Medicare rebates are governed by political whim. Is the time right for a return to an independent tribunal?
A long time ago, in a galaxy far, far away – John Gorton’s 1968-1971 federal government – life was different.
Professor Stephen Duckett, former head of the health program at the Grattan Institute and former Secretary of the Australian Health Department, believes there is something to be learned from the Gorton era.
“In the 1960s, the medical insurance and rebates system was a complete mess,” Professor Duckett, who is now Honorary Enterprise Professor at the University of Melbourne’s School of Population and Global Health, told The Medical Republic.
The Nimmo Enquiry, set up by the Gorton government in 1969 to investigate a better way of doing things, recommended a new national health scheme which came into effect on 1 January 1970. It was recommended that free private health insurance was given to the unemployed, workers on sickness benefit, the severely disabled, new migrants, and households on a single minimum wage.
Part of that recommendation was the establishment of an independent body – the National Health Insurance Commission – made up of “the Commonwealth Director-General of Health as chairman, and, as members, a person with financial qualifications, a representative of the medical profession, a person to represent the interests of hospitals, and a person to represent the interests of contributors and patients.”
The enquiry recommended that the NHIC set rebates.
“The government introduced what was called ‘most common fees’,” said Professor Duckett. “The rebates were based on what were the prevailing charges by doctors at the time. The question then became, how do we index those rebates over time?”
Malcolm Fraser’s government (1975-1983) wound back many aspects of Medicare, including abolishing the NHIC.
When the Hawke/Keating government relaunched Medicare in 1984, it did not re-establish the independent rebate-setting body.
“What we have seen over time since then is that the rebates have been set by political whims. Rebates were frozen six years ago on a political whim,” said Professor Duckett.
Professor Duckett, who has received a lot of criticism from GPs about his resistance to simply raising rebates, tweeted on 3 February:
It is possible to agree with all these things simultaneously: GP is under-remunerated, there shd be independent rebate setting, increasing rebates is not the right thing to do right now
— Stephen Duckett (@stephenjduckett) February 3, 2023
“In-hospital rebates should be set by negotiations between doctors, hospitals and insurers, but for primary care only, we need a new specific, independent rebate-setting tribunal,” he told TMR.
Given GPs are crying out for immediate help, beyond the scope of the Strengthening Medicare Taskforce report – of which Professor Duckett was a member – why not increase rebates right now?
“More money needs to be put into primary care, more than was promised nine months ago by the incoming government,” Professor Duckett said.
“But are we sure that the rebate is the right variable to be changing? What about a bulk-billing incentive? What about a payment for continuity of care?
“The way you put the money in is very important.
“What is the right way and do we have the right mechanisms in place – voluntary patient enrolment, for example.
“It’s always nice to do more of the same, but that doesn’t mean increasing the rebate is the right answer to the question.”
