Women and complex-care patients losing out under Medicare, review says

Topic: Health Doctors argue a "flaw" in Medicare is incentivising GPs to churn through patients. (AAP: Tracey Nearmy) Michael Wright says GPs are spending more time with patients as care becomes more complex. (ABC News) This means patients are typically about $52 out of pocket, but because prices vary significantly, the gap fee can be as much as $100. However, the Medicare rebate does not double just because the appointment time does — generally the rebate per minute decreases as the appointment gets longer. The Medicare Benefits Schedule (MBS) Review Advisory Committee report suggested this was inequitable. "Patients aren't getting a fair go when it comes to longer consultations," Danielle McMullen, president of the Australian Medical Association (AMA) said. "Those longer visits have a poorer rebate and we really need to rebalance the scales there."  The review suggests increasing the rebates for appointments lasting longer than 20 mins. (ABC News: Maren Preuss) Major medical bodies have long argued the current system is not fit for purpose as patients are presenting with increasingly complex needs. The review said increasing the rebates for appointments lasting longer than 20 minutes was an option that could be implemented the fastest. But it did not say how much the rebates should be increased by, with Dr Wright noting the "devil is in the detail". The RACGP has previously said increasing the rebate for appointments between 20 and 59 minutes by 40 per cent would cost the federal government up to $1 billion a year. Abolishing acupuncture and antenatal Medicare items Female patients and GPs are particularly disadvantaged under the current system, according to the report, because they are more likely to use or provide longer consultations. Dr McMullen said complex issues such as reproductive care or menopause management took time, and she had personally experienced the gender pay gap in practices where male doctors saw more patients per hour. Danielle McMullen says women are particularly disadvantaged under the current system. (ABC News: Charlie Mclean) "That has an impact on the sustainability of the business as well, which is a factor when we're trying to improve flexibility in our workforce and get more doctors to be GPs," she said. The report also found bulk-billing incentives further exacerbated the issue, as GPs currently received the same flat-rate incentive for both short and long appointments. The federal government last year expanded the bulk-billing incentive to all Australians, as part of a plan costing $8.5 billion over four years.