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Healthcare Down Under

Australian HealthcarePERTH, Western Australia: There are more choices for Americans to consider in health care than the plans offered by the US, Canada, and Great Britain. As a practicing physician in Australia with over 20 years experience I thought your readers at the NIP would be interested in healthcare down under.

Australian citizens each have a medicare number which gives them free medical coverage in Australia and overseas in countries with reprical agreements. You can attend any General Practitioner of your choice, as often as you want. The vast majority of medicines are subsidised by the Government to a max cost to the patient of around $30 AUD. After you have spent around $800 in a year on pharmaceuticals, you’re covered by a safety net and it’s free after that until the end of the year.

You can have whatever pathology testing is deemed necessary by your doctor, including preventative care. Most doctors “bulk bill” the government for pathology so that it doesn’t cost you anything. There are some radiology businesses that bulk bill for scans, Xrays etc – again no cost to you, and others that issue an account of which the government pays between 50 – 80% depending on the test. The radiologist can charge whatever fee they wish. MRI’s have to be ordered by a specialist to be eligible for medicare rebate.

In addition to this, families can take out private health insurance (around $1300/year for a family), to give them access to private hospitals and the private specialist of their choice. This is necessary if one can afford it, as there are significant waiting lists for elective orthopaedic procedures, and colonoscopy/endoscopy in the public system. But if the condition is urgent, it can be fasttracked in the public system.

I believe that the Australian system combines the best of the British with Universal Health Care and the US with private medicine.  Most Australians could not comprehend a system in which someone wasn’t entitled to quality free health care, without means testing, prior illness history or background.  The British system is awful but in Australia the system generally works well. We all complain about waiting times and busy hospitals and red tape, but if you present to an ED with a major illness/accident you will receive top care regardless of anything– free.

Our system isn’t perfect but there is strong focus nowadays on preventative healthcare, especially at the GP level, with increasing rebates for this area. GPs are rebated pittance for our time, that’s why many chose to charge privately whatever fee they consider appropriate. The patient is still entitled to medicare rebates.

There are 8 petition points that are central to our healthcare system here in Australia. These points are germane to the public debate that you are having in the US, vital to the functioning of the system, and essential to protect the rights of all:

  1. INDEPENDENCE: Doctors are professionals. They answer to their patients, not the government or an insurance company or any other third party. Treatments should be decided by doctor and patient exclusively. This is important and in Australia, public healthcare is decided by doctor and patient exclusively. One must remain vigilant of governments of any persuasion trying to gain more control of the health dollar, but as long organisations are aware, it works.
  2. VALUE OUR SERVICES: Physicians have a right to be paid a market-based fee for their services, and to be paid at the time of service or within a reasonable period. I chose whatever fee I want to charge my patients. The market determines its viability. For patients that I chose to bill 100% to the government i.e. bulkbilling, fees are paid directly into my bank account within 2 days of seeing the patient.
  3. DOCTORS ARE NOT INSURANCE BILLING CLERKS: Physicians should not be forced to act as billing or collection agents for third-parties, whether private insurance or the government. I use a new system where patients can chose to have the government rebate back into their account within 11 seconds. It reduces paper work, 
is a selling point and the government pays doctors around 20 cents per incident for doing it. Most specialists give the patient the full account and the patient is responsible for claiming from medicare. There is no obligation to act as collecting agents for the government.
  4. REGULATIONS GET BETWEEN PHYSICIANS & PATIENTS: Excessive regulatory burden on physicians is interfering with patient care. We must decrease regulations, not pass more. There is a lot of red tape in General Practice these days, which is the worst of the system.
  5. LIABILITY COSTS MUST BE REDUCED: Costly defensive treatment and tests, and predatory litigation result in excessive liability costs for physicians and patients alike. My medical defence cost as a nonprocedural GP are around 3000 AUD per year.
  6. AUTONOMY: Neither physicians nor patients should be forced to participate in government nor private health care plans or programs. In Australia one can act entirely independently and the patient does all the claiming through insurance or medicare.
  7. RIGHT TO CONTRACT: Neither physicians nor patients should be prohibited from entering into mutually agreeable private contracts for services and payments.
  8. PRIVACY: Physicians must not be forced to disclose patient records without the express consent of patients. This is very important right to fight for. At present in Australia, patient records cannot be disclosed to anyone without the express consent of the patient.

Good luck to you “Yanks” with your public health care debate. I hope my brief comments here demonstrate that down under we are not just about “shrimp and barbies” but we have put some serious thought into health care that you could do well to consider.

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  1. October 12th, 2009 at 10:37 | #1

    Thank you Dr. Yeoman for your insight. This is a perspective missing from the debate here in the US. This should be of great interest to all regardless which side of the debate on which they are standing. A real eye-opener.

  2. Sam S
    October 12th, 2009 at 13:22 | #2

    Sounds like some of my MD friends will find Australia a pleasant place to practice when reform puts medicine out of business here in the US.

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