Australian Doctor Australian Doctor 12 May 2017 | Page 29

Letters

How they pay for healthcare in NZ

Letters

Your Views
EDITOR Australians have been so brainwashed in expecting medical care for free(‘ The future of general practice: How should we pay for GP care?’, 17 April, australiandoctor. com. au).
I am working in one of the poorest towns in New Zealand, where the co-payment is NZ $ 18( all figures in NZD). It would be double that if the practice was run commercially( it’ s been bought by the district health board). In the Big Smoke it’ s more like $ 50, no rebates.
Children under 13 are seen for free( at most places, not obligatory). There is little evidence of this being abused because appointments are not easy to come by, even if you have a sick kid. High-needs patients get a modest discount, but only very unwell patients get four measly visits a year for free.
EDs have the right to refuse to see Category 4( potentially serious) and 5( less urgent) triage patients and redirect them to after-hours clinics($ 80).
Outpatient services have the right to decline referrals— for instance, for an inguinal hernia($ 5000).
Contracted radiology services often cite protocols( the‘ health’ pathways) to refuse imaging; for example, for a liver ultrasound in haemochromatosis.
FROM THE WEB
Tests are free at governmentappointed labs, as is essential imaging, but if you need to go private, you pay hundreds of dollars for consultations and minor procedures if your GP won’ t do them.
It’ s $ 300 to see a respiratory specialist to skip the queue for CPAP assessment; $ 800 for a plastic surgeon to remove two little moles; and
$ 2000 for an knee MRI if you are not under an accident compensation scheme.
The single pension is $ 450 a week, which is well below the poverty line. Average national household income is $ 29,000.
Dr Iliya Englin, VMO Reefton Medical Centre and Hospital,
Reefton, New Zealand
No wasted tears for e-PIP practices
EDITOR As a doctor who does not receive a single penny from the Practice Incentives Program, because my practice is not accredited and therefore ineligible to participate in these incentives, this article has really brightened my day(‘ Practices that missed targets asked to give back e-PIP cash’, 24 April, australiandoctor. com. au).
Why should doctors who are encouraging low rebates for patients by accepting money from the government think they are above the law, or that certain rules shouldn’ t apply to them?
I don’ t care how much they whinge about losing this money— after all, they signed up for it with their eyes wide open. Surely, they must expect a contract to be filled or have to pay the consequences.
Dr Lou Lewis GP, Sydney, NSW
Have your say
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TWEET OF THE WEEK

“ It’ s the patient’ s Medicare rebate. Not the doctor’ s.”
— Dr Bastian Seidel, RACGP president @ DrBastianSeidel
Follow us at @ australiandr
Who’ s liable?
( NSW looks set to ditch mandatory reporting of colleagues, 27 April) It will be interesting to see how they word the legislation changes. The NSW Government isn’ t going to be volunteering to take responsibility for any adverse effects on patients as a result of this. Will the onus reside with the treating doctor, or with the affected doctor? Obviously there are times when a notification will be necessary to protect the public. Where will the liability reside?
Karina
What about some older specialists who are underperforming? For example, a cardiologist, orthopod or nephrologist who simply sees patients and writes rmedical reports, but does no procedures and also falls behind with knowledge of recent medications? But who still draws specialist fees, and does unnecessary and irrelevant ECGs, X-rays or blood tests on all consultations. In other words, they should be retired, as they are only working now to support their other interests such as farms, wineries,
etc. I know one or two, and often their reports are wrong, but unfortunately accepted by courts and insurance companies to the detriment of patients’ wellbeing.
Hypocrites GP
Vaping safely
( Lowdown on e-cigarettes, 21 April) Thank you, Professor Colin Mendelsohn, for pragmatic and extremely useful advice to assist us in helping our nicotine-addicted patients. The NHMRC and TGA should be more concerned about regulating useless complementary medications rather than e-cigarettes and get on board.
Rick Hambour
Train the patients
( Medicare freeze looks set to stay another year, 24 April) The choices are either to see more patients in an everdecreasing amount of time, or charge a fee. But the market is about to be flooded with doctors. Some years back we were graduating about 500 per year and now the number is more like 1500. So there won’ t just be a bulk-billing clinic nearby; there will be one on each side of your clinic and another across the road. All these doctors are going to cost the government a lot of money over the years. Meanwhile, in order to survive, either find a niche where you can charge gaps, or train the patients that
it is now‘ one problem per consult’.
James Moxham Whether the freeze ends or not, general practice still dies— it’ s just a matter of time. Rather than fight for meagre increases, we should be pushing to change the system to make it more convenient. A smaller upfront payment and rebate to the doctor.
Harry Nespolon
Divided we fall
( Divided college ploughs ahead with constitution vote, 28 April) The RACGP sets the‘ minimum requirements’ for GPs to keep up with their professional knowledge. It has used this power to include the QI & CPD annual, mandatory fee. The fee is currently around $ 700, and you’ ve got to pay that whether you are a member or not. With such guaranteed income every year, the college does not need to value GPs’ opinions at all, whether from members or non-members. I’ m afraid the new board will be tempted to add further tax-like‘ minimum requirements’ to the current list.
Mehdi Zahedpur This is why I resigned from the college.
Michael Serafim
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