Concerns over the ongoing financial viability of General Practice were raised again recently, culminating in a summit on the future of General Practice held a month ago in Canberra. The dire straits of General Practice funding come as no surprise to those working in healthcare, as the impact of years of indexation freeze and partial indexation of Medicare item numbers comes home to roost.
Unlike other areas of healthcare in Australia, General Practice is almost completely run as private businesses that utilise Medicare funding, with no equivalent service provided in the public, state government funded system. This means that there is more pressure on GPs to bulk bill their patients as there is no public funded service to provide care for folk unable to pay private fees. This leaves General Practice particularly vulnerable to the vagaries of Medicare funding. This has resulted in a direct impact on our GP workforce - the proportion of medical graduates choosing to go into general practice has reached an all time low; GPs near retirement age are bringing forward their retirement; experienced GPs are quitting or reducing their hours and picking up other work. These workforce pressures are felt the most in rural and regional areas which have always struggled to find GPs, but even General Practices in metropolitan areas are struggling to find doctors now.
In a recent news report, a small country town in Queensland (Julia Creek) was offering a $500K package for a GP to work there without luck. Dr Michael Mrozinski, a GP that does rural work, has summed up well the reasons why recruitment is such a challenge on his TikTok. Spoiler - it's not about the money.
And talking money... What about those ABC reports on the 8 billion dollars leaking from Medicare due to poor billing practices by doctors? First a quick fact check - the figure of 8 billion dollars is dubious according to the ex head of Medicare's PSR and the MJA. Undoubtedly there are some doctors intentionally billing Medicare poorly, and even fraudulently, but the actual cases are miniscule compared to the errors in billing related to the ever increasing complexity of the Medicare schedule. The myriad of separate item numbers with specific clinical and administrative requirements, which have little relevance to actual clinical care, increases the likelihood of billing errors. So complex, in fact, that if you contact Medicare for advice because you have difficulty interpreting the clauses in the schedule the person you speak to is equally as unlikely to know the answer and will basically read back to you the same passage that you have just been struggling with. Rhetorically - how much simpler would it be if item numbers were simply time based? How much easier and cheaper would it be to audit a time based schedule? Does a Medicare bureaucrat really need to know if I have mental health issues or was late for a PAP smear? My GP's time is as valuable whether they are checking my blood pressure or treating a sinus infection; and none of the clinical details need to be visible to non clinical folk who sort out the billing.
The simple solution would be for GPs to stop bulk billing and start setting the fees that would make their practices viable. This would probably help maintain the viability of General Practices, but would also leave less well off patients at higher risks of falling through the cracks
