Stewards of the system

Stewards of the system

Change is needed to ensure Medicare meets the needs of Australians, as is a truthful public debate about the issues, writes AMA President, Professor Steve Robson.

MEDICARE. It’s perhaps Australia’s most treasured piece of public policy. The green and gold card is practically part of the Australian identity. As well it should be. 

Introduced by the Hawke government, the insurance scheme has helped millions of Australians over the better part of 40 years, to access high quality, affordable healthcare. 

It’s completely understandable, therefore, that when allegations of $8 billion being wasted in fraud are made, national attention is swift and condemnation fierce.

If only it were true. 

The suggestion that $8 billion (around 30 percent) of the spend on Medicare is being defrauded has been shown to be based on anecdotes, simplistic analysis and opinion, rather than any rigorous data or comprehensive statistical analysis. This goes someway to explaining the utter puzzlement of the medical profession, and the Federal Government (as the holder of Medicare data) for that matter, at the suggestion. 

But it’s completely understandable that Australians responded this way, when presented with these figures as “facts”. 

We’ve seen Medicare used as a political football before — through five years of a Medicare freeze as a savings measure — pushing costs away from government and onto patients. 

And we’re seeing pressures on general practice like never before, with increasing out-of-pocket costs as the Medicare patient rebate falls further and further behind. 

Clearly change is needed. Doctors and the community know this.

From the AMA’s perspective, to achieve this change it’s critical we do three things. 

Firstly, we do need to increase the funding to Medicare. At the beginning of the year the patient’s rebate for a regular GP consult was $39.10. After indexing it in July, it is now $39.75. That’s not going to do much in an inflation environment of around 7 per cent. Something is broken here.

Secondly, we need to continue to stamp out any fraud, mistakes, and wastage — something the AMA (with the wider profession) has dedicated a significant amount of its resources to over many years. 

Over 700 clinicians gave up their time to be part of a five-year effort to review the entire Medicare system, through the MBS Review. You don’t do that if you’re not interested in protecting the system from misuse. 

In recent years we have backed legislative reforms to increase Medicare audit and compliance powers, making it easier for Government to tackle allegations of Medicare fraud. The specific cases being quoted in the media are largely those that have been detected under the current compliance and audit regime, showing the system is working. 

We’ve been regularly consulted on the Department of Health’s education program — helping to shape letters to practitioners on Medicare by using the Department’s advanced data analytics to support practitioners who genuinely struggle to understand often complex Medicare rules. 

Where issues of fraud appear, we’ve worked with the government’s compliance and risk program, alerting them to issues, and supporting efforts to quickly address any inappropriate and unethical use — including where necessary through referral to the Professional Services Review. The AMA always has, and always will, have a strong stand on our role as stewards of the system. It’s also why we implored health ministers to ditch a plan that would have seen cosmetic surgeons able to use patient testimonials on social media. We need tighter controls on cosmetic surgery, not a TikTok free for all.

Thirdly, much of the recent debate has centred on how complicated, confusing, and convoluted the system is. We’d agree. It’s why the AMA is running a campaign called “Modernise Medicare”, focussed on reforming the system to fund co-ordinated, multi-disciplinary care under one roof. 

You shouldn’t have to bounce around the health system to see a doctor, a nurse, an allied health specialist. It’s a travesty those with chronic wounds can’t afford bandages to take to the GP, because we don’t fund it as a nation. We don’t fund GPs to make it sustainable to be open after hours, while also expecting them to devote huge of amounts of their time to completely unfunded healthcare delivery, because the ‘system’ hasn’t kept up with Australian’s healthcare needs. 

It’s no surprise Australian’s needing healthcare miss out, become sicker and end up caught in the hospital logjam.

One of the very few areas of the recent media coverage we do agree with is that there is more work to be done. 

Doctors go to work every day with the express purpose of caring for other people, healing them and making them well. Recently in theatre I worked to save the life of a woman who had lost 12 litres of blood — more than twice her blood volume. This is the job doctors quietly go to work and do every day. That’s what doctors want to focus on.

It’s no surprise then that hundreds if not thousands of hard-working dedicated doctors have been dismayed by recent media stories.  

There are important issues to be debated relating to the health system, including the pressures placed on that system by an ageing society, rising chronic disease rates and the long tail of COVID-19 in the community. I can only hope we have the political will to invest in Medicare as it is needed, and the opportunity to have a truthful public debate about these issues.

ABOUT THE AUTHOR

Professor Steve Robson was appointed the President of the AMA in July 2022, and is an obstetrician & gynaecologist.