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Australia Anthony Albanese says the cost of visiting your doctor has increased by more than 30 per cent since the Coalition took office. Is he correct?

23:02  01 august  2021
23:02  01 august  2021 Source:   abc.net.au

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The claim

In a prelude to what the next federal election campaign may look like, Labor says cutting Medicare is "in the Liberals' DNA".

On June 8, 2021, Opposition Leader Anthony Albanese attacked the Coalition's record, publishing a tweet that said:

"It costs 34 per cent more to see your doctor today than it did when the Liberals came to power."

Is that correct? RMIT ABC Fact Check investigates.

The verdict

Mr Albanese's claim is misleading.

In more than seven years of Coalition government, the average out-of-pocket cost for GP visits for those patients who are charged fees increased by 38 per cent.

However, more than 66 per cent of patients pay nothing at all to visit their GP, according to data from 2018-19.

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Bulk-billed services, or those that cost patients nothing, account for the vast majority of GP services.

And as Fact Check recently explained, bulk-billing rates have increased under the Coalition, though before the pandemic struck this growth had been slowing.

Critically, experts consulted by Fact Check said increases in out-of-pocket costs could not be attributed to any one government.

In fact, the trend for out-of-pocket costs has been upwards since at least the early 1990s.

Moreover, Mr Albanese's focus on total change does not account for how long the Coalition has been in power.

In annual terms, the cost to visit the GP grew by an average of 4.3 per cent under the Coalition. That compares with 8.9 per cent under the last Labor government.

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For several years of the Coalition's time in office, rebates for GP visits were "frozen" at 2015 levels.

However, experts told Fact Check there was limited evidence at the national level to show that this freeze had led to higher out-of-pocket costs for patients.

Seeing 'your doctor'

Mr Albanese spoke of the cost to see "your doctor", but did not specify whether this included specialists.

On June 10, he made a similar claim about Medicare costs, referring to general practitioners in Queensland.

"Visiting a GP has gone up by almost 40 per cent under this government," he told a Townsville media conference.

For simplicity, Fact Check's analysis is limited to patient fees for general practitioners.

The cost of GP visits

Subsidised medical services, including GP visits, are listed on the Medicare Benefits Schedule (MBS).

For each MBS item, the government sets a "schedule fee" and corresponding Medicare rebate, or subsidy.

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Schedule fees are the government's estimate of what particular medical services would reasonably cost, on average.

The Australian Medical Association (AMA), however, contends that they "do not reflect the value of a medical service or an amount that medical practitioners should or must charge".

Medicare rebates are typically set as a percentage of the schedule fee, which for GP visits is 100 per cent.

Doctors are free to set their own patient fees but may instead choose to bulk bill.

This means they accept the subsidy amount as full payment for their services. The government is billed directly and the patient pays no out-of-pocket costs.

Where patient fees are higher than the rebate, patients must pay the gap.

Where's the data?

The Department of Health publishes Medicare statistics on the average patient contribution for GP visits (or "total GP non-referred attendances").

These figures are available as quarterly, financial year or a rolling 12-month time series.

Due to volatility in the quarterly data, Fact Check has relied on the rolling series, which also affords the best match with electoral cycles.

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So, have costs risen under the Coalition?

The Coalition came to power in September 2013 under Liberal leader Tony Abbott.

At the time, the average patient cost per GP visit over the preceding year was $29.74. By March 2021, the most recent data shows, the cost had climbed to $41.04.

This equates to a 38 per cent rise over seven and a half years.

Alternatively, data for financial years shows that, consistent with Mr Albanese's claim, GP out-of-pocket costs rose by 34 per cent over the Coalition's first seven years.

This covers the period from 2012-13, the last full financial year under Labor, to 2019-20, the most recent year for which data is available.

In his Townsville media conference, Mr Albanese also said the cost of GP visits in Queensland had risen "by almost 40 per cent".

Fact Check's analysis of data for the above periods reveals that average patient costs in Queensland rose by either 34 per cent (financial years) or 39 per cent (rolling series).

Is it fair criticism?

Mr Albanese focused on the Liberal-National Coalition's time in power, arguing that the cost of visiting the doctor had risen by 34 per cent.

However, the historical data shows increases to out-of-pocket costs are very much the norm.

[albo chart 2]

Highlighting this fact, Anthony Scott, a health economist with the Melbourne Institute of Applied Economic and Social Research, told Fact Check the increasing cost of GP visits could not be attributed to the Coalition.

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"Though [the] cost might have increased under this government, it also increased under Labor," he said.

"The long term trend is steady."

Indeed, when Labor was last in government, out-of-pocket costs generally increased faster, rising by 8.9 per cent per financial year, on average, compared with 4.3 per cent under the current Coalition government.

[albo chart 1]

Is that the full story?

Kees Van Gool, deputy director of the University of Technology Sydney's Centre for Health Economics Research and Evaluation, told Fact Check that it was important to note that although average patient costs were rising, so too were bulk-billing rates.

He said Mr Albanese's comment was focused on the "relatively small percentage" of medical services that attracted patient charges, rather than those that cost patients nothing.

As Fact Check recently explained, nearly 90 per cent of GP services were bulk-billed over the year March 2021, having increased by 8.7 per cent since the Coalition was elected.

It's not clear how many people benefit from bulk billing, as patients can receive a mix of patient- and bulk-billed services in the same visit.

However, the share of patients who were entirely bulk-billed for their GP visits — and therefore paid nothing at all — was 66.3 per cent in 2018-19.

For those that paid to see their GP, the official figures probably underestimate out-of-pocket costs.

Margaret Faux, a lawyer specialising in health insurance law, told Fact Check this was because some doctors may charge "off-books" transactions that were not picked up by the Medicare system.

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"In addition," she said, "unlawful gaps may be charged concurrently with bulk billed claims due to poor legal literacy of medical practitioners around correct use of Medicare."

Deeper issues

Ms Faux said the reasons for rising patient costs were "deeply structural and much more complex" than the actions of any one government.

In a 2019 pre-budget submission, the Royal Australian College of General Practitioners (RACGP) argued that patients were paying more "due to longstanding issues around the lack of adequate funding for GP services".

It singled out the failure of successive governments to increase patient rebates, which had "never accurately reflected" the costs of providing medical care.

Moreover, it said, annual increases to rebates had for decades failed to keep pace with the rising costs faced by clinics.

What about the Medicare freeze?

The RACGP submission argued that the growing gap between rebates and running costs was made worse by the recent freezes to Medicare indexation.

This meant many GPs had "forgone income and absorbed the rising cost of providing care in efforts to ensure services remain accessible and affordable for patients".

As Fact Check has previously explained, in 2013 the then Labor government froze MBS rebates temporarily when it pushed out the annual MBS indexation date from November to July.

The Coalition government reintroduced the freeze on GP rebates from July 2015.

For standard GP consultations, it was eventually lifted in July 2018. (Other GP-related rebates remained frozen until July 2019).

In an email to Fact Check, Professor Van Gool said it was "difficult to pinpoint" the extent to which the Coalition's freeze had affected patient out-of-pocket costs.

He said that "any GP fee increase would have directly translated to higher OOP costs" but that "bulk-billing rates kept increasing during this time — so many GPs were able to freeze their fees for at least part of the services they provided".

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However, Professor Van Gool cautioned that this explanation was plausible but "not proven".

In research from 2017, Professor Scott found that while out-of-pocket costs for GP visits had risen following the fee freeze, the "trend rate of growth [was] the same as that which existed previously", and that there had been "no evidence of any further incremental increase in this trend".

And although GPs facing revenue shortfalls during the freeze could choose to bulk bill less often, Professor Scott told Fact Check there was no evidence of this occurring at the aggregate level.

Principal researcher:

factcheck@rmit.edu.au

Sources

  • Anthony Albanese, Tweet, June 8, 2021
  • Anthony Albanese, Doorstop interview, June 10, 2021
  • Fact Check: Greg Hunt says nearly 90 per cent of people receive their GP services for free, July 22, 2021
  • Fact Check: Kristina Keneally says out-of-pocket costs to visit a GP have gone up 25 per cent under the Coalition Government, April 8, 2019
  • Parliamentary Library, Medicare: A quick guide, July 12, 2016
  • Department of Health, Medicare Benefits Schedule — Note GN.10.26
  • AMA, Guide for Patients on How the Health Care System Funds Medical Care, January 2, 2015
  • RACGP, Medicare and billing, accessed June 2021
  • Department of Health, Out of pocket costs, October 21, 2020
  • Department of Health, Statistics under Medicare, June 7, 2021
  • RACGP, Pre-budget submission, 2019-20
  • Access Economics, Indexation of MBS rebates for GP consultation items, June 2004
  • Parliamentary Library, Medicare — Background Brief, October 2004
  • MBS Online, Medicare benefits indexation realigned to the financial year, May 17, 2013
  • Parliamentary Library, Budget Review 2017–18 (Medicare), May 2017
  • MBS Online, Medicare indexation schedule, January 21, 2020
  • Helen Dickinson, What is the Medicare rebate freeze and what does it mean for you?, March 26, 2019
  • Anthony Scott, FactCheck: Have average out-of-pocket costs for GP visits risen almost 20% under the Coalition?, October 19, 2016
  • Anthony Scott, How likely are doctors to charge more due to the rebate freeze?, March 6, 2015
  • Anthony Scott, ANZ–Melbourne Institute health sector report: General practice trends, 2017
  • Jim Gillespie, Election campaign lesson #1: don't mess with Medicare, April 17, 2019
  • ABC, Timeline: The rise and fall of the GP co-payment, March 3, 2015

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