GRAEME STEWART. Major holes in Medicare.

For a very large and growing number of poorer Australians, the high out-of-pocket expenses for medical care in Australia to which Ross Gittins refers (SMH ‘Prevention is better than cure’, April 24), are tearing major holes in the safety net Medicare was designed to provide to us all, rich and poor. 

One large hole is access to specialist consultation for people who cannot afford the fee gaps in the private sector and for whom the waiting time in a public hospital clinic, if it exists, is far too long. In western Sydney, many GPs have all but given up for what is now an underclass of sick people. A single consultation with an expert can provide the patient and GP with a definitive diagnosis, a long-term management plan and a high likelihood of avoiding future unnecessary suffering and hospital admission. But if the patient or family can’t afford the fee gap, forget it.

The solution is straightforward.  Fund outpatient clinic expansion in the public hospitals and there are many young specialists prepared to see patients in them without charge to the patient. They will do so in order to give back to the system that trained them, to continue to work with the professor that mentored them and to participate in intellectually stimulating highly specialised and multidisciplinary services, teaching and clinic-based research. Enhanced competition from the public system will also put downward pressure on the gaps charged in private consultation.

When the Labor Party announced in February its intention to establish a National Health Reform Commission, it listed amongst three priorities increased access to public hospital specialist consultation. To date, policy has been announced only for cancer patients. This is a good start but less than 10% of the need.  It is hoped that before May 18 more detailed policy will emerge on establishing expanded specialist clinic access for all patients facing risk of all forms of serious illness. The even greater hope is for the Coalition to match this policy.

Specialists are becoming the doctors only rich people can afford and I find that deeply offensive. As a nation, we are better than that and Medicare used to prove that we were. With bipartisan commitment and state-commonwealth co-operation, it can do so again.

Prof Graeme Stewart, Westmead Hospital.

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