The MyMedicare program and bulk billing incentives are undermining access to primary healthcare, especially for Indigenous people in rural and remote areas, senators heard today.
The public hearing into rural, regional and remote Medicare access and funding saw an exchange between Dr Sophia Couzos, public health medical director of the Queensland Aboriginal and Islander Health Council, and Labor Party Senator Josh Dolega (Tas) over the purpose of Urgent Care Clinics, bulk billing incentives and MyMedicare changes ushered in since November last year.
Urgent care clinics were not evidence-based and diverted “scarce resources towards creating a system for which we already have a system” and the MyMedicare program was “an enormous hurdle and obstacle anathema to comprehensive primary health care,” said Dr Couzos said.
The reforms added complexity to the system, diverting resources away from healthcare, and were structured to suit private general practice for-profit models, but not services for Aboriginal and Torres Strait Islander people, she said.
“It undermines the best model of comprehensive primary healthcare that Australia has created, which is incredibly ironic because we all want a more cost-effective healthcare system, we all want to reduce hospitalisations, and yet they’re going about it in the wrong way, in simple terms, and undermining comprehensive primary healthcare.
“I don’t know of any other healthcare system that seems to justify undermining comprehensive primary healthcare and preventive health, not just through these sorts of things that are introduced, but through urgent care clinics and a whole range of other incremental type strategies that are being imposed,” said Dr Couzos.
One example she gave was the provision of chronic disease plans. In order to be funded under Medicare, they had to be provided by the clinic to which the patient was registered under MyMedicare. But sometimes her service’s patients went to more than one clinic, which meant that when they came back to the Aboriginal Community Controlled Health Service for the plan, the funding was rejected.
The patient did not necessarily remember that they had been registered at all. And administrative resources had to be diverted away to re-register the client with the service to get the funding for the plan, she explained.
In addition, Aboriginal Community Controlled Health Services were already bulk billing, she said.
But now, for GPs who wanted to access the bulk billing incentive payment, the practice had to be registered under My Medicare and the existing payments system, under which GPs were salaried, had to be retro-fitted she said.
“[Services] are struggling enough to get a general practitioner employed in the first place through salaried systems, without having to then re-engineer with each general practitioner that comes into the service.
“Some of them want are happy to forego the bulk billing incentive. Some of them aren’t. You can imagine the administrative nightmare that’s involved in managing this with patients. And then what happens is that the doctors then refuse to work for the Aboriginal Community Controlled Health Service because they can get more from the private general practice because they actually get the bulk billing incentive there.
“So this is just an example of how the administrative difficulties at the frontline clinical service level are the difficulties that come along from these sorts of Commonwealth reforms.
Senator Dolega took issue with the characterisation of urgent care clinics, saying he wanted to go on the record that there were “very legitimate needs in particular areas of the country for Medicare urgent care clinics to reduce … strain where it may not be practical to go to your general practitioner, or … not even be able to get into a general practitioner to see your regular GP for such a matter”.
Dr Couzos wanted to know why the Commonwealth funded super clinics did not resolve this problem in Tasmania.
“Those models of care already exist, and if that degree of resourcing was given to the existing models of care then yes, they’d be able to operate after hours and have a nurse to triage and do all those sorts of things and more.
“But what you’re doing is you have the urgent care clinics that are a band-aid model of care rather than a comprehensive model of care, and it is far more cost-effective to have a comprehensive model of care than a band-aid model of care.”
“I think we might have to disagree with that one, Doctor, on this one. And I know from my constituent perspective from Tasmania, the Medicare urgent care clinics that have opened have been very welcomed by the community,” said Senator Dolega.
He also wanted to address her point about patients not remembering if they had registered with MyMedicare and the subsequent problems caused by switching between practices.
In his own personal experience, he had received a text message after a GP appointment to assign the Medicare benefit.
“Just click and agree to assign the benefit to that GP,” he said. The same had happened after another visit.
Didn’t her organisation have such a system, he asked.
“You’re assuming quite a number of things there. You’re assuming a high degree of literacy, you’re assuming access to SMSs, you’re assuming a number of things in that sort of interaction, and you know the real world doesn’t work like that.
“It might work for the you know for people of a higher socioeconomic status, but I think for many people these things are incredibly confusing, and it’s very hard, particularly with a population that’s highly mobile and attends various different service providers with no fixed address. This is not how life really is.”
Senator Dolega said he just wanted to know how the process could be improved to make it easier for people accessing care through her organisation.
“Which process are you talking about? The program of MyMedicare, which was introduced by the Commonwealth for a reason that is unclear? What is the problem you’re trying to solve in the first place?
“There are a couple of points about that that you’ve made. You’re saying, what can we do to retrofit this initiative that, in itself, has very little merit, so that it can work better for Aboriginal Community Controlled Health Services.
“What benefit … is the Commonwealth aiming to achieve through this national process? What is the actual point of it all? What is the problem that is trying to be prevented?
“The beauty of Medicare is that patients can see and access comprehensive primary healthcare and receive universal healthcare when they need it, at very little cost to them or at no cost to them. And if there are layers of a complexity built into the program where they have to be incredibly health literate in order to manage this, then you really are reducing the the universal access system that that was created for people….
“This is a program that’s been imposed, and we have to undo systems in order to make it fit into the comprehensive primary healthcare model. And there are ways in which we can do that. It just compounds the problem. It’s difficult. Software changes, changing rules about this or changing rules about that. What a diversion of scarce resources is my point. We shouldn’t have to do that sort of stuff. Our focus is in providing comprehensive primary healthcare to people who can’t access care.”
The lack of positive impact of the Medicare reforms implemented since 1 November last year was also felt by Western Queensland Primary Health Network, which said in its submission that “Voluntary Patient Registration (VPR) with MyMedicare remains unworkable where practices lack stable workforces and business models” and “Medicare’s complexity has increased, not decreased, for rural and remote providers”.
“Outcome: The reforms have not materially improved access, continuity or equity,” the submission said.
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