Parents, needy hit as fees increase BULK-BILLING CRISIS
Catherine Robinson went to a 24-hour clinic with severe pain. She was a student and needed bulk-billing, but it was a Sunday morning and the clinic told her it no longer bulk-billed on Sundays. Unable to pay $32 up-front, she was turned away.
“Even if I’d had the money at home, I didn’t have the strength to go and get it and come back,” she says. “And I was in so much pain that I didn’t care. I just went home to bed.” Later she spoke to her mother, who was so concerned that she paid to have her own GP visit her daughter, then 21, at her home in Caulfield. He admitted Ms Robinson to hospital and she had emergency surgery that afternoon.
The link between money and medical care has strengthened since that incident, 18 months ago. The rate of bulk-billing has been falling since 1997 and is now at a 10-year low of 74.5 per cent of GP consultations. The number of visits to GPs that were bulk-billed fell by 1.6 million in the March quarter.
AMA Victorian president Mukesh Haikerwal predicts the rate of fall will accelerate because of the cost to doctors of the indemnity insurance disaster. “By September, I’d estimate the figures would show another 20 per cent drop,” he says.
Where does that leave patients who cannot easily afford to pay? They can try alternative services, scrabble for the money – or avoid going to the doctor, making a mockery of the idea of a universal health care system.
For city people, there are alternatives. The State Government says the number of patients presenting to hospital emergency departments with GP-style problems has jumped 6.6 per cent in the past 12 months. Dr Chris O’Neill, of the North Yarra Community Health Centre in Hoddle Street, says its custom has risen 10-15 per cent in the past year after two “stalwart” bulk-billing doctors moved out of the area.
But the crisis is most acute in rural and outer metropolitan areas. Program manager for the Eastern Ranges GP Association in Lilydale, Kristin Michaels, says a recent consumer consultation found lack of bulk-billing was the second greatest medical concern of local residents.
Sandra Daly, 56, recently moved to the outer suburb of Cranbourne. She says she has been unable to find a medical practice that will bulk-bill her, even though her only income is a widow’s allowance.
Ms Daly says she could not afford to get her usual flu vaccination this year, and now she cannot afford to see a doctor with the flu she has caught as a result. “I happened to go into a clinic off the street last week, because I was not very well at all, and they refused me,” she says.
For families whose children have special needs, putting off doctors’ visits is not an option. Darrell Harding, from Lara, near Geelong, has a son, Rhys, 10, with an autistic disorder. Mr Harding says: “I work full-time, but on pretty low wages. Our family doctor used to bulk-bill but doesn’t any more. The difference we have to pay is about $12 per visit.
“When it comes to the weekend and you want go for a drive to the beach or into town, that’s about $12 worth of petrol. Some weeks, if Rhys has had a bad run and needed several visits, we’re forced to stay at home.”
Chief executive of the Association for Children with a Disability, Michael Gourlay, says the problem is widespread.
“All the good doctors – the ones who are prepared to take the extra time to understand children’s special needs – are saying they can’t survive on bulk-billing,” he says. “If families look elsewhere, they face an inferior service from the few doctors still prepared to bulk-bill on the basis that their consultations are kept very short.
“Bulk-billing’s demise is hitting hardest among parents who are in the paid workforce but on low wages. They’ll still go to see the GP but it will mean they get behind with their electricity bills, or they’ll have to make a heartbreaking decision not to let their child go on a school camp or excursion.”
City people are only just discovering what country people have long endured. The rate of bulk-billing has always been much lower in regional areas.
A sole parent who lives in Sale, Nadine Hatfield, says she found the lack of bulk-billing humiliating.
“When I wasn’t working, it was either pay up-front or buy food for the week, but you don’t want to have to explain that to a doctors’ receptionist because the waiting room is full of people and it’s a small town, so everyone knows everyone,” she says.
Kaylene Lay, who lives in Stratford, about 12 kilometres from Sale, says there is no medical practice near her that bulk-bills all patients.
“If I or my husband or my children visit the doctor, it costs $45 up-front, so we’re $21 out of pocket for every visit,” she says. She says this means “you watch their temperature and hope they’ll get better. You try and barter with your doctor to get prescriptions you may never need to fill. A couple of times I’ve been to the doctor with my son, who gets tonsillitis, and if he hasn’t needed penicillin that day I’ve said, `Can you give me a script and if his tonsils get worse I’ll fill it?’ rather than having to pay another $45 the next day.”
For Christina Jones, of Benalla, the issue is the way in which cancer tests and treatments are not bulk-billed. Her breast cancer has now spread.
“I just had radiotherapy, and the gap was just on $650 for two weeks,” she says. “Some of the scans – MRIs are up to $700 and you only get something like $400 back . . . I only earn $18,000 a year.”
She says she would rather pay an extra 3 per cent Medicare levy and just “walk in and have everything for nothing and know I’d be all right”.
First published in The Age.