Health system row: where does the truth lie?
The ongoing argument over the reasons for our health system woes highlights the need for an independent review.
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National Seniors Australia (NSA) research highlights growing unrest about the unaffordability of private health care in Australia. This must be addressed to preserve private health as an option for older people.
That’s why we are calling for an independent inquiry into the private health system. Join our Health Costs campaign to support cheaper health care here.
In August, we reported on the Grattan Institute’s analysis of what’s wrong with our health system, especially the out of the pocket costs of going to a specialist.
The institute concluded “these problems have festered because the system has been running on autopilot. Governments must tackle … root problems to improve access to specialist care for all Australians.”
At National Seniors Australian (NSA), we wholeheartedly agree – and that’s why we’re calling for an independent inquiry with the aim of drilling down into our complex and opaque health system and focussing in on identifying improvements and reducing costs.
More information about this and our other Health Costs campaign solutions is available here.
While community groups and the news media largely accepted the Grattan Institute analysis as a truthful insight into the system, professional medical groups have taken aim, saying the Grattan Institute has got it wrong.
We can look at that a little later, but NSA is not taking a position on the accuracy or otherwise of the report and the responses. What we’re saying is that the level of debate and disagreement points to confusion and the need for an independent review to get to the heart of the problem.
Our recommendation stands: the government must bite the bullet and direct the Productivity Commission to conduct a full review into the entire health system.
You can read more about our proposal and join our Better Health Campaign here.
Did Grattan get it wrong?
The Grattan Institute called on the Federal Government to combat extreme specialist fees. It found that an initial consultation with a cardiologist or endocrinologist can cost up to $370, and up to $670 for a psychiatrist. The government should claw back public subsidies from specialists who charge extreme fees, it says.
On average, patient’s bills for specialist appointments add up to $300 a year. This excludes people who were bulk billed for every appointment, but that’s relatively rare: patients pay out-of-pocket costs for two-thirds of appointments with a specialist doctor.
“Increasing GP costs make national headlines, but specialist fees have risen even more – they’ve grown by 73% since 2010,” the report asserts.
Grattan’s report attracted push-back from doctors; the latest coming from the nation’s ophthalmologists – medical doctors specialising in eye and vision care, diagnosing and treating a wide range of eye conditions and performing surgeries.
“The Grattan report is a good piece of work, but it draws many wrong conclusions,” says Australian Society of Ophthalmologists (ASO) president, Dr Peter Sumich.
He rejects the assertion that a shortage of ophthalmologists is due to a bottleneck in specialist training. The Grattan reports says that although demand for ophthalmology training positions is high, places are limited – influenced by hospital workforce needs and specialist colleges.
However, Dr Sumich says this framing doesn’t strike at the root of the problem.
“Firstly, we have to clear up this urban myth about the colleges not training enough specialists. Specialists are trained in public hospitals, not inside a college,” he says. “If public hospitals are not doing enough surgery or outpatient clinics, then we can’t train more specialists. Simple maths.”
Dr Sumich argues that the Grattan report fails to grasp the underlying issue: the deteriorating performance of the public hospital system and a lack of government money to train ophthalmologists.
“Any real reform must start with fixing public hospital capacity,” he says.
“The most egregious aspect of this coordinated media blitz is the smokescreen it provides for the woeful failure of public hospitals.”
Medicare rebate
Specialists have blamed out of pocket costs on what they see as the inadequate Medicare rebate not keeping pace with the cost of doing business. Grattan said over-charging specialists should have the rebate totally withdrawn.
The ASO says the Medicare rebate is out of date.
“It has no meaning in the commercial world,” Dr Sumich said. “It’s been frozen, cut, and has never kept up with inflation or average wages. Therefore, as a metric of a medical service, it is unreferenced and meaningless.”
He says specialist fees reflect real-world costs – wages, insurance, rent, medical technology, and more, and rejects “the implied threat” to remove patient rebates.
“The Medicare rebate belongs to the patient, not the doctor. If it is withdrawn by the government, then specialists would go the way of dentists and charge their own fees regardless,” he warns.
“Most patients would be furious if the rebate was withdrawn.”
And so, the debate comes back to the poor consumer, paying more and doubting they’re receiving value for the money they spend on their health.
That’s why we need an independent review – to get to the guts of what is going wrong.
Related reading: Grattan Insititute, NSA news, Insight News, NSA advocacy
