Medicare changes could leave patients thousands out of pocket

Changes are coming to the Medicare rebate – and it's feared elderly Australians will be hit the hardest.

Changes are coming to the Medicare rebate – and it's feared elderly Australians will be hit the hardest. Photo: AAP

Patients could be forced to pay thousands of dollars out of pocket for some surgeries following sweeping changes to the Medicare rebate next month.

From July 1, more than 900 items on the Medicare Benefits Schedule (MBS) for rebates for private surgery are set to change as part of the five-year MBS Review of all 5700 Medicare rebates.

The latest changes will affect rebates for orthopaedic surgery, general surgery and heart surgery.

The move has prompted outrage among some sectors of the medical community, and confusion among Australians who have surgeries booked in July.

What are the changes to the Medicare rebate?

The Medicare Benefits Schedule is a list of medical services subsidised by the Australian government to help make health care more affordable.

If your GP or specialist charges more than the MBS fee, Medicare pays the benefit set out in the MBS and you’ll have to pay the rest out of pocket.

From July 1, a number of changes will be made to the list, mainly relating to general surgery, orthopaedic and cardiac services.

At this stage, we don’t know how much the changes will cost patients.

It could be anything from a couple of hundred dollars to more than $10,000 in some cases.

There are many different surgeries on the list, and it’s too early for doctors to say what each procedure will cost under the amendments, Australian Medical Association president Dr Omar Khorshid said.

“We simply don’t know what the rebates from funds will be, as they haven’t had the time to prepare and release them in advance – including for surgeries already booked for next month,” Dr Khorshid told reporters on Sunday.

What’s the point of the changes?

The changes are intended to modernise Medicare and the MBS, which were designed in the late 1970s and early 1980s when Australia’s population looked very different.

Now, Australians are generally older, living longer and have more complex and chronic health issues.

Since 2015, a taskforce made up of doctors, patient advocates and academics has been gradually reviewing more than 5700 items listed on the MBS to bring it up to speed with the needs of modern Australia.

It is their job to refine the list to make sure patients are accessing “best clinical practice” rather than outdated and potentially risky services.

Previous changes include offering a comprehensive medical treatment plan to Australians with severe eating disorders, and removing a debate for spinal fusion after it was found to be an ineffective treatment for uncomplicated axial chronic lower back pain.

Why are people outraged?

Dr Khorshid said the rebate changes have been rushed in without enough notice.

He said the private healthcare sector – including health funds, hospitals, doctors and patients – won’t be ready by July 1, and said they needed at least six months to prepare.

Adjunct Associate Professor Lesley Russell, from the Menzies Centre for Health Policy at the University of Sydney, said it was common for medical professionals to feel anxious about changes to Medicare.

“Everything the MBS review has put out has ended up being controversial, simply because it changes the way doctors and specialists work,” Professor Russell told The New Daily.

“They like to do things the way they’ve always done things, and the change has dollar signs attached, so it’s always going to be problematic.”

Associate Professor Russell stressed it was too early to tell what the changes will mean for the average Australian just yet, but said she feared patients will be hit hardest.

“People don’t trust this government to do the right thing around Medicare,” she said.

“Everybody is nervous and the chances are pretty good that patients will be paying more in out-of-pocket costs.”
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