Before the ink was dry on the proposal - and well in advance of a possibly hostile Senate considering the measures next year - the Government’s Mid-Year Economic and Fiscal Outlook (MYEFO) statement had drawn considerable flak from key health industry bodies.
Changes to the Medicare Benefits Schedule for diagnostic imaging and pathology bulk-billing incentives would save more than $650 million over four years. The pathology incentive is currently paid at $1.40 to $3.40 per patient, with bulk-billing currently at 87.6 per cent.
Health Minister Sussan Ley said the incentive, which had cost taxpayers half a billion dollars since 2009-10, did not work, with bulk billing rates increasing just 1 per cent during that time.
The government attributed this largely to the competitive nature of the industry, which comprises of more than 5,000 pathology collection centres.
Critics of the MYEFO health proposals include the Australian Medical Association (AMA) whose president, Professor Brian Owler, called it “another chapter in the Coalition’s consistent health policy since being elected – cut health funding and shift costs to patients”.
Also critical of the proposed axing of the bulk billing incentives for pathology and diagnostic imaging is the Consumers Health Forum. The not-for-profit body said the prospect of a fresh cost barrier could dissuade patients from undergoing important tests.
“Many patients requiring pathology tests would face out-of-pocket costs for the first time under these budget measures, if pathology practices fail to absorb the impact of reduced Medicare benefit payments,” the Forum’s CEO Leanne Wells said. “Pathology tests for the most part have not attracted any out of pocket charges in the past. The Government’s saving measure however poses a new hurdle in the way of patients whose GP has referred them for what could well be a significant test.”
She added, “Australia needs to be strengthening its primary care services, as shown in a recent international survey and as canvassed widely by the Government’s Primary Health Care Advisory Group’s recent consultations on how we can better respond to people with complex and chronic conditions.
“Introducing a new price for pathology will not help improve primary care services and will discourage early diagnosis.”
The AMA’s Prof Owler said the axing of the bulk billing incentives for pathology and diagnostic imaging services would increase the health cost burden for Australian families, with the poorest and the sickest being hit the hardest.
“These measures are simply resurrecting a part of the Government’s original ill-fated co-payment proposal from the 2014 Budget,” Professor Owler said.
“It is yet another co-payment by stealth. The Government is continuing to retreat from its core responsibilities in providing access to affordable, quality health services for the Australian people.
“Cutting Medicare patient rebates for important pathology and imaging services is another example of putting the Budget bottom line ahead of good health policy.
“These services are critical to early diagnosis and management of health conditions to allow people to remain productive in their jobs for the good of the economy.
“The AMA strongly opposes these measures, and we will be encouraging the Senate to disallow them.”
Other key MYEFO measures for the AMA included:
- the abolition of the National Hospital Performance Authority (NHPA) and its highly valued health reporting arrangements;
- the abolition of the National Health Funding Body and Funding Pool (the death of activity based funding?);
- on the plus side, there is extra money for the Rural Health Multidisciplinary Training Program, which supports clinical training in rural areas; and
- $93.8 million is flagged for an integrated medical training pathway for rural areas, a concept lobbied for by the AMA.
According to the government the cuts should be absorbed mostly by the competitive sector, although pathologists are already warning of increased fees for patients that may cause some to forego tests and the closure of services in rural areas.
Health Minister Sussan Ley reacted strongly to such comments, lashing out at ‘large pathology companies’ and saying she was ‘cranky’ at the claim that patients would be worse off.
Asking where the government’s $500M incentive to increase bulk billing rates had gone, the minister said these companies had been doing “very nicely”, and should be expected to not increase their fees.
Ms Ley said Labor’s incentive payment for bulk billing of diagnostic imaging services, introduced from 2009-10 at a cost of $1.3 billion over five years, had failed to increase bulk billing rates beyond expected ‘‘natural growth’’.
This claim has been contested, with data indicating that bulk billed diagnostic imaging services increased from 66 per cent to 77 per cent during that period.
The proposed changes are intended to take place from July 2016, with no pathology service to attract an incentive payment, and for the bulk billing incentive for diagnostic imaging to be paid only for concession patients, such as pensioners and children under 16.
