Health Funds and Medicare

It is hard to know where to start with the Federal Government’s thought bubble about allowing health funds to run medical practices.  The reason put forward to support the idea assume an ant has more intelligence than a person.  But I will come to that.

Let’s look at the differences between a government funded enterprise and a publicly owned business.  A publicly owned business exists to make a profit. The focus is on generating maximum profits within the scope of legal constraints, and passing these to the shareholders.  If any of the directors or management deny this, they should be sacked by the shareholders.  Read your job description.

A government funded enterprise exists either because free enterprise cannot see an opportunity to make a profit, or the service provided is too important to allow commercial interests to take over.  Basic services such as supply of water, and providing support for those unable to support themselves fall into these categories.  Major infrastructure projects sometimes only happen when the government funds it.

Now the health funds want to employ doctors.  Why?  Obviously, because they are public companies, to increase the profits of the health funds.

Imagine you turn up at a doctor who cannot pinpoint the cause of your illness.  In the current environment, the doctor may prescribe a range of tests to diagnose the underlying problem.  It may be that some of those tests look for indicators of an illness, where the probability of you having such an illness are low.

Say there are five tests.  The probability of the illness being identified by three is 80% but there is a 20% chance you have an illness that can only be identifies by the other two tests.  If you go to a doctor who is paid by Medicare, the doctor might send you for five tests simultaneously.  If however, there is pressure to increase profits, the doctor will think twice before sending you for five tests.  Maybe he sends you for one test at a time.  If the test shows nothing, you go for the next test on the list until something turns up.  It may take weeks.  The health fund only pays for the tests you have up to the point the illness is identifies.  Much more efficient from a profit perspective.

It sounds OK in theory, but how many people are diagnosed with a particular problem and immediately admitted to hospital for urgent treatment.  It might be something as simple as a persistent cough that turns out to be lung cancer.  Carrying out one test after another until the cause is pinpointed might cost you your life.  Is this where we are going?  Is this what we want from our Medicare?

I want a Medicare system that gives the doctor the ability to address my health concerns as soon as possible.  I don’t want the doctor’s decision made with a financial cloud looming over that decision.  If it means paying a slightly higher medicare levy to achieve that situation, so be it.  I understand medical costs are increasing and there is no bottomless pit to pay for it.  If I want to retain the level of service Medicare has delivered over the years, I might have to pay more tax to achieve it.  What I don’t want is a health fund dictating how much a doctor can spend on my medical issues.

Finally, I am offended by the treatment of the public by the health funds.  To say the reason for the health fund becoming the service delivery arm of the health industry is to improve preventative medicine is an insult to the intelligence of the Australian public.  If the health fund believe they can exert enough pressure on doctors to focus on preventative health, they can put enough pressure on doctors to do other things.  For example limiting testing,  less services or discouraging visits for less critical illnesses.  They cannot have it both ways.  They can either influence doctors in their employ, or not.  They have already said they can exert influence.

I don’t want to hear from a GP:

“Why did you come to see me?  It is only a minor problem.”

Preventative medicine is a noble cause but we don’t need health funds to take over doctors to promote it.  Can they come up with any other good reasons for allowing them to control delivery of medical services?