Australian taxpayers subsidise rising specialist fees as spending on Abbott-era Medicare safety net ‘explodes’ | Health

Taxpayers are increasingly covering specialist doctors’ rising fees as new data shows government ‘explosive’ spend on The Medicare safety net has more than doubled in 15 years.

Total Medicare safety net benefits rose from $339 million in 2010 to $871.4 million in 2024, according to data requested by Guardian Australia from the federal health department; While the Abbott-era expansion is causing the biggest explosion in costs, it is also increasing inequities in the healthcare system.

The two safety nets support people with high out-of-pocket medical expenses and provide them with higher benefits when they reach certain thresholds spent on non-hospital Medicare services each year.

the original Medicare safety net “program fee” (the amount the government deems appropriate for the service) and Medicare rebate (75-100% of the program fee). This means that once a patient’s annual gap cost reaches $576 (the threshold set for 2025), Medicare will pay 100% of the program fee for each additional service that year.

Expanded Medicare safety net Introduced in 2004 by then health minister Tony AbbottIt covers out-of-pocket charges, which are the difference between the Medicare deductible and what the doctor or healthcare provider actually pays. Once a patient pays $2,615.50 (2025 threshold) in out-of-pocket costs in a year, Medicare will pay up to 80% of future out-of-pocket costs.

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While government spending on the original safety net has increased more modestly, from $14.1 million in 2010 to $20.9 million in 2025, expanded safety net spending has nearly tripled.

government spent $850.4 million in 2024 compared to $324.9 million in 2010.

Peter Breadon, director of the Grattan Institute’s health program, described this growth as “explosive” at a time when specialist fees are “growing really fast, much faster than inflation or the cost of providing care.”

Breadon said the system has two main problems. First, costs are rising because this is a poorly designed subsidy. money Going to paid specialists and the richest patients who can afford to see them again and again. Specialist fees are also rising rapidly, and more patients are moving over this threshold each year.

A 2009 article in the Australian Economic Review It found that the expanded Medicare safety net “likely creates greater inequalities in Australia’s healthcare financing arrangements”.

Albanian government is examining the issue Medicare safety nets and covers Extended safety net benefits for some items, first introduced in 2010 to reduce wage inflation, have been expanded.

A spokesman for the Ministry of Health, Disability and Aging said it had established a working group to discuss the operation of safety nets. advisory for feedback and is now considering reform options.

Addressing the fundamental problem of increasing specialty wages, Addressing workforce shortages, improving access to public health care and regulating excessive fees are being addressed, Breadon said.

Following Guardian Australia’s series highlighting Australians’ struggles to access specialist care, former chief medical officer Prof Brendan Murphy said safety nets had provided some relief for patients but the expanded safety net had proven “…inflationary and required additional caps to limit further wage growth”.

He said high fees were leaving patients unable to afford specialist consultations and pushing them into an “overcrowded public hospital system” published in said the Australian Medical Journal.

“Unfortunately, this is a failure of one of Medicare’s original goals: that even the uninsured have access to private outpatient care with an affordable copayment,” the article said.

He said high specialist incomes and the fees that generate them create challenges and that the disparity between the incomes of GP specialists and many other non-GP specialists is now “unfair”.

While some have suggested redirecting expanded safety net savings from caps to higher specialist deductibles, Murphy argued that the focus should be on any new Medicare investment. primary care and that “additional investment in specialists is more difficult to justify when income is high.”

“Given community and government concerns about this issue, it would be good for specialists to think about the impact of their fees on patients and potentially consider a small trade-off in income,” he said.

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