Inquiry into Medicare
Medicare - healthcare or welfare?

30 October 2003

© Commonwealth of Australia 2003

ISBN 0 642 71275 1

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TABLE OF CONTENTS

Membership of the Committee (PDF format) (Word format)

Executive Sumary (PDF format) (Word format)

Chapter One: Introduction (PDF format) (Word format)
Background to the Inquiry
Conduct of the Inquiry
Commissioned research
Structure of the report
Assistance with the Inquiry

Chapter Two: The Medicare System (PDF format) (Word format)
Introduction
Australias Constitution and a shared responsibility for Health
Australian Health Care Agreements (AHCAs)
History and purpose of Medicare
Original Purpose
Financing and Cost
Changes under the Fraser Government
Medicare from 1984
Medicare cost and financing
The operation of Medicare an overview
Eligibility
Safety Net Arrangements
Blended payments
Consumer organisations
Australian Consumers Association
Consumers Health Forum of Australia
State Based Health Consumers Organisations
General Practice in Australia
Vocationally registered and non-vocationally registered practitioners
Professional Organisations

Chapter Three: General Practice Incomes and the viability of Practice in Australia (PDF format) (Word format)
Introduction
Viability
The viability of General Practice
The viability of exclusively bulk-billing General Practice
Models of Payment
Fee-for-Service
Capitation
Salaried Doctors
Blended payments
General Practice incomes
Practice costs
Costs of rural practice
The cost of accessing blended payments
Practice Incentives Program
Enhanced Primary Care
Conclusion

Chapter Four:  Access to General Practice in Australia (PDF format) (Word format)
Current GP services
GP numbers and their location
Declining Rates of Bulk-billing
The causes of reduced access
GP Morale, a falling participation rate and the ageing of GPs
The drop in bulk-billing
The maldistribution of GPs
The increase in GP attendances
An increase in consumer expectations
More chronic disease and a move into community-based care
A move towards prevention
Over-servicing
Impact of the lack of access to GPs
Overflows from GPs to public hospitals
Delays in consultation cause general deterioration of problems with greater long
        term costs & hospitalisation
Reduced capacity to provide preventative health care
Conclusion

Chapter Five: A Fairer Medicare Package (PDF format) (Word format)
Introduction
The Governments proposed changes to Medicare
Changes to methods of payment and rebate
New safety nets
Workforce measures
Veterans and the Local Medical Officer scheme

Chapter Six: Proposed billing arrangements (PDF format) (Word format)
Introduction
The reaction of General Practice
Other issues
Conclusion
Bulk-billing for Commonwealth Concession Card holders
A step away from universality?
Is it a problem that needs to be solved?
Concession Cards as a measure of need
Restricted access for concession cardholders?
Problems with access to After Hours services
Access to GPs for non-concession card holders
Effects on gap payments
Effects on the overall rate of bulk-billing
Direct rebate at point of service
Inflationary pressures
Conclusion: a three tier system?

Chapter Seven: Safety nets (PDF format) (Word format)
Introduction
The need for additional safety nets
Criticism of the proposals
Increased complexity and administrative costs
Boundary problems
Transferring responsibility to the private sector
Inflationary pressures
Conclusion

Chapter Eight: Workforce and business measures (PDF format) (Word format)
Introduction
Bonded medical places
Equity issues
The workability of bonding
Two tiers of graduates?
Alternatives
Conclusion
Additional practice nurses
The role of practice nurses
Scope of the program
Conclusion
Assistance with IT infrastructure
Conclusion

Chapter Nine: The ALP Policy (PDF format) (Word format)
Introduction
Reactions to the ALP plan
Key findings from the AIPC Report
Conclusion

Chapter Ten: Allied and Dental Health Care (PDF format) (Word format)
Introduction
Dental Heath Care
The importance of dental health
Access to dental services in Australia
Options for a wider Commonwealth role in dental services
Extending Medicare to cover dental services
A new Commonwealth dental health program
Conclusion
Allied Health Services
Allied Health Spending
Current Provision for Allied Health under Medicare
Other Commonwealth Funded Allied Health Programs
Alternatives for enhancing the role of Allied Health
Conclusion

Chapter Eleven: Private health insurance rebate (PDF format) (Word format)
Introduction
Criticisms of the PHI rebate
Social equity
An inefficient path to public health objectives?
Ineffective at meeting its objectives
Reallocation of rebate to public health
Effects of removing the rebate
Alternative uses for the funds
Alternatives to abolishing the rebate
Conclusion.

Chapter Twelve: Other reform options (PDF format) (Word format)
Introduction
Raising the Medicare Schedule Fee and Rebate
What is the role of the rebate?
What should the rebate be now?
The relationship between bulk-billing rates, doctor shortage and the MBS rebate level
Setting the MBS rebate level in the future
Conclusion
Addressing perverse incentives: refining payments to General Practice
Blended payment
Capitation
Differential Rebate
Geographically based item numbers
Improving after hours access
Conclusion
Building primary health care teams
Perverse incentives
A new model for Community Primary Health Care
Conclusion
Funding mechanisms
Hunter Region initiatives
Primary Health Care Access Program
Additional funding
Conclusion
Need for research and analysis
Improving Australias use of Overseas Trained Doctors
Problems in accessing work
Problems with qualifications and supervision
The extent to which Australia should rely on OTDs
Conclusion
A national consensus?

Government Senators Minority Report (PDF format) (Word format)

Democrats Additional Comments (PDF format) (Word format)

APPENDICES

Appendix 1 (PDF format) (Word format)
LIST OF PUBLIC SUBMISSIONS, TABLED DOCUMENTS, SUPPLEMENTARY INFORMATION AND OTHER WRITTEN MATERIAL AUTHORISED FOR PUBLICATION BY THE COMMITTEE  

Appendix 2 (PDF format) (Word format)
WITNESSES WHO APPEARED BEFORE THE COMMITTEE AT PUBLIC HEARINGS AND ROUNDTABLE DISCUSSIONS. 245

Appendix 3 (PDF format) (Word format)
BIBLIOGRAPHY MEDICARE WEB RESOURCES

ATTACHMENTS

Attachment One: Report from Australian Institute for Primary Care (PDF format) (Word format)

Attachment Two: Australian Institute for Primary Care - Appendix A (PDF format) (Word format)