Additional Comments
Senator Rachel Siewert, the Australian Greens
Introduction
The Extended Medicare Safety Net
(EMSN) was introduced in 2004 as part of the previous government's Medicare
Plus reforms to provide individuals and families with an additional rebate
for out of hospital Medicare services once an annual threshold of out of pocket
costs was reached. The Act provides that once an individual or a member of a
registered family reaches the out of pocket EMSN threshold, they are entitled
to a Medicare benefit equal to 80 per cent of their out of pocket costs for
that claim for the rest of the calendar year. There is currently no limit on
the amount of benefit payable under the EMSN. The Explanatory Memorandum (EM)
notes that this has led some doctors to increase their fees with the knowledge
that the majority of the cost will be funded by the Government once the person
has reached the EMSN threshold. This also has implications for those people
that have not qualified for the EMSN benefits. The amendments to the Health
Insurance Act proposed by the bill would create a mechanism enabling the
Minister to determine a cap on the EMSN benefit payable.
The Australian Greens
acknowledge this is a step in the right direction. There is evidence from the
Centre for Health Economics Research and Evaluation (CHERE)[1] of
significant and excessive fees being charged by certain medical practitioners.
The Australian Greens support the move to instigate changes to the legislative
framework and are broadly supportive of the provisions in this Bill.
However, while the Committee
report does address the key issues raised in the course of the Inquiry, the
Australian Greens wish to make some additional comments on a few of these
issues and also make additional recommendations.
Key Issues
Excessive Fees
The Australian Greens believe
the EMSN is an inflationary policy. The EMSN was designed to provide financial
relief for those who incur high out-of-pocket costs and thereby make health
care services more affordable. The EMSN appears to have little benefit for
those in more remote areas or in lower socioeconomic groups. According to the
CHERE report, ‘the EMSN appears to be a relatively ineffective way to direct higher
benefits to those households.’ The report says that most of the EMSN benefits
have flowed to services more often used by wealthier sections of the community,
increasing the affordability of high-cost services but making little impact on
the affordability of medical services for other sections of the population. The
CHERE report describes the EMSN as ‘poorly targeted policy because it has not
addressed one of the main barriers to access that many patients on low incomes
face.’
The impact of the EMSN on
fees is most pronounced for Medicare items that are usually associated with
high out-of-pocket costs per service. The Australian Greens believe that
providers know if they bill these items their patients are likely to qualify
for EMSN benefits. Under these circumstances providers feel fewer competitive
constraints on their fees.
Between 2003 and 2008 the
fees charged by obstetricians for in-hospital services reduced by 6%, whilst
the fees charged for out-of-hospital services increased by 267%. Similarly the
fees charged by ART services fell by 9% for in-hospital services while the fees
charged for out-of-hospital services increased by 62%.
The Australian Greens believe
this shows that some doctors are structuring their billing to take advantage of
the EMSN.
EMSN benefits are highly
concentrated in certain types of services. In 2007 over 30% of all EMSN
benefits helped fund obstetric services and 22% went towards assisted
reproductive services. The EMSN has more than doubled the amount of
Commonwealth funding going towards these two professional groups. Only 8% went
towards funding general practice consultations.
The Australian Greens
recognise the need to address the lack of constrains on excess fee increases.
The Government estimates there will be net savings of $451.6 million over four
years as a result of these measures. However this is a blunt instrument
approach to the matter of excessive fees. The Built into this Bill is the
assumption that the provider will be pressured into reducing their pricing by
the patient rather than tackling the problem more directly. The Greens are
concerned that this will cause considerable heartache for certain sections of
the public, particularly in ART and obstetric services.
Cataract Surgery
The Australian Society of
Ophthalmologists (ASO) noted that the Medicare reimbursement for cataract
surgery as of November 2009 would be reduced from $623.70 to $307.20. It
identified the 'most concerning effect' of this reduction as the 'economic
viability of the delivery of eye care to rural and remote centres'. They were
unequivocal: if the Medicare rebate is cut by 50 per cent, the cost of cataract
surgery will be ‘beyond the reach’ of the ‘average Australian’.[2]
The
Australian Greens accept that improvements in technology have meant that
cataract services can be provided more quickly and safely – up to one third of
the time since the fee level was first set – but are particularly concerned
about the implication these changes will have to provision of services in rural
and regional patients. According to the Royal
Australian and New Zealand College of Ophthalmologists (RANZCO), ‘The economic
viability of the delivery of eye care to rural and remote centres will very likely be
destroyed.’[3]
Recommendation 1: The Australian Greens recommend that the Bill be
amended to include the provision of a Medicare provider number for cataract
surgeon in rural and remote areas to ensure that the changes will not
negatively impact on people in those areas.
Recommendation 2: The Australian Greens recommend that Bill is amended
to include a provision for an independent evaluation of the impact of the caps
measures with the report to be tabled in Parliament no later than 1 July 2011.
Senator Rachel Siewert
Australian Greens
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