So this is about charging what |
process , and we have titrated this |
the road , as many GPs would fear ?
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You don ’ t want to disadvantage a bunch of people if you can avoid it , and we needed a system that still allows people to get their kids care if needed . |
AD : The RACGP is encouraging more GPs to abandon universal bulk-billing , but it never seems to happen . Why ? |
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The Melbourne GP has been gradually introducing fees for a range of patients over the past 18 months .
DR Mukesh Haikerwal has a message for GPs looking to cut back on bulk-billing : be brave , offer a quality service and patients will stick by you . Two years ago , the former AMA president bulk-billed almost all patients at his Melbourne practice .
Today , everyone except pensioners and holders of Services Australia Health Care Cards are charged fees — typically $ 84 for a standard consult .
Australian Doctor : Why the shift away from bulk-billing ?
Dr Mukesh Haikerwal : The Medicare rebate and the AMA rate used to be about the same . Over time , those two have parted company and filed for divorce .
we are worth . The Medicare rebate hasn ’ t kept up with inflation .
And costs have gone up : PPE , infection control , staff , compliance . The list of expectations and demands is always growing , and it costs money .
For a standard consult , the AMA says it should be $ 86 . Medicare thinks it can be done for $ 39.10 .
It means you can ’ t do everything that you previously did in a consult , and care suffers .
AD : So what have you done ?
Dr Haikerwal : Our fees are similar to those recommended by the AMA , although we charge a lower rate for children and concession card holders .
This has been an 18-month
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in a way , trying to be mindful of the fact that those who require the most care are often those with the least ability to pay .
Initially , we decided to end all bulk-billing on Sundays . So everyone pays an out-of-pocket fee , adult or child .
Then we moved to no bulk-billing on Saturdays , and then for anyone coming in after 6pm on weekdays .
The reasoning is that most concessional patients should be able to come in during the day , when there are ample appointments .
And those who can only come in during the evenings or on weekends are more likely to be able to afford to pay .
The most recent change is moving away from all children under 16 being bulk-billed , but their fee is lower than for an adult patient .
AD : How have patients responded ? Have they left en masse to the bulk-billing clinic up
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Dr Haikerwal : Interestingly , we are flat out every Sunday , which is when nobody is bulk-billed . In fact , we charge a higher fee compared with weekdays .
That ’ s because the alternative is for patients to go somewhere they don ’ t know or perhaps to ED , where they will have to sit and wait six hours for the privilege of not getting very much .
They see the benefit of a practice where they are known , they know the people caring for them and the quality is guaranteed .
Saturdays have been more difficult , especially with charging kids on a Saturday , but patients have got used to that .
But perhaps the most difficult change was when we stopped all bulk-billing after 6pm .
Patients would find it very confusing because they would be bulkbilled at 5.30pm but asked to pay a fee at 6.30pm .
Simplicity is king , but unfortunately you can ’ t always be simple .
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Dr Haikerwal : There is also a school of thought that healthcare should be free at the point of use ; that ’ s the ethos of the National Health Service in the UK , where I once worked before coming here .
But as I have been saying for 20 years , the goodwill of the doctors has been exploited .
We saw that with the Federal Government ’ s announcement a few weeks ago about yet another bulk-billing record .
There was a Greg Hunt press release saying it had reached 88.4 %. This has happened even though the rebate has gone backwards in real terms .
It gets said a lot but the response has to be that GPs charge what they are worth . The specialty is suffering ; our vibe is negative , and we can ’ t recruit .
This is clearly happening because we are relying on a dwindling rebate .
AD : Do you have any advice for GPs who want to start charging fees ?
Dr Haikerwal : You need to make people understand what the issue is and what the costs you are dealing with are .
Once that happens , they ’ ll get that you ’ re not trying to fleece them .
And yes , some patients might leave for somewhere they will be bulk-billed . But what we have found is an awful lot actually end up coming back .
They are used to a certain level of service , and they go somewhere else and realise they aren ’ t getting it .
So it ’ s about being brave and actually believing in your own value .
You ’ re not being a QC in the High Court , charging $ 2000 an hour ; you ’ re being very reasonable about what you ’ re doing . You are worth the money .
Dr Haikerwal spoke to Geir O ’ Rourke .
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