Ideas@TheCentre
Irrational Medicare system delivers inverse health care
Jeremy Sammut |
19 February 2010
In Victoria, The Age has reported on a convicted conman investigated twice in recent years for suspected Medicare fraud who continues to bill the system for hundreds of thousands of dollars.
Meanwhile, the Daily Telegraph has alleged that the Federal MP for the NSW Central Coast seat of Robertson, Belinda Neal, offered (though she strongly denies it) to have a local Labor Party branch member moved up the waiting list for hip-replacement surgery in return for supporting Neal in a bitter pre-selection contest.
The extent to which Medicare may be being ripped off is unknown. Incredibly, healthcare providers are not obliged to hand over their billing records to investigators, and one in five who are audited refuse to do so.
The federal government spends about $14 billion a year on bulk-billed general practice and other allied health services, or about half the amount state and federal governments spend on Australia’s 750 public hospitals.
Expenditure on this part of the Medicare program (which all governments treat as a political sacred cow) is uncapped and demand-driven. Unquantifiable amounts of health dollars are being wasted due to not only fraud but also overuse of bulk-billed services consumed without upfront charges and co-payments.
By contrast, public hospital budgets are capped and this part of the system is supply-driven. Budget limits determine services levels, and public hospital care is rationed not only by elective waiting lists but also by emergency patients waiting for hours, sometimes days, before a free hospital bed is found.
Australia’s ‘free and universal’ public health system is therefore well-described as an irrational ‘inverse insurance system.’ The worried well can see the doctor for ‘free’ an unlimited number of times although their health needs are mostly minor, leaving taxpayers to pick up the ever-increasing bill. But when medical problems are most serious, an ‘inverse care law’ applies, and patients are forced to queue to receive hospital treatment.
The diminishing numbers of true believers who think Medicare the unblemished jewel in the crown of Australian social democracy are truly deluded. Medicare is not free, let alone universal, and beyond the cost to taxpayers, the highest price is being paid by the truly sick who are routinely denied timely access to essential hospital care.
Dr Jeremy Sammut is a Research Fellow at the Centre for Independent Studies.
