Medicare funding trial to commence

Announced on Friday, the Government’s Health Care Homes funding policy could see those with chronic illness turned away unless they’re willing and able to pay.

Under the Government’s proposed changes to how doctors are paid, patients with chronic illnesses, which include cancer and diabetes, will have their Medicare funding for treatment for these illnesses capped. And if they have to consult a GP for issues other than their chronic illness, Medicare will fund only five additional visits per year.

The model is based on that currently used to pay GPs for treating war veterans.  However, according to the Australian Medical Association (AMA) Vice President, Dr Tony Bartone, doctors are paid about 30 per cent more to treat veterans than will be allowed for patients under the Health Care Homes model. “We’re concerned that the trial will fail and it’s too important an initiative to fail,” Dr Bartone said. 

Some doctors who initially supported the new model now claim that the Government is cost cutting and it is therefore likely to fail, with patients being left worse off.

“It sounds more like a cost-cutting exercise or a defunding exercise, and that’s the last thing we need if we are to have a sustainable healthcare system that provides quality healthcare for patients,” Royal Australian College General Practioners (RACGP) president Dr Bastian Seidel said.

“It’s really difficult to see what patients gain. For our patients, I can’t see a major benefit compared to the current system,” he said.

The two-year trial of the program will commence in July 2017 in 10 regions, with $100 million being allocated. The trial will recruit 65,000 patients in 200 practices with chronic disease. The levels of funding will be tiered, with those who have self-managed chronic conditions being allocated $591 and those with multiple chronic diseases and moderate treatment needs receiving a Medicare benefit allowance of $1267. For those with the highest care needs, about one per cent of the population, the average payment to doctors will be $1795 per year.

A spokesperson for Health Minister Sussan Ley said the key to the program was to deliver services in a more flexible manner. “At the heart of stage one is an attempt to address common patient concerns that there is fragmented care being delivered under existing arrangements and we are looking at delivering Medicare in a more flexible and targeted way to co-ordinate clinical resources to meet patient needs.”

In regards to the restriction on funding and the number of additional visits to see a GP, the spokesperson said that this was a trial only and that the funding “is an indicative figure for modelling and planning purposes and no patient’s access to Medicare will be restricted or capped”.


Read the media release at Department of Health


Opinion: Most vulnerable again at risk

Managing chronic conditions is often a merry-go-round of GP and specialist visits, interspersed with bouts of illness and pain, so worrying about funding for your treatment is the last thing sufferers need.

For those who have more than one chronic condition to manage, be it cancer, diabetes, back pain or mental illness, the future is often uncertain. Being able to work, look after a family and function as part of society is often hindered. And while there maybe no cure for such conditions may be available, there is a certain comfort that you can access medical treatment and support when needed.

So imagine then if this safety net is removed? What will happen to those who have reached their Medicare cap, or who have used up their additional five Medicare-funded GP visits? They will simply stay at home in pain, perhaps causing further complications to already complex medical conditions.

While a revamp of Medicare and a review of funding may be necessary, it simply isn’t just to target those who are most in need. According to the RACGP, the sickest 12 per cent of patients rack up 40 per cent of overall Medicare benefits, receiving an average of 51 services a year. Under the new model, funding will only cover 48 GP visits each year. For a disease such as diabetes, the dressing of a resulting sore on the leg would require a GP visit three times per week – the 48 visits won’t last long at that rate.

Of course, the Health Care Homes program is only proposed as a trial period, but will there be sufficient patients willing to give it a go if their health is the price of failure?

What do you think? Should access to Medicare benefits be limited for those with chronic pain? Do you suffer from chronic conditions? How would such a limit to treatment affect you?


Related articles:

Medicare rebate delay on the cards
Medicare review could cut services

Written by Debbie McTaggart

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