Push to end gap fees a win for your hip pocket

IN a win for the hip pockets of patients, Medicare rebates for a GP visit would have to rise by $42 to $79 under a push to have the AMA schedule of fees used as the basis for Medicare and health fund rebates.

This move would increase the Medicare rebate patients receive potentially reducing gap fees when visiting a doctor.

Bulk billing doctors who don't charge patients fees would pocket the increase themselves.

Obstetrician Dr Gino Pecoraro who hopes to become the new AMA president next week says he wants the AMA schedule of fees, which is more than two times higher than the Medicare fee schedule, used to set Medicare and health fund rebates.

Medicare rebates have never been fully indexed to inflation since 1985 and have been frozen at 2014 levels to save money which means one in three patients are now paying gap fees of around $38 to see a GP.

It would cost the government $4.6 billion to increase GP rebates to AMA fee levels and even more if Medicare rebate for specialist fees were to rise to AMA levels.

 

Dr Gino Pecoraro wants Medicare rebates indexed. Photo: Glenn Hunt News Corp.
Dr Gino Pecoraro wants Medicare rebates indexed. Photo: Glenn Hunt News Corp.

 

The AMA fee for hip and knee replacements is nearly $4000 while the Medicare fee is just over $1300.

Medicare pays around $700 for a birth but the AMA fee is over $3000.

Dr Pecoraro said he intends to make better indexation of medical fees his main pitch to win the AMA presidency next week.

"The only system of fees that has any indexation is the AMA schedule and I'd like to make the system of indexation robust and transparent," he said.

If Medicare accepted the AMA recommended fee as the basis for paying for medical care patient gap payments would "overnight be virtually eliminated," he said.

A government review is looking into gap payments faced by patients and Dr Pecoraro said it's wrong to blame doctors for the growing gap fees, when it is the fault of inadequate Medicare and health fund rebates.

"I don't accept that doctors are charging more than they should, the other way of looking at it is isn't it sad that two insurance products aren't meeting the cost of service provision," he said.

 

Health funds and Medicare to blame for gaps, says Dr Gino Pecoraro.  Picture: Tim Marsden
Health funds and Medicare to blame for gaps, says Dr Gino Pecoraro. Picture: Tim Marsden

 

Even if the government did not accept raising Medicare rebates to AMA fee levels Dr Pecoraro said it must agree to a better system of indexation.

"The actual fee is not as important as the process, we need a process to guarantee ongoing indexation," he said.

He says an independent body that determined the indexation rate could be one solution.

Private Healthcare Australia chief Rachel David said the cost of raising Medicare rebates to cover the AMA fees would be over nine figures.

"Very quickly you'd be looking at putting up taxes and it's not politically or economically feasible," she said.

And she says there is not a lot of evidence it would eliminate patient gap payments.

In the past when Medicare rebates had been raised gap fees faced by patients were at similar levels two years on she said.

A recent News Corp investigation found some doctors are charging triple the fees recommended by the AMA.



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