03 September 2015
Subjects: Medicare annual figures, Medicare sustainability and Medibank and Calvary negotiations
Leon Byner: Now this story is one that is so important for all of us, because much of the Federal Budget is spent on our health. And Medicare is now being billed over a million times a day for the first time in history. New figures show growth in claims outstrip the number of new patients three to one in the past decade.
Now I gave you some stats leading up to the news which were pretty interesting, and that is the amount of money, benefits paid, has gone up 104 per cent between 2004-5 and 2014-15. So in view of that, the Federal Government are basically saying that the Government is currently developing a blueprint to build a healthier Medicare that is patient-focused in direct consultation with clinicians and consumers.
The Federal Health Minister, a most competent Minister, is Sussan Ley. Sussan, if it’s not that now, what is it?
Sussan Ley: Good morning Leon. The system does need an overhaul, the system does need to be brought more in line with the needs of patients. And just the number of times Medicare is billed doesn’t always equal the best possible care for patients. Plus it’s not the most efficient spend of the taxpayer dollar.
So, we launched a couple of key reviews earlier this year looking at new models of care, particularly for patients with chronic disease, and also a spring clean of the Medicare Benefits Schedule, so that the way that government remunerates doctors for what they do better reflects what they actually do. And that’s really and update, since so much of what’s on there is out-dated.
Leon Byner: Has that saved much money, or is expected to save a lot of money?
Sussan Ley: Well it’s expected to realise where the efficiencies are, and I have yet to receive the first report, but very soon I will, and I’ll be able to scope out what we do from here on. I’ve made it very clear to all of the clinicians that I’ve spoken to that this is an exercise primarily for the patients and the doctors, because it does make sense to have an MBS that really reflects what I call the right care, at the right place, at the right time for patients.
Leon Byner: I need to ask this question, because it comes up in various forms, it was part of the discussion of various treasurers with each of the states when they were messing around with the GST. But the Medicare levy, of our spend – just for the record, we’ve already broadcast a couple of stats but I think this would be interesting for people – what proportion of our costs are supported by the levy? How much, five per cent, 10 per cent, 15 per cent - how much is it?
Sussan Ley: Less than 50 per cent and declining all the time. Now, I’m not suggesting that the Medicare levy was ever meant to cover all of the costs, but the fact that it is- the costs are increasing faster, mainly because healthy inflation rises more quickly than other inflation.
Leon Byner: Yeah.
Sussan Ley: And the reason for that is often due to new technology, And that’s often a good thing, because new technology brings …
Leon Byner: Sure.
Sussan Ley:… better results for patients, But no, the Medicare levy doesn’t cover the cost of Medicare. I’m not expecting it to. We don’t need to raise any more taxes on the Australian population; what we do need to recognise is that spending more money – and this Medicare claims hitting $1 million a day is a good example – doesn’t necessarily mean that that spend is as efficient as it possibly can be, or directed best at health outcomes for people.
Leon Byner: So what does that really mean in practice? I mean, at the moment you go to the doctor, he either or she either bulk bills, or if they don’t or you pay, what would change? If there is going to be some kind of modification, what would it be? What kind of things are we looking at?
Sussan Ley: More and more Australians have chronic disease, and that means not just the odd visit to the doctor, that means an ongoing connection with your doctor …
Leon Byner: Yes.
Sussan Ley:… with your nurse …
Leon Byner: Yes,
Sussan Ley:… with your podiatrist, your dietician …
Leon Byner: Sure.
Sussan Ley:… your mental health counsellor. We are really interested in models that would connect someone to a usual practice, a usual doctor, a usual clinic, and that payments would be made that were directly relevant to how people’s health is better managed and improved. So right now you can go to your doctor, you can get a diagnosis of high blood sugar, you’re rapidly getting Type 2 Diabetes, you go home and you think well I don’t feel any different, don’t particularly want to change my diet or lifestyle, and you don’t actually necessarily hear from your doctor. We need something in place, you know, integrated, team-based, that gets you back, talks to you about your diet, your lifestyle, helps you manage what will be a significant change for you, works with you, keeps you healthy, and most importantly Leon keeps you out of hospitals, because that’s where the health costs really skyrocket.
Leon Byner: If you’re going to involve more people in the line of treatment, isn’t that going to be more expensive?
Sussan Ley: Well they’re involved now but I think we can do better. So right now you can have team-based care plans where you get referred to all of these other health professionals, but I think it’s a bit clunky, and when I talk to doctors and practice managers they say if we were to throw up all these revenue streams that Government gives us - not just the Medicare rebate, there’s many others - how could we reconfigure them in the best interests of keeping people healthy and out of hospital? And that’s what I’m interested in because we build a system for the patients.
Leon Byner: Are we taking a plan to the next election of changing Medicare in any way?
Sussan Ley: I’m looking at what comes back to me from these reviews, which are led by doctors, and then whatever we do – and I’m not going to pre-empt what they tell me – will be again in broad consultation. But I believe it will be well accepted by all. I’m not talking about radical change, I’m talking about sensible things that we really need to get right to, as I said, keep this large and growing group of patients with chronic and complex disease healthier and out of hospital.
Leon Byner: See one of the things that’s challenging for you as a Federal Health Minister is the reality that we are an ageing country, and we probably don’t have enough young people coming in to replace some of the older ones who no longer are in the workforce for a start. So that’s the other thing here that in a way the stats that I broadcast earlier today are predictable because we are an ageing or greying nation, and that’s got to be a concern too, surely?
Sussan Ley: Well that’s part of the picture, and by the way an ageing nation is something I always say we should celebrate.
Leon Byner: Yes.
Sussan Ley: We’re all going to live longer, happier lives.
Leon Byner: Yeah.
Sussan Ley: And we’ve got technology that makes us healthier than we’ve ever been before.
Leon Byner: Sure.
Sussan Ley: Let’s look at the other end of the spectrum; the young people. We’ve got a very strong digitally focused group of the I Generation that will, I believe, use apps, wristbands, lots of other technology to monitor their own health, to keep themselves healthier, and to recognise the benefits which, you know, will no doubt be number one for them, but also for the health system along the way. So we do have that, and you know back to numbers of times Medicare’s billed; we’re improving the electronic health record.
So at the moment you turn up at your hospital going to be admitted, you’ve got your arm full of scans and records from your GP, unfortunately your hospital often doesn’t pay much attention to those, they say no, we’re going to do all those again, off you go to pathology, off you go to diagnostic imaging. And nobody… you know the patient doesn’t pay, the hospital doesn’t pay, but Medicare, i.e. the taxpayer pays. So a perfectly functioning e-health record, which we are aiming for, will have all your records sitting there for any health professional to see and not necessarily to repeat the barrage of tests.
Leon Byner: Well Sussan thank you for joining us today. One other question, you must be happy that the people at Calvary and Medibank Private have finally brokered a deal?
Sussan Ley: Look I’m very happy, and it was important that the Australian Commission on Safety and Quality accelerated their list of adverse events; things that shouldn’t happen to you in a hospital, and I asked them to do that, and they said they could by the end of this year. That’s a strong foundation for conversation that will always happen on a commercial basis between insurers and private hospitals.
Leon Byner: Sure. Sussan Ley, Federal Health Minister just having a discussion about the fact that we are really billing Medicare to the tune of a million times a day.