Pearls and Irritations

Well done John Menadue for starting 2019 off with something that must strike at the heart of all Australians- out of pocket medical expenses. Some of the highest in the world and showing no sign of slowing and driven by – let’s be honest – greed on the part of some of our most highly paid doctors. Despite comments over the last few years from some of the Colleges saying that they do not support the significant fees charged by some doctors (and remember it is not a small minority),  little has changed. Comments from the Colleges have stopped and out of pocket expenses continue to increase. Australians are opting out of health insurance, placing strains on both the public and private systems. How long should Australians put up with this behaviour from the medical profession which seems hell bent on destroying the ‘golden goose’ (uncapped fee for service – i.e. charge what you think you can get away with) that has funded their lifestyle.  

How many saw this article in the Sydney Morning Herald just before Christmas –   threatening  Minister Hunt about the MBS (Medicare Schedule) review report on anaesthetic funding   https://www.smh.com.au/politics/federal/greg-hunt-moves-to-appease-anaesthetists-over-medicare-rebate-changes-20181221-p50nqn.html0 and the recommendations of the MBS Review.

Now let us put this in context. I note that the  recommendations of the MBS review still sit on the government website, so we can only assume that the decision is not yet final. That the Australian Society of Anaesthetists – the ‘union’ arm representing some of the most highly paid doctors in Australia – is actively lobbying the Minister, there is no doubt. After all they seem only to be interested  in the fees they can charge – patient perspectives do not seem an issue. To argue as the Society does  in the article that the changes will lead to a significant increase in out of pocket expenses to the patient is a little simplistic : it may BUT only if this highly paid group of doctors  do not change their practice and actually absorb at least some of what they may refer to as increased practice costs – something that most other industries have had to do over the past ten years.

To quote the article: “Peter Seal, president of Society of Anaesthetists – welcomed Mr Hunt’s response which came after months of lobbying by the peak body”. Remember this is the “Society” of Anaesthetists – the Union, not the College of Anaesthetists – the professional body- which is the ‘Peak ‘ body and likely to be a little more interested in standards of care and how these changes might impact on patients .  Let’s consider the real issue here. The MBS Review as set up under the  government has been one of the better things it has done. It has acted with extraordinary rigor under Chair, Professor Bruce Robinson, and has established large discipline-specific committees in many specialties with consumer representatives  included. The reports are all available on the  MBS Review website and  the level of evidence-based discussion has been exemplary. The Anaesthetic Schedule – like most of the  schedule of fees –  has not been reviewed for a  number of years and certainly not with the rigor and independence that has been a feature of the MBS Review.  For the Society to say that the Review has been carried out ‘without any clinical understanding’ is ludicrous in the extreme.

If the Minister has caved in to this self-interested lobby group, that is  very sad and certainly not in the interests of the health system as a whole. Dr  Seal is quoted: “we are white hot angry”.  Well,  Dr Seal, one might ask how the patients feel about your rapacious comments. Not very happy, I suspect .

The Minister should remember that his responsibilities (and electorate ) are not just the well paid specialist anaesthetists  but also the patients – and a patient who is at a very vulnerable time when they are facing being put to sleep for surgery!

Australians now pay some of the highest out of pocket expenses in the world and specialists here are amongst the highest paid globally. Few will know that there is a very significant gap between what we pay the general practitioner and what we pay the specialist in this country  – yet we boast (and so we should) that our health system is based on the fact that GPs provide much of the care and we pay them on average about a third to a quarter of what a specialist is paid . The comments of Dr Tony Bartone – President of the AMA, and a general practitioner – in the same SMH article  are interesting: “any savings from the review of the MBS —must be reinvested in the health system”. I am sure many would agree and perhaps a solution would be to take all of the savings from the specialist groups and use that to increase the funding of general practitioners who have seen their incomes stagnate (in comparison to their specialist colleagues) and who are the real ‘specialists for life’ (the RACGP mantra) on which our health system is based. If the  medical profession cannot control the fees they charge then surely we should be pushing for a Royal Commission into medical fees to get things right once and for all. I suspect that, like the Banking Royal Commission, Australians would be shocked by the data that will come to light.

I reiterate the Medicare Review has been one of the really good initiatives instituted by this Government – it is independent and seems to have very thoughtfully considered the evidence behind all of its recommendations. It would be unfortunate if the Minister was swayed by such a lobby group as the Society of Anaesthetists who have not shown any desire to act in the interests of good patient care. They, and other specialists, might remember one of the basic tenets of Medicine – ‘First do no Harm ‘ – and that should mean financial harm as well. Stay strong Minister – remember – patients should come first.

Peter Brooks MD FRACP, is Professor Centre for Health Policy, University of Melbourne, and  Research Lead Northern Hospital Eppin.

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