License article

Universal healthcare 'under threat'

The cost of seeing a doctor would soar if private health insurers were allowed to cover GPs' fees, a health economist has warned. And consumer advocates say such a change would erode the universal access to basic healthcare supposedly guaranteed by Medicare.

On Friday Health Minister Peter Dutton opened the door to lifting the long-standing ban on private health insurers paying for GP services.

''I want every Australian to have a good relationship with their GP, so I wouldn't rule out any changes,'' Mr Dutton said in a statement.

The largest insurer, Medibank Private, has been pushing for several months for the change, arguing that treating medical conditions at an earlier stage would reduce the need for more expensive hospital care later.

In November, the company began a trial with medical centre manager Independent Practitioner Network in which six of its Brisbane centres will provide Medibank members with a range of enhanced GP services - including a guaranteed appointment within 24 hours and after-hours home visits - for no out-of-pocket costs.

Medibank is not paying IPN for the services directly but contributing to the ''administrative and management costs'' of the trial. Neither Medibank nor IPN responded to requests for details about those costs on Friday.


Medibank said the arrangement complied with the Health Insurance Act, which prohibits insurers paying for services covered by Medicare, such as GP visits, and Mr Dutton said he was ''confident the relevant parties have considered the legal requirements and I see no evidence that they are acting contrary to the legislation''.

But the chairman of the Australian Medical Association's council of general practice, Brian Morton, said the arrangement was ''not in the spirit of the law'' because the money paid by Medibank would eventually flow to the GPs.

Dr Morton said he believed private insurers should be allowed to cover GP services but this should be accessible to every patient and every GP.

Jeff Richardson, foundation director of the centre for health

economics at Monash University, said private insurers were concerned only with competitive advantage over one another and if they were allowed to cover GP fees this would invite fee inflation.

''One of the reasons we've managed to keep GP fees very low … is that bulk billing has been a very effective technique for competition to prevent [doctors] from raising fees. If we let the private sector in … we're really taking the lid off the can.''

The concerns raised by consumer advocates focus on the possibility of a two-tier health system, under which those who can afford private cover receive a higher standard of care from GPs charging high fees (which are paid by the patient's health fund). Those without insurance would rely on a dwindling number of bulk-billing GPs, who must churn patients through quickly for their practices to remain viable.

The debate comes as the government's Commission of Audit considers a proposal by Terry Barnes, a former adviser to Tony Abbott when he was health minister, for a $6 fee to visit a GP to reduce ''avoidable'' demand for GP services.

Mr Dutton told Fairfax Media last week there was growing concern that the growth in health costs was ''unsustainable'' and would become unmanageable without change.

A spokesman for the Consumers Health Forum, Mark Metherell, said such a change would ''erode the notion of universal access that Medicare is supposed to provide.

''We fear that the Medibank scheme further entrenches a two-tiered Medicare where those with insurance get better access than those who can't afford insurance.''

Labor health spokeswoman Catherine King said Mr Dutton needed to explain how such a plan would improve access for disadvantaged Australians.

''The government should be doing everything possible to ensure equality of access to doctors. Labor did this in government by raising bulk-billing rates to their highest rates ever,'' she said.

Michael Armitage, the chief executive of Private Healthcare Australia, which represents private insurers, said allowing health funds to cover GP visits would provide ''a huge boost to preventive health''.

''Currently, the first time a health fund knows that one of its members is sick is when they receive a bill from the hospital.

''Encouraging GPs and insurers to work in partnership will help to identify potential health problems earlier and, in some cases, prevent these from developing to the point where hospitalisation is required.''