GRAEME STEWART. Growing inequality in access to health care is curable.

Oct 17, 2018

It has been sad to observe the growth in out-of-pocket expenses for patients seeking expert medical consultation and the resultant rising inequality in access to timely care and in health outcomes (“Specialists charging extreme fees”, March 6. These twin inequities are deeply felt in western Sydney.

No Australian with the possibility of serious illness should be prevented from seeking expert assessment or treatment due to the expense involved or fear of expense.

This basic principle was upheld for the first 20 years of universal health insurance in this wealthy country but increasingly less so over the past 20.

Australia is fortunate in having parallel private and public options for care but the balance has been driven too far towards private by the reduction in proportionate support from the Commonwealth to the state-based public hospitals.

There are many specialists who would happily provide more public outpatient clinics (where they would bulk bill) in order to give back to the system that trained them and where they can also contribute to multidisciplinary clinics (difficult to organise in private practice), teaching and clinical research.

But sufficient resources are not available for clinic space or staff payment for chronic disease management. The failure of the Medicare rebate to keep pace with inflation over the past 40 years has driven the rise in fee gaps as has disproportionate reimbursement for procedures compared to consultations. It is not surprising that the leading specialists in the list published in the Herald are those without major procedures and hence highly reliant on consultation fees for income. With some specialists there is also an element of greed but in my experience that is still an uncommon contributor in western Sydney. Build more public outpatient clinics and the specialists will come. Inequity is curable.

Graeme Stewart, Head, Ambulatory Services, Westmead Hospital. Published, Sydney Morning Herald, March 2017

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