Where is Medicare ‘leakage’ coming from? GPs point the finger

Yasmin Clarke

writer

Yasmin Clarke

Data analyst; Journalist

Yasmin Clarke

Many GPs think large, profit-driven corporates and hospitals are the main sources of Medicare misuse, Healthed survey finds.

This week, Healthed asked around 350 GPs what they thought were they main causes of Medicare misuse. Their answers suggest a more complex picture than the simplistic ideas put forward by recent mainstream news reports, which focused almost exclusively on waste and fraud by GPs, and hence the ‘greedy doctor’ trope,  as the main sources of Medicare ‘misuse’.

In this survey, Healthed asked GPs:

“If there are Medicare funds being inappropriately used, where do you suspect the main ‘misuse’ or ‘leakage’ is?” GPs could select multiple options, and could also provide their own responses.

Around 40% of GPs surveyed identified over-billing and over-servicing from profit-driven GP organisations as a leading source of leakage.

Around a quarter of GPs (27%) identified state-funded hospital outpatient services as the main ‘misuse’ of Medicare. These outpatient services are nominally already funded by the relevant state government.

GPs also identified inappropriate pathology ordering (22%) and inappropriate chronic disease care plans (22%), as well as non-GP specialists over-servicing (19%), as other potential sources of Medicare leakage.

Interestingly, one-third of GPs surveyed said they did not believe there was inappropriate usage of Medicare funds.

Of the 50 or so GPs who provided written comments, many pointed to bureaucratic inefficiency and unnecessary complexity as major reasons for leakage of funds out of Medicare. Several GPs said that confusion or lack of clarity with MBS item numbers was leading to incorrect billing – which could manifest as overbilling or underbilling depending on the situation.

It’s been argued that Medicare was never set up to become the primary source of income for profit-oriented corporations and this survey clearly shows that GPs themselves suspect that this is where a lot of the ‘leakage’ is to be found. Hopefully, the Philip Review will shed more light on this.

Perhaps most importantly, the majority of GPs don’t work in corporate or commercially-driven environments, however the media reports have failed to distinguish between the vocationally driven GP and the profit-driven, large corporates.

When presented with the Heathed survey results showing the devastating impact of the media reports on frontline GP morale, burnout and intentions to depart the workforce, Dr Karen Price, outgoing RACGP president, said “It’s an absolute tragedy. The fallout will be felt for a long, long time.”

“Given what we’ve done” during the pandemic this latest negative news coverage makes GPs “feel absolutely devastated, demoralised, angry and sad”, Dr Price said.

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Yasmin Clarke

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Yasmin Clarke

Data analyst; Journalist

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