Questions and Answers
How can the government and the individual save money in health care?
Various studies around the world have shown that the better the primary health care system the cheaper the healthcare to the government and surprisingly to some, the better the health of the population.
The number of general practitioners is important, but once over a certain level it can encourage overservicing.Use of a team approach with other health professionals has also been shown to be beneficial. The primary service needs to have a focus on prevention and what we call secondary prevention. That is once someone has a disease we can't prevent the disease but there are often steps to take to decrease progression and development of complications of that disease. The medicare levy only pays for a small proportion of health care and general practice only takes a small proportion of the total health spend. Thus the more people that can be kept out of hospitals (through being well rather than being denied entry) the less the government has to pay.
This doesn't mean a greater spend for the individual. In todays high tech times sometimes it is felt that if you can do a test do it, if you can take a pill to fix it then do it. The reality is medicine still doesn't know everything. As many people know it is a long way from knowing everything. We do know that simple things are often best left alone and given time to settle. We do know that sometimes an improved diet can help. Examples may be a low "fod map" diet for irritable bowel or a lower calorie diet for weight loss. The cheapest things to do to feel better may be keeping busy and getting your mind off focusjng on your problems, perhaps along with some simple medications. Most vitamins and nutritional pills are far more expensive than dietary change ie adding more fruit and vegetables. Many of these " pills" have very little evidence of benefit and may not be worth spending precious money on. Avoid spending up big at a pharmacy, sometimes they can give good advice but ultimately they make their money from a lot of those extra sales. Make the most of your visits to doctors and come prepared having already thought through the history of your illness or what your concerns are. Tell the doctor what you are worried about. If they regularly aren't willing to listen then think about trying another doctor. You need some time to tell your story and what is troubling you. It has been shown that even for something simple there can be a mismatch in what the doctor thinks you want and what you want. For example many people come to a doctor wanting to check it is still normal to be coughing and spluttering 2 weeks into a cold and would prefer reassurance they don't have pneumonia, however the doctor may assume they have come because they believe they do have pneumonia and want antibiotics. Have a conversation and talk about all the external costs that can occur with managing your health.
What is Bulk Billing?
If a doctor bulk bills a patient it means he accepts the government decreed fee for his service. For those patients who are on a health care card there is also a top up of about $6 if in Perth and $9 elsewhere. This is a government carrot. If doctors billed the same fee then they would also have to consider the bad debts and time spent chasing thus a "bulk bill" fee pays less. Under the current set up, Drs are paid $9 less for patients who theoretically have more ability to pay. The current medicare began in 1984 and today patients are rebated 100% of the government schedule for GP visit items. Since 1992 the schedule fee for a "standard" gp visit has increased by 54% Over the same time the CPI has increased by 86%. There have been some other payments given at times to, (and taken away from) General practice however these were contingent on spending more time and money in infrastructure, technology etc. (more of a stick)
A standard Gp visit is up to 20 minutes so there is a big variation on how long doctors need or do spend this time sorting out and managing problems as well as preventing illness. As a doctors "equipment" is primarily their brains and that of the practice team, costs have not gone down. At some point the compassion of general practitioners may reach a limit at which stage they will either
1- quit / have to close
2. see more people or work longer than the average 43 hours per week
3. charge more patients.
If they are in an area where there are a high number of :concession patients (who are also the ones that often have to see doctors more often), then this will mean charging them. Private patients can't subsidize the care of everyone else if they are only a small percent of the practice population. (They are also often contributing more in the medicare levy as well.)
What about enduring power of attorney, guardianship and advance health directives?
Yes, what on earth is all that. These forms enable you to 1) appoint someone to manage your money if you are no longer able 2) decide on health matters and where you live if you are no longer able and 3) direct doctors what treatment you are happy with if you are unable to communicate your wishes. The advance health directive overrides guardianship where the decisions are relevant.
Why bother if you are young and well? What about a bad traffic accident? or an unexpected severe heart attack or stroke? The documents can all be regularly reviewed and re signed off to make sure it is still what you want. In our forms section we have some downloads to look at. Of course the other legal document that may need to be caught up on involves a will. If you have any sort of property/savings that you want to have a say in where they go -organise or update your will. Simple ones can be done with out seeing a lawyer, so cost doesn't have to be an issue.