I recently took myself to a medical clinic that bulk-billed. I didn’t go there because they bulk-billed. I went because the clinic was walking distance from my office building. I needed to get tested for Helicobacter pylori. Here’s what happened:
GP: You can take the test home, do it yourself and bring it back to be sent to the lab. (No further instructions so I leave and I attempt to pick up the test from reception.)
Medical Receptionist: No, you do the test here, but after two hours of fasting, water is allowed.
(I return after two hours of fasting, having drunk a glass of water during that time.)
Centre Manager: Actually you need to have fasted for 6 hours, nil water, but it should be OK.
(At this point I have to say I was less than confident but nonetheless I entered the pathologist’s lair where I was given a pill to swallow.)
Pathologist: You have fasted for 8 hours with no water right?
Um no, but I was told that it ‘should be OK’. Apparently it wasn’t. Perhaps I should have been asked that question before I swallowed urea with a radioactive isotope. Just sayin’.
I repeat the test the following morning after fasting for 8 hours, with no water and more importantly and unfortunately for those who encountered me, no coffee!
I received no less than four different pieces of information about the one test from the same medical centre. I’m not suggesting that this was the worst experience imaginable. I’m acutely aware that poor medical care often ends tragically. It was however, my experience.
A bit of back-story in case you were wondering if I was spreading some medieval disease. Helicobacter pylori is actually the bacteria responsible for most stomach ulcers. It is also strongly linked to stomach cancer.
Why does this matter to me? My father died from stomach cancer after suffering from ulcers for years, most likely caused by the bacteria. His youngest brother also developed stomach cancer but is thankfully in remission, that old chestnut about early detection. The sad reality for my father is that an oral antibiotic in most cases treats the bacteria.
So in the interest of preventing the heinous and seemingly genetically inherited disease that took my father’s life, I need to get tested regularly. An accurate test result is fairly important given my family history and ‘should be OK’ doesn’t really cut it.
Had the GP been able to spend more time with me perhaps he would have enquired about my family history or at the very least asked why I wanted to be tested for Helicobacter pylori and informed me accurately about the testing process.
The lack of care wasn’t moderated by the fact that I had no out of pocket expenses. I have private health insurance. I pay the Medicare levy. I’m under no illusion that I haven’t already paid for this service and I could care less about out of pocket expenses. I make sacrifices in other areas of my life for the sake of my health.
My broad concern is that universal access to quality medical care is being compromised and that we now have a two tier system where quality is determined by what you can pay. Have we learnt nothing from our allies across the pond?
Over the last decade bulk-billing has rapidly declined. In fact by 2004 only 67.4 per cent of GP consultations were bulk-billed and the lowest rate in the country now is in the ACT where it has fallen to 46.4 per cent. One of the reasons cited is the failure of the Medicare rebate to keep up with inflation.
The key purpose of bulk-billing is to provide economic constraint on medical fees and charges. Medicare, introduced by the Hawke government, was a reincarnation of Whitlam’s Medibank and promised to cover 85 per cent of the cost of seeing a doctor. But as rebates have not risen the $34.90 is now inadequate for a standard doctor’s visit.
If prices are set too low doctors struggle to recover their costs and are potentially forced to lower the quality of service via shorter consultations, less equipment and fewer staff. In turn, limited availability of bulk-billing practices places extra pressure on our public hospitals and emergency departments.
One of the principles of Medicare is Universality. All people have the same rights and entitlements to good quality healthcare. Another is that Access is based on health care needs rather than an individual’s capacity to pay.
So my question is two-fold; do we all have access to good quality healthcare, and has bulk-billing become synonymous with poor quality?
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