David Pocock is skeptical about the Department’s modelling for universal bulk-billing clinic numbers under Labor’s $8.5bn Medicare package.
In what world would universal bulk billing be more viable than mixed billing, asked ACT Senator David Pocock at today’s Community Affairs Committee Senate Estimates hearing.
Last week, Labor announced an $8.5 billion Medicare package which promised to boost bulk-billing rates to 90%.
Speaking on the pledge in estimates, DoHAC’s first assistant secretary for Medicare benefits Daniel McCabe said that modelling suggested that 27 practices would choose to universally bulk bill in the ACT – up from two, currently – under the new arrangement.
These clinics would be eligible for a 12.5% PIP payment under Labor’s plan.
Deputy secretary of the health resourcing group Penny Shakespeare said the department was confident in the reliability of the data but was unable to release it.
“The modeling has been done based on individual practice and what they have charged over the most recent financial year,” she said.
“We’ve looked at an individual practice level, whether the additional income they would receive under the policy that’s been announced would be more than what they’ve charged patients through out-of-pocket fees.
“We think that it’s reliable. However, because we have modeled at that individual practice level, we have some restrictions on what we can release because of Section 130 of the Health Insurance Act.”
According to independent ACT Senator David Pocock, he contacted all 80 practices in the ACT. Out of the 25 who had replied so far, none said the incentives would mean they would bulk bill all of their patients.
“How will you ensure that the PIP is actually passed on to the GPs, given the practice is a separate thing to the GPs?” asked Senator Pocock.
Mr McCabe said the tripled bulk-billing incentives flowed directly to GPs, but that the payment mechanism for the PIP was undetermined and would be discussed with peak GP representative bodies.
Senator Pocock queried how universal bulk billing, the requirement for the loading payment, could possibly be more financially viable for GPs.
“The average fee is currently $90 [in the ACT], but the bulk-billing incentive, plus the PIP, plus the rebate, only brings the rebate to $60,” he said.
“How are [practices] better off if it is currently $90 and it’s going to go down to $60 and you’re saying [they are] going to have to have to bulk bill every single patient to get the PIP?”
Ms Shakespeare said these numbers were averages across all GPs and all practices.
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“We have looked at specific practice level income from patient charges, and whether or not that is lower or higher than what practices would be eligible for under these changes, which triple the bulk-billing incentives for all patients and provide an additional 12.5% uplift.”
Senator Pocock asked Ms Shakespeare to clarify whether “every GP at 27 practices will be better off with these arrangements under your modeling”.
“Every practice would be better off …” replied Ms Shakespeare.
“That’s not how practices work, practices made up of individual GPs who make their own decisions, and if that GP is not better off bulk billing, then why would they bulk bill all their patients?” said Senator Pocock.
“The individual GPs at a practice would have billed those patient out-of-pocket costs, which add up to the overall clinic out-of-pocket cost income,” said Ms Shakespeare.
“These [GPs] are not just a homogenous group in each practice, they may specialise in different cohorts,” replied Senator Pocock.
“Practices, and the GPs that work within them, would need to make decisions about whether they took up eligibility for the incentives on offer,” said Ms Shakespeare.
“Our modeling indicates that they would, if they’d be financially better off at a clinic level,” she said.
Senator Pocock said the premise seemed “super optimistic”.
“We’ve seen a targeted tripling result in basically no increase at all, and now you’re saying that a more universal tripling will have this extraordinary increase where we go from two to 27 fully bulk-billed clinics in the ACT,” he said.
“The impact that you mentioned before [0.7% increase] is the overall bulk-billing rate for the entire population, including people not eligible for the tripled bulk-billing incentives,” said Ms Shakespeare.
“My colleague did go through the bulk-billing rates for children under 16 and people with concession cards earlier on, which are higher than the general patient population,” she said.
According to DoHAC assistant secretary Mary Warners, average out-of-pocket costs for a non-referred GP attend in the ACT in the December quarter was $51.04.
When asked by Opposition health spokesperson Senator Anne Ruston if she thought that social media stating that Australians would be able to see a GP for free with Labor was misleading, Senator Malarndirri McCarthy, representing the minister for health, replied with a categorical no.
“I think it’s wonderful that you’re following the Minister for Health and the Prime Minister’s social media,” said Senator McCarthy.
“Clearly your own policy statement in terms of Medicare bulk billing is also following the health minister and the prime minister, and there are certainly no misleading statements by the minister or the prime minister.”
Senator Ruston said the Liberal Party had never promised free GP care.
“Can I make it quite clear for the record in response to the comments that were just made by the minister, at no time have I or anybody from the Coalition ever suggested that the only card you needed to take to the doctor going forward was your Medicare card,” she said.
“We have never said that Australians will get access to free GP services without exception.”
The federal health minister has since issued a release suggesting that the comments are indicative of the Liberal’s disregard for Medicare.
“This is not some slip of the tongue by the Shadow Health Minister, but a clear articulation of the Liberal disdain for the promise of Medicare to deliver free health care,” it read.
“Today’s comments by Shadow Health Minister Anne Ruston shows Australians cannot trust Peter Dutton and the Liberals on Medicare.
“Cutting Medicare is in the Liberals DNA.”
