The " Bulk Billing " Concept !

The original " Medicare " idea was to bring a visit to the doctor within the reach of every Australian.  The cost would be shared with the government paying part of the doctor's bill and the patient paying a co-payment, but even that was out of financial reach for some people.

So a " Bulk Billing "option was introduced.   Doctors had the option to accept less than their normal consultation fee when treating low income patients by simply billing the government directly - at no cost to their patient.

This had a mixed reception.   In some areas it became near impossible to find a doctor willing to bulk bill, and in others there emerged the " thirty second consultation " doctor who made a motza ramming an incredible number of people through in an hour.   Generally, bulk billing worked well - and after the economic crash of 08 there were few doctors not offering that option.

These are tough economic times and it is suggested that bulk billed patients pay a five dollar co-payment to access the service.  The obvious down side to this is that it will cause some people to avoid the fee by seeking help at their local hospital emergency department as an out patient.   Logic dictates that this five dollar charge should then also apply to hospital emergency rooms.

The suggestion exempts pensioners and those with a concession card, and exempts all families until they exceed twelve doctor visits in a calendar year - which brings this scheme into a similar concept to the " safety net " that applies to pharmaceutical prescriptions.

The aim is to recoup government costs with a saving of $ 750 million a year, but of course there will be a new cost of setting in place the " administration " that will be needed to run the scheme.  It is inevitable that this $5 fee will require a form to be signed by the patient and a record forwarded by the doctor  - and somewhere in the health bureaucracy there will be the need for a whole lot of civil servants to tie all the loose ends together and account for the outcome.

The problem with any fee structure - is that it tends to rise on a regular basis.   Inflation is always a valid reason and in hard times the Treasury is nickel and diming everything it can target to bring in a few more dollars.    There is every chance that a few years into the future, that innocuous five dollar fee has grown into a monster - and we are right back where we started before Medicare came to the rescue !

Maybe this is not a good idea !    Maybe - if we need to generate more money for the public purse - we would do better to look elsewhere.

The Medicare system in general and bulk billing in particular are working well and meeting the needs of the community.    That old adage -  "If it 'aint broke - don't fix it "  comes to mind !