Doctors have a fat co-payment scheme of their own<\/h1>\n
PUBLISHED: 13 AUG 2014 00:05:00<\/span>\u00a0| UPDATED: 20 AUG 2014 11:53:54<\/span><\/span><\/div>\n Even if Medicare rebates don\u2019t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes.\u00a0Photo: Glenn Hunt<\/b><\/p>\n<\/div>\n TERRY\u00a0BARNES<\/p>\n While relentlessly attacking the federal budget\u2019s $7 co-payment on bulk-billed GP services measure as unfair, neurosurgeon and Australian Medical Association president Brian Owler asserts doctors\u2019 rights to charge co-payments generally. His specialist members certainly do with gusto, and presumably he does too.<\/p>\n If he but realises it, Health Minister Peter Dutton is ideally placed to drive a hard bargain with the AMA on containing excessive out-of-pockets, especially given the doctors\u2019 trade union is pressuring the government to dump the $5 cut to Medicare rebates intended to drive GPs to charge the co-payment.<\/p>\n The ace up Dutton\u2019s sleeve is that doctors, particularly surgeons and specialists, depend on Medicare income like a smoker depends on his nicotine fix. Even if Medicare rebates don\u2019t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist services accessible and affordable to most Australians on low to middle incomes, especially the pensioners and fixed-income retirees who dominate the demand for medical services.<\/p>\n Given this financial reality, the government should use its domination of purchasing by Medicare on behalf of patients to bring the AMA to heel on excessive specialist charging. Doctors are entitled to a fair and reasonable fee above the Medicare schedule fee, and there\u2019s no cap on what doctors can charge, but too many specialists have assumed this is carte blanche to gouge poor paying punters.<\/p>\n To end specialist billing rorts, the government can and should impose out-of-pocket capping that is simple, elegant, and transparent, using the AMA\u2019s own benchmarks against it.<\/p>\n The AMA has its own private fee schedule, in which it determines what it considers appropriate prices for specific Medicare service items. AMA fees have long been an unofficial benchmark for doctors, the association stressing that it is staying on the right side of competition law by offering general advice to its members rather than giving them direction. The government\u2019s published Medicare schedule fee observance and out-of-pocket data indicate that a great many doctors, notably GPs, apply the AMA recommended fee when they don\u2019t bulk bill.<\/p>\n <\/p>\n What\u2019s more, specialist association submissions to the current Senate inquiry into patient out-of-pocket expenses repeatedly cite AMA recommended fees as being fair and reasonable, especially when compared with what they depict as woefully inadequate Medicare rebates.<\/p>\n With this in mind, the government should take doctors at their word and insist, as a condition of specialists\u2019 access to Medicare, that patient contributions for any billed service that exceed AMA recommended fees will be prohibited. If doctors exceeds this cap, they could be fined have their Medicare billing rights suspended or cancelled, and be required to refund gouged patients their contributions plus credit care-level interest. The current but secret AMA recommended fee schedule would be published as a baseline, and subsequently indexed annually under a formula agreed by the government and the profession.<\/p>\n Recommended fees for future new items would be set by the AMA and relevant specialist colleges in consultation with the government.<\/p>\n Should a doctor want to be more competitive on price, there would be no prohibition on their charging a fee lower than the AMA\u2019s recommendation.<\/p>\n But they would not be permitted to exceed it if they bill Medicare as their patients would expect.<\/p>\n Further, private health insurers should be permitted to cover the gap between specialist Medicare rebates and AMA recommended fees. This would be fairer to patients than current arrangements in which insurers have no gap, or no known gap deals with some specialists but not with others. It would also tackle those GPs and specialists, most notoriously anaesthetists, who blatantly ignore their patients\u2019 rights to be informed of and consent to fees before a service is provided.<\/p>\n Private insurers also should be able to advise their members on the comparative performance of doctors, especially in relation to price. In a market for health services bedevilled by information asymmetry, insurers have a wealth of consumer knowledge that can be shared without compromising the privity of the doctor-patient relationship. Let them share it. For too long, medical specialists have got away with ripping off patients through excessive charging practices. Dutton, therefore, should use his negotiations with the AMA to take a stand for patients, call Owler\u2019s bluff, and wield his own market power to bring the AMA to heel over specialists\u2019 stubborn, arrogant and contemptuous disregard for their patients as customers. If the minister does take on the AMA over blatant fee-gouging, he\u2019d be onto a political winner.<\/p>\n Terry Barnes authored the Australian Centre\u00a0for Health Research\u2019s $7 GP co-payment proposal.<\/p>\n<\/div>\n The Australian Financial Review<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" Another cracking, clean head shot from Terry… totally concur with this one! http:\/\/www.afr.com\/p\/business\/healthcare2-0\/doctors_have_fat_co_payment_scheme_g9tVCa7kjp7RkGhXIHh3tN TERRY BARNES Doctors have a fat co-payment scheme of their own PUBLISHED: 13 AUG 2014 00:05:00\u00a0| UPDATED: 20 AUG 2014 11:53:54 Even if Medicare rebates don\u2019t cover the full cost of medical services plus a reasonable margin, their subsidies make costly specialist … Continue reading Terry Barnes: Doctors have a fat co-payment scheme of their own<\/span> ![\"Doctors](\"http:\/\/www.afr.com\/rf\/image\/2009-2014\/AFR\/2014\/08\/12\/Photos\/b655fbf6-21ef-11e4-8478-96786c9d6792_526833460_5_0_2624173450--646x363.jpg\")
<\/div>\n<\/div>\n\u2018FAIR AND REASONABLE\u2019<\/h2>\n