Australia’s Medicare health service is in need of reform with the current system producing low quality care, ordering excessive medical tests, making it difficult for the disadvantaged to use it and deterring many from going to the doctor because of cost.
A group of doctors led by Dr Vlado Perkovic from the George Institute for Global Health in Sydney said Medicare has served Australia well for 30 years but it needs some work now.
He says dramatic changes in demand, new technologies, medical practice, and the blurring of the line between private and public systems means Medicare is creaking under the strain.
The doctors write that Medicare has become increasingly complex due to the “modern epidemic of chronic diseases”, additions and changes to Medicare reimbursement structures and the mix of private health insurance coverage, the authors explained.
Affordability is also less clear, with proposed mandatory co-payments for GP visits, most specialist care not being bulk billed and the non-funding of a growing number of drugs and devices.
“Many patients, especially those least able to pay, report deferring visits or treatment because of [out-of-pocket costs]”, the doctors write.
Universality and access were threatened by “significant inequities for different community segments”.
“Access is reduced in regional and remote Australia and disadvantaged areas of our cities, for reasons including availability, transport and ability to pay”, they wrote.
“There is a need to discuss what ‘universality’ means today.”
Efficiency was threatened by medical waste, including “inappropriate and ineffective care”, and fee-for-service based systems which promote short visits, suboptimal quality of care and excessive use of pathology and radiology services, the doctors say.
Key to improving efficiency was “good research to understand effectiveness and cost-effectiveness, as there are still many interventions of unknown value”.
“The medical profession has an important leadership role in this public discussion and in designing and implementing subsequent changes”, the doctors said.
“But the time to act is now.”
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