Wednesday, January 14, 2015

Can you help me scope the dynamic patient costs of the proposed Medicare changes?

On 9 December, Prime Minister Abbott announced changes to medicare arrangements. You will find details of that announcement here. Elements of those arrangements are in trouble with the Senate.Leave that and the broader politics of the changes aside. I am trying to understand what all this means by way of costs to individual patients. So a few questions.

 At  present some 30% of non-concessional patients are not bulk billed. Non bulk billing appears to be concentrated in particular areas, Tamworth is an example, whereas bulk billing seems to be concentrated in high volume areas with commercial practices. Does anybody know the present geographic distribution of bulk billing vs non bulk billing?

 Where doctors set their own fees and do not bulk bill, patients seem to pay a premium (call it a co-payment) that seems to vary from $25 to $75 per visit. That's not a rigorous figure, just a rough estimate based on anecdotal evidence. Is there any information on the present level of that additional payment?

While most non bulk billing doctors seem to have systems that allow the medicare rebate to be claimed at visit, some seem to require the patient to claim the rebate themselves. In this case, the patient has to find the full fee up front. Am I right here? Does anybody know what proportion of doctors require the patient to claim back themselves?

Turning to the future, whichever way you cut the numbers and whatever the configuration of fee rebates, it seems clear that the real value of the medicare rebate will decline. I have seen various reports of the impact of this, but is anybody aware of modelling that shows the likely impact on the proportion of doctors who bulk bill, on general patients costs?

Finally, are all these the wrong questions? What questions should I be asking? Here I am not interested in the question of whether or not the country can afford the maintenance of the current system. That's a different issue. I am interested in the dynamic effects of the changes as they stand now.

9 comments:

Legal Eagle said...

My local practice generally doesn't bulk bill unless I turn up with two sick children (in which case the first one is billed, the second one is bulk-billed) or if I come in for a check up of my asthma. Because I'm ill so often I get over the safety net very quickly. The quickest was in April one year...

Legal Eagle said...
This comment has been removed by the author.
Legal Eagle said...

Whoops, posted same comment twice...

Jim Belshaw said...

Hi LE and thanks. Interesting pattern. When billed, does the practice do the rebate for you on the spot or do you have to claim back? Roughly, how much extra do you pay when billed?

Legal Eagle said...

I think I would get about 50-60% of the bill back, usually on the spot unless it's a weekend. Once I hit the safety net I get much more back - more like 80%.

Just went to see my respiratory specialist - got about half of that back - again, got it back on the spot.

Jim Belshaw said...

Thanks, LE. That's very helpful and fits with the impression I was forming, including the weekend bit.

marcellous said...

Of course the Gummint knows the answer to most of those questions, including I expect, since the invoice has to be produced, what non-bulk-billing charges are levied.

Anonymous said...

Katy I'm sorry to hear you are still battling the asthma. Never mind; you will slay many dragons - even if it may leave you a little breathless - I believe.

kvd

Jim Belshaw said...

My first reaction was to say that's right, marcellous, and then I wondered. If we take LE's case or that of my friend who helped start this thread, the medicare claim is processed at the time via a separate process. The bill goes to the patient, not the Gumnint. If the patient claims back later, that is again a different process.

The thing that is made me pause in in the discussion was the apparent disconnect between what I have seen on-ground and some of the more academic or ideological discussion. It strikes me that the idea of universal health care may already be dead, a move to something like a US system inevitable.

That was well said, kvd.