By Steve Painter
At present, if a person visits a doctor who bulk bills, Medicare covers the full cost, and the patient pays nothing directly (though they do through the taxation system). The Hawke government's proposal to impose a fee (probably of $3.50) on such visits will discourage people from seeking medical attention when they need it, says Dr Con Costa, a Sydney GP and spokesperson for the Doctors' Reform Society.
If the government introduces its proposed fee in the budget on August 20, that's "really the end of bulk billing" and an attack on Australia's system of primary health care, says Dr Costa. The first level of Australia's health system involves people going to a GP when they become sick, and this is much cheaper in the long run than a system that discourages people from seeking attention until they are seriously ill.
"Primary health care is very cost efficient", says Costa. "It only takes about 10% of the health budget. It's very important that people see the doctor early in their illness and whenever they're sick. You've got a lot of highly trained people out there who are GPs. If people can't see them, they'll end up going straight to hospital casualty departments or straight into hospital, and that will cost a lot more in the long run."
Costa thinks the proposed changes to Medicare will affect patients and doctors in rural and outer-suburban areas most. He also says it's a myth that people are over-using the health service because of bulk billing.
"That's one of the greatest lies being perpetrated. When people go to see the doctor, they have to wait sometimes for hours, they have to answer a lot of questions, they have to submit to examination. People don't do all that because they've got nothing better to do."
Costa thinks the government will try to disguise its assault on primary health care by excluding pensioners and the unemployed from the new fee and setting a maximum of perhaps $250 on what families have to pay over a year. But ultimately "that's just cover for dropping bulk billing.
"It's not good enough for the government to say it will provide some sort of safety net. We think bulk billing should be available to everybody, not just a few. All the studies have shown that there's no real overuse of the system because of Medicare."
Costa also thinks the government is wrong in trying to curb the growing use of pathology services: "If we really believe in
catching people's illness early, or in keeping them healthy rather than waiting until they get sick, then we should be encouraging them to go to the doctor and have check-ups, or to go early in their illness.
"If you start restricting pathology services, it's inevitable that doctors will do less blood tests, and people will end up developing illnesses that might have been preventable."
It seems there's a "clash within the government between the finance people and the health and social welfare people, and it seems to me that the finance people are holding sway. Hence, short-term financial gains will be given priority over the long-term health benefits of a fairer health system."