It is an inescapable fact that our Medicare system is becoming a drain on the economy. The government tried to impose a five dollar co-payment on patients bulk billed by their doctor but that idea crashed and burned when it failed to pass the Senate - and it has been abandoned.
Now it is proposed that the rebate doctors receive from Medicare for their services to patients be frozen at the present level. Inevitably, as staff wages rise and the cost of drugs and services increase the income of doctors will decline and they will have to impose a charge on patients to maintain their income level. It is estimated that by 2018 they will need a co-payment of about $8.40 for each visit.
That idea simply transfers the blame away from the government and places it squarely on the shoulders of the medical profession. Either way, the cost to see a doctor rises and it kills the much vaunted "bulk billed " option that was such a boon to the low wage and under privileged strata of our society.
Any change to medicine comes up against a rock hard and implacable dogma that sees those with the title of "Doctor " resistant to any form of change. The medical profession insists that they - and they alone - must evaluate the patient and authorise even the most minor procedure - and that even transcends into a visit to receive the annual flu shot. Doctors guard their turf jealously.
Perhaps we need to revisit the whole concept of medicine and reevaluate what is in the best interests of both the doctor and the patient. That thought will run headlong into the contention by doctors that any change to the present regimen will involve patient risk - but a reality check discloses that a great many doctor's visits are simply routine and for matters that do not involve a medical examination.
How many times do we visit our doctor to get prescription renewals ? When we have an annual check for skin cancers by a Dermatologist or many other routine specialist visits these all require a "referral " from our General Practitioner. Surely the time has come when patients should first pass through the " filter " of a Paramedic nursing sister authorised to renew prescriptions and handle routines such as referrals - and who would carry out the normal procedures of checking blood pressure and reevaluating medication normal on such GP visits. The annual flu shot would certainly fit into such a routine.
Paramedics are skilled people able to spot symptoms that need attention by the doctor and who would pass the patient for a consultation automatically when specifically requested. If the aim of Medicare cost containment is to be met, we need to filter the patient flow and reduce the doctor's work load to those who need specialised knowledge.
Undoubtedly, such a suggestion will be rejected by the medical profession, but if we blindly stick to dogma and make no change we will see a steady erosion of those who fail to consult a doctor because of the cost and instead rely on advice from their friendly local chemist. There is also the danger that if the Medicare rebate loses value it will see consultation times shaved. Face to face time with a qualified doctor may decline to the point that forensic medicine becomes meaningless.
We could easily see Australian society revert to the pre-Medicare days where desperate people were being sued for unpaid medical bills and many existed with curable medical conditions that went untreated because visiting a doctor was out of the question - on cost grounds. Even in todays more enlightened age, we tend to have doctors grouped in fashionable suburbs while some country towns lack even a single consulting general practitioner.
We need to live within the confines of what is economically possible to spread the Medicare net for the widest coverage. Perhaps neither doctor nor patient welcomes change, but sheer economics is going to force a review - and we need to face reality. The old medical model has passed it's use by date. A clever country will adapt - and universal health care will survive !
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