is being taken away form under their feet,” underscores Costa.