May 02, 2014 | Graham

Most of us already pay a Medicare co-payment

There’s hysteria over suggestions that the government might introduce a Medicare co-payment, and while the introduction is a worthy idea, for the life of me I don’t understand why the government might want to introduce it as a new policy because it is effectively the status quo for most Australians.

Medicare works on the basis of the government setting a prescribed fee and paying the doctor 85% of that fee. So Medicare envisages a 15% co-payment in the first place.

The doctor is not obliged to charge the prescribed fee. They can charge more, or they can charge less. They can bulk-bill, which consists of not taking any money from the patient and taking the government’s 85% discount of their fee from the government in full and final settlement.

That means that most doctors charge a fee that is higher than the Medicare payment. Generally much higher than the $6 the government is rumoured to be thinking about, and even higher than the $15 that the Commission of Audit has suggested.

There are some bulk billing clinics, but they are the minority, although regular doctors generally bulk bill for children, pensioners, and friends. Unless they are just starting out when the rules of economics suggest they should prudently charge less than their elders.

The scheduled fee hasn’t kept pace with growth in wages, meaning fewer and fewer doctors can afford to charge it and keep up their standard of living.

The longer that goes on, the more substantial the “co-payments” that will be levied by doctors.

Both sides of government have indulged in this subterfuge, so why would Abbott break cover on the issue for a very marginal financial gain? It’s almost as though someone doesn’t understand how the system works now.


Posted by Graham at 9:23 pm | Comments (2) |
Filed under: Uncategorized


  1. What did we do before medicare?
    As I recall, we paid our own health insurance or suffered the consequences, as extremely basic care, in large dormitories.
    If public health provision was means tested, as it was then, those who could afford to pay for health insurance but chose not to, were handed some very big bills!
    Ditto ambulance transport, which should not be seen as essentially different!
    Those that choose to take their chances, should suffer the Russian roulette consequences, when they suddenly need medical assistance?
    A co-payment, that the Doctor collects, is not a new idea, however, one as dear as proposed by the audit is.
    A co-payment, that is applied to those without sufficient private health cover, might encourage the better off to get some?
    I mean, the age of entitlement, or should that read, middle class welfare, is over!
    Hopefully, occasionally, allegedly?
    What we do need to focus on, is much cheaper preventive medicine, and were we to concentrate on that, and more primary care in the hands of less costly, but comment health workers, Nurses, Doctor’s assistant paramedics?
    We could begin to rein in the health budget?
    Surely a competent nurse can administer vaccines or flu shots, or organize an xray, as they did when I was younger.
    I mean, the doctor still interpreted xrays and decided what the appropriate care was?
    And a traveling district nurse providing advice, and most preventative medicine/routine advice etc, for all pensioners?
    Should also help to reduce health costs, by keeping people out of vastly more expensive public hospitals; as would obliging the better off to make better use of purely private medicine, rather than clog the already overloaded public system!
    If those who can see the writing on the wall, writ large, and chose to, if they can actually afford to, take out private health cover; the extra numbers, should spread the actual risk, and in so doing, bring down the price of private insurance for all.
    Particularly, if budget conscious providers, can chose the caregiver?
    I mean, there are conditions and circumstances, where it would be cheaper, to fly people halfway around the world, and pay their hotel bills etc, in order to get them first class care and or outcomes, without it costing the proverbial arm and a leg.
    We can claim, we produce superior outcomes?
    But when properly researched, many of those claims can be both fallacious and or fatuous?
    Private health cover, provides many new options, including some off-shored medicine, like cataract removal, which could be done in some offshore locations, for as little as $25.00 dollars an eye?
    Just be certain to make extensive inquires, and seek advice from those who have already used this or that service; given its not just your bank balance you could be risking!?
    There are some professional services, who can do that research for you, for an appropriate fee?
    Alan B. Goulding.

    Comment by Alan B. Goulding — May 3, 2014 @ 12:35 pm

  2. Dear Graham,

    It is not often I directly criticise any of your pieces for accuracy both in difference to your position and for the fact you don’t often get off the mark.

    You are incorrect when you imply that bulk billing is not a major part of the delivery of GP services. “There are some bulk billing clinics, but they are the minority, although regular doctors generally bulk bill for children, pensioners, and friends.”

    Bulk billing rates are currently the highest they have been in the scheme’s life, and occur in well over 80% of visits. In fact the highest rise was during Abbott’s tenure as Health minister when they climbed from 66% to 77%.

    The reason why they climbed during this was twofold, the rebate was increased from 85% to 100% of the accepted figure (thus your point “Medicare works on the basis of the government setting a prescribed fee and paying the doctor 85% of that fee.” I feel is also inaccurate) and the fact that the government introduced an incentive scheme depending on the patient and the location which pays between $7.05-$10.65 extra to the doctor for a bulk billed consultation.

    Both were incentives brought in by the Howard government and which served to strengthen our universal health care system. Howard was rightly proud of these changes and it is disappointing to see the current crop of free marketeer ideologues looking to roll them back.

    Comment by Steele Redux — May 4, 2014 @ 11:33 am

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