As a follow-on to a recent discussion thread over at
PagingDr, I had cause to review the effect of the 10 Year Moratorium on Medicare Provider Benefits.
This has been a big deal because it effectively limits non-Australian Citizens or Permanent Residents from gaining access to Medicare Provider Benefits.
You may recall from the
first instalment of my
Mind the Gap Series that outside of the public hospital system the Federal Government funds medical services via the
Medicare system (including the
PBS and the
Commonwealth Medical Benefits Schedule [CMBS]).
This renders the Federal Government extreme power and influence over who delivers medical care to the community via the allocation and restriction of Provider Numbers, and also how that care is delivered via limitations, restriction and conditions placed upon services before they are eligible for reimbursement via Medicare.
Note that this is a relatively roundabout method of control over medical practitioners. The Federal Government does not tell doctors what to do. They merely tell doctors that unless they do things in a specific way, satisfying Medicare guidelines and Ministerial Determinations, that their patients will not be able to have their medical costs reimbursed.
Therefore in theory it is not the doctor who is being punished, but the patient. Unfortunately, the doctor is the one that the patient sees face to face. The bills and invoices carry the doctors name. If the patient can't get money back from Medicare or their insurance company, it is the doctor they complain to, not the 17 year old counter chick at the Medicare office, or the faceless call-centre operator on the end of the phone line.
And if you are unfortunate enough to be one of the 90% of doctors that do not get payment upfront then you end up unpaid because the patient can't get their Medicare reimbursement.
What does this have to do with the 10 Year Moratorium?
Well, the 10 Year Moratorium is one of the limitations (along with Bonded Medical School Places) that the Federal Government applies to restrict access to Medicare benefits. It's purpose is to encourage doctors to enter and remain in the public hospital system, or to work in "areas of need" as defined by Medicare, brought in as part of
John Howard's 1996 Provider Number reforms (
More Info).
It applies to Overseas-Trained Doctors who migrate to Australia as well as non-citizens and non-permanent residents who commence studying medicine in Australia.
Basically if you fall into the target population, patients who see you in private (in your clinic or rooms) or on whom you operate in a private hospital will not have their medical costs reimbursed or subsidised by the Federal Government. In a system where patients are accustomed to paying little or nothing out-of-pocket this is tantamount to shutting these doctors out of the market, unless you do what the Government tells you to, and work where they tell you to work.
Fine, it's primary purpose is to encourage doctors into "areas of need". But what about non-resident doctors who gain their medical qualifications in Australia? These include full-fee paying students from overseas, as well as New Zealanders (who are on Special Category Visas) who study medicine in Australia. These students take up valuable medical school positions, but are discouraged from working in Australia for 10 years after their graduation, when they have careers they can easily go to in New Zealand and elsewhere.
Furthermore, they aren't banned from working in Australia - only from working outside the public hospital system. That means that they are free to pursue their specialist qualifications and postgraduate degrees (but GP trainees have to enter the Rural Training Program). After this, however, they have to go overseas or off to the bush (which increasingly means
outer metropolitan urban fringes) to bide their time.
It seems a colossal waste of university and hospital resources to train people who can easily avoid the rest of their Provider Number limbo by heading overseas (and most likely never returning).
But then again, maybe the Department of Health knows what it's doing...
Exemption guidelines for doctors need fixing: report - The Australian
(Click to Expand)Exemption guidelines for doctors need fixing: report
The Australian
Sean Parnell | November 17, 2007
THE much-criticised system of regulating overseas-trained doctors has been dealt another blow, with the Department of Health and Ageing confirming the existence of a damning internal report on its distribution of Medicare provider numbers.
Two years after the furore over the alleged criminal malpractice of foreign doctor Jayant Patel in Queensland, which prompted a concerted reform push across Australia, the commonwealth is under fire over its use of overseas-trained doctors to fill gaps in primary care and private practice.
Section 19AB of the Health Insurance Act stops overseas-trained doctors receiving Medicare benefits for 10 years, unless, as temporary residents, they agree to serve in an area of need known as a District of Workforce Shortage. At the end of October, 4148 overseas-trained doctors had been given exemptions -- double the 2004 figure.
More of Australia is being classified by the department as a District of Workforce Shortage and, with the staffing crisis now reaching into the suburbs, its own research has found Section 19AB exemptions are considered vital to filling outer metropolitan GP vacancies.
But a report commissioned by the department last year pointed to serious flaws in the Section 19AB process, which has existed since 1997 and is now covered by six-year-old guidelines.
A department spokeswoman confirmed doctor Eleanor Long, a renowned Australian medical education consultant, had used her report to recommend the guidelines undergo "major revision".
According to the spokeswoman, Long wants the validity of the guidelines improved as they apply specifically to GP numbers through an overhaul of the District of Workforce Shortage process.
Long believes more attention should be given to the factors leading to shortages, and how the department should assess District of Workforce Shortages and applications for an exemption from Section 19AB.
The spokeswoman said Long also wanted the department to improve the reliability of the guidelines through the development of a proper assessment tool, in effect doing away with a largely discretionary process.
Yet despite the findings, the spokeswoman said the guidelines were only being monitored and a statutory review of Section 19AB was not due until 2009-2010.
Her comments suggest a review has been considered and delayed, given a department spokesman in July said a review of the guidelines would be undertaken within a year "with input from medical professional peak bodies".
Efforts by Weekend Health to obtain a copy of the otherwise secret report have failed. Long is restricted by a confidentiality agreement, and a freedom of information application was rejected on the grounds that a review may yet occur and the information contained in Long's report might undermine the system.
David Dennis, assistant secretary of the department's Workforce Distribution Branch, ruled "to the extent that the document exposes weaknesses or 'loopholes' in the current scheme, disclosure could compromise the integrity and viability of the decision-making process in granting or rejecting exemptions".
Dennis warns of a premature public debate on the issue if the report is released. "This has the potential to disrupt the policy review process, delaying the important reforms which are intended to improve the operation of the legislation; and disclosure could disrupt the strong public interest or faith in the policy-making process leading to the allocation of Australia's medical workforce, particularly in relation to districts of workforce shortage."
But it appears both overseas-trained doctors and Australian-trained doctors have lost faith in the department's short-term response to the doctor shortage.
Surgeon Russell Stitz, chairman-elect of the Committee of Presidents of Medical Colleges, says the District of Workforce Shortage process is "flawed" and hides problems in the system. Stitz says the colleges should be involved in the assessment process to determine why Australian doctors are not filling vacancies and whether, for example, it is due to a lack of support staff or infrastructure.
Andrew Schwartz, from the Australian Doctors Trained Overseas Association, says the Section 19AB guidelines are also discriminatory in that they favour temporary residents over permanent residents.
"Australian Governments all favour temporary residents because they can be more easily restricted to where they work, and kept out of the private market," Schwartz says, again accusing the colleges of market protection.
But Stitz says the colleges acknowledged the doctor shortage and believed there would continue to be scope for overseas-trained professionals to work in Australia.
He says the Section 19AB exemptions should not allow doctors to bypass Australian Medical Council assessments and all overseas-trained doctors should first work under supervision to learn the system, the culture, and where they could seek help.
"What happens with area-of-need specialists -- and you must feel sorry for them -- (is) they get brought in, often very rapidly put through the system, and sent to an area where they have no support and are expected to function in a very difficult environment."
(Click to Expand)GP shortage in outer suburbs: report
The Australian
Sean Parnell | November 14, 2007
JOHN Howard's bid to upstage Labor with a promise of after-hours medical clinics has been undermined by a federal government report, which reveals suburban GPs are already struggling to meet demand and unable to recruit enough staff.
The confidential report, which also damages Labor's policy, was written by Woolcott Research and delivered to the Government in August.
It advises the incentives it offered general practitioners to work in outer metropolitan areas had only limited success and 68per cent of clinics felt they were still short-staffed.
"These outer metropolitan practices indicated that they were trying very hard to recruit doctors ... by various methods, but often these methods were unsuccessful and ineffective," says the report, obtained by The Australian under Freedom of Information laws.
The Prime Minister has vowed to establish 50 Family Emergency Medical Centres, half of which would be open around the clock.
Health Minister Tony Abbott argues the centres would complement existing clinics, unlike Labor's plan for GP superclinics on predetermined sites, which he claimed would compete with established practices.
But while training more doctors has bipartisan support, GP shortages will continue for several years.
The Woolcott Research report and the decline in bulk-billing indicates policies that congregate GPs at certain sites will only force patients to travel further for treatment.
The report questions the Government's ability to address the maldistribution of doctors in outer metropolitan areas. Three initiatives are used to fill outer metropolitan vacancies: pay Australian-trained doctors a Relocation Incentive Grant of up to $40,000; force GP registrars to undertake a six-month placement in those areas; and offer to fast-track overseas-trained doctors into areas of need.
"Whilst these initiatives have been successful to a degree, with relatively high numbers of doctors relocating to or increasing their hours in outer metropolitan areas as a result of the Relocation Incentive Grant, as well as the placements of registrars for their six-month periods, evidence suggested that they had not been fully subscribed, and that more recent uptake of the RIG in particular was declining," the report finds.
GPs surveyed for the report found the RIG initiative was "viewed more in terms of being a retrospective bonus, and was not necessarily seen to offer sufficient incentive in itself to initiate the relocation of a GP."
Australian General Practice Network chairman Tony Hobbs - who raised concerns over the Coalition's plan for 24-hour services - said after-hours clinics would succeed only if they had enough staff.
Dr Hobbs welcomed any policy that fostered a team environment.
"What we really need, though, and it's a big call, is an over-arching primary healthcare policy in this country," Dr Hobbs said.
"What we've had is a piecemeal policy approach from both sides - something about clinics, something about practice nurses, something about dental care - but it virtually operates in a policy void without long-term, structured planning."
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3 comments:
Thank you Mr. Sheepish. Appreciate your constant supply of news on medicine in Aus :)
i concur
Just one point of emphasis ...
"It applies to Overseas-Trained Doctors who migrate to Australia as well as non-citizens and non-permanent residents who commence studying medicine in Australia."
It's not just "migrants" that this applies to - an Australian born "citizen" would also be restricted if they trained overseas.
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