''Medicare, Private Health Insurance, Public Hospitals, Doctors Bills, Physios, Chiropractors... How does our system give us access to all these health care providers??
DR GEORGE QUITTNER, 1 April 2001''
All Australian taxpayers contribute to Medicare. This is a compulsory levy. The Medicare levy only covers a small portion of the nations health costs.
Medicare is a universal insurance system. All Australians are entitled to claim from Medicare for medical services. This ONLY applies to services rendered by a medical practitioner such as a surgeon, pathologist, radiologist or general practitioner. It does NOT cover the cost of related services such as pharmacy, physiotherapy or hospitals.
The government health department; the HIC (Health Insurance Commission) sets a SCHEDULE OF FEES. This attaches a value to every medical service such as a chest X ray , a Urine test, or a face to face consultation. Services which are not covered by the SCHEDULE do not attract a Medicare rebate. For example, treatment of a skin cancer by a general practitioner with liquid nitrogen cryo-therapy, does NOT attract a rebate. (This is despite the fact that Australia has the highest incidence in the developed world of this condition).
There is a law to PREVENT individuals from insuring for services rendered by a doctor with any other insurer. Thus even though Medicare may not cover a service legitimate service provided by a doctor (such as freezing a skin cancer) it is illegal to insure with anyone else. Even though Medicare covers less than half the fee charged by many obstetricians to manage a pregnancy, it is illegal to insure for the difference with any other insurer.
The fee charged by many doctors in in excess of the amount in the Medicare schedule. For example, for many years, a house call by a family doctor attracted a rebate of about $40. Many doctors have stopped doing house calls for this reason and those who do charge considerably more than the rebate.
This repressive system has spawned a number of medical perversities. The most important in metropolitain areas is the BULK-BILLING MEDICAL CENTRE . Here a patient may see a doctor anytime as often as he or she wishes for free. Numerous expensive facilities are provided - such as pathology tests, X-rays, Electrocardiographs and lung function tests. These are all free and can be accessessed repeatedly, without any disincentive by doctors and patients.
The bill for these services is siphoned directly from the coffers of Medicare with computerised efficiency through a system called BULK-BILLING. Taxpayers' money is transferred directly from the HIC in Canberra to the Medical Centre Bank account. Most times, patients have no idea of the cost of the services they have generated.
This system is designed to generate income for enthusiastic medical entreprenneurs. It is possible to convert any ailment into a source of anxiety and cash. Every headache may be a brain tumour. Every fever may be leukaemia. Every ankle sprain a fracture. That this travesty has continued for almost 20 years is a testament to the moral bankruptcy ("bankruptitude"?) of our health department ...and sadly some of the medical profession.
Every day the newspapers spawn a new medical "business". Five years ago there was no such thing (outside major hospitals) as a "skin cancer clinic". Now they are popping up everywhere. Any doctor who graduated yesterday can set up a "skin cancer clinic". Note, every advertisement for a "skin cancer clinic" contains two key words: "BULK-BILLING". The service is "fee" (except to the poor taxpayer). How many would survive the blowtorch of reality? If they had to attract a paying customer, where would they be? Needless to say, any freckle is a Melanoma in the making. They need to be watched. Repeatedly.
...but back to the health system:
Who needs private health insurance? After all you can wander into any public hospital and they will take care of you! That is true in the case of a life-threatening emergency ... The best place to go during your heart attack or stroke is probably a public casualty department.
...but
If you need elective (non urgent) surgery, it is a very different matter.
I often compare the public hospital system to a public bus. You have to queue to catch one. It may run late. When it does finally arrive , it may be full. When you do get on, it may be standing room only and the person next to you may have inadequate ideas of hygene. The bus may not take you exactly where you want to go and it may just be pouring with rain when you have to get off and walk the last mile. That being said - It will still get you there.
Me, I would rather get in my nice Toyota and travel in privacy and air-conditioned comfort with my favourite music playing. I like to arrive at my destination at the time of my choosing. I am willing to pay extra for the comfort and convenience. If you are lucky enough to afford a Merc, even better.
Private Hospitals are like that. Private Health Insurance allows you to choose your own doctor. If all the old guys at your bowling club are satisfied with the hip replacement done by the famous Doctor Carpenter - Then you should ask for nothing and no-one less. That is what your insurance will buy for you. Remember, though; Your insurance is paying for the hospital bed, the operating theatre, the crutches, the physio BUT NOT THE DOCTOR! The law says only Medicare can pay for the doctor ...even if it only covers a quarter of his fee.
Still if the all up cost of your hip replacement comes to $20,000 ...hopefully you will only have to find 10% of that.
On the subject of $20,000 - If you have a money tree, you don't need health insurance. You can always shake the tree and pay the full price. Health Insurance is so expensive (That is another subject) that some people prefer to put the premium in their own bank account and self-fund any health expenses. This is not so stupid, when you consider there is always the public system to fall back on when the money tree has lost all its leaves.
Thus if the annual premium for a healthy young family is $2000. It is not unreasonable to expect 10 years of good health ...by which time, with compound interest, there is a nice nest egg of over $25,000.
There is something peculiar about health insurance. For some reason people WANT THEIR MONEY'S WORTH. You never hear about someone complaining that their house did not burn down so they "wasted" their fire insurance ....Yet for some reason, people always want to claim and get their value from health insurance. Surely the whole idea of insurance is NOT TO CLAIM ... unless of course you cop the big one!
To my mind, the logical type of insurance is "disaster" insurance. I am prepared to pay the first couple of thousand dollars in health expenses ...I just don't want to pay the fifty thousand. That makes sense doesn't it? High excess, low premium disaster insurance: Can you buy it? Of course not! It is illegal !! Yep, the government regulators got in there and stuffed that up too.
"Why?" you ask ...Well, in an egalitarian society like ours we could not have insurance companies selling insurance, now could we. That would be unfair. That would mean, insurance companies would choose only to insure healthy, low-risk individuals. Or they would charge such people less. Now we couldn't have that. The social engineers came up with a "community rating" system. Thus a healthy 20 year old brick-layer must pay the same premium as a 50 year-old chain smoking diabetic. Guess what happened? There are very few insured 20 year olds. It just so happens a few hundred thousand healthy young people, paying premiums are needed to sustain an insurance system. ... One day they will get old too!
Once there was a respectable balance between the public and the private system. Those who lacked the means had access to excellent public health, supported by those who paid their own way. The sacred cow of "free health care" is now giving rancid milk...and will soon be fit only for the butcher.
Remarkably ...despite all the above, doctors are still able to contract with patients to provide health care. Theoretically, a doctor can hang out her shingle anywhere she pleases an "open for business".
There remains a small group (including yours truly) who focus their efforts on their patients. This effort is rewarded by a burgeoning and appreciative clientele.
Most doctors are dependent on government handouts either directly or through the bulk-billing system. They must go where the government tells them (through control of "provider numbers" without which the doctor is not entitled to a Medicare rebate). They must treat patients according to the government regulations (through the "Item number" system) or they will not be paid. What is the point of freezing a skin cancer if you won't be paid for it. You are better to cut it out! There is an item number to cover that. These doctors must be "vocationally registered" and "accredited", or the government won't feed them. As the bar moves higher, doctors must spend more and more time trying to jump over it. Meanwhile, the patients wonder why the doctors' attention seems focussed elsewhere.
A brilliant Mayor in a populous Sydney suburb found an innovative solution to the problem of dealing with garbage in public places. He removed all the garbage bins. No garbage bins...ergo; No garbage! The man was a genius. Every doctor looks after sick people. This costs the government money. The way to solve this problem is to reduce the number of doctors ! Genius is contagious. There has been promulgated a mythical over-supply of doctors as an excuse for reduction in numbers of medical graduates.
Meanwhile the remaining doctors are aging fast, working harder and harder for the crumbs thrown by the government.
Specialists are in short supply for another reason. The learned colleges have slammed the door on many young doctors who do not meet their "standards". One would have to wonder, after the top 1% matriculating students make it into medical school, just what kind of standards are to be met?
The very best GP's are to be found in the country. These doctors have many skills and a vital place in their remote communities. One after another, country towns are losing their GP's as the strain takes its toll. They cannot find doctors to assist them. In the end there will be no-one to replace them. This is a tragedy for the community and the profession.
While all this was happening, the learned bodies stood idly by. The College of General Practitioners added to the GP's burdens by acting as the government enforcer of so called "standards". The AMA watched, inert while general practice was eviscerated by the Medicare system. Finally, these organisations are making noises and pathetic gestures toward our government masters. If the ambulance ever does come, it will be to resuscitate the corpse that was general practice.
Now before you rush off and slash your wrists - There is a solution. It is simple.
There is a doctor. There is a patient. The two need each other. They do not need anyone else telling them how to treat each other. The more Australian citizens commit to this idea, the better. Find a good doctor and take good care of her. In return, she will take good care of you.