The Future Of Aussie Home Doctor Services Is In Limbo

It’s 3am and my eldest has woken up vomiting and developed a rash. She also has a burning temperature.

The worry sets in because I know that a combination of symptoms can mean all sorts of things and is not always a regular virus.

My youngest is asleep peacefully in bed and my husband is away, so I have two options; wake up the little one and bundle them both off to the emergency department, which is a 30-minute drive away for us; or try to settle my eldest down and call a home doctor service to see if there is anything sinister going on.

It really is a no-brainer!

But the future of these services, which provide at-home care after hours, is in limbo as a government task-force undertakes a Medicare Review behind closed doors.

The review comes after a quadrupling of bulk billed after-hours visits over recent years to 2.8 million, which has, in turn, caused a Medicare cost blowout.

The government’s Medicare watchdog, the Professional Services Review, warned in its annual report that some doctors are now billing Medicare $129 for an urgent after-hours visit simply to reissue a prescription or deal with an uncomplicated rash.

The Royal Australian College of General Practitioners says these types of visits should instead be paid at the non-urgent rate of $75.

When John Howard was in government, he raised the amount Medicare paid for home visits to encourage them to flourish and take pressure off hospital emergency departments.

It worked, with GP-related presentations at hospitals falling from 54% to 47%.

Department of Health data shows $195 million was billed to the Medicare Benefits Schedule for urgent after-hours visits in 2015, compared to $90.8 million in 2010.

The medical deputising services that provide after-hours care are worried about cutbacks and restrictions following the review, and they are already fighting back.

A Deloitte Access Economics Report they commissioned shows it will cost the health system $724 million over the next four years if after-hours visits to homes and aged care facilities are discouraged.

A survey of 50,000 patients using after-hours doctors showed 56% would have called an ambulance, gone to an emergency department or attended an after-hours clinic if they couldn’t access a home visit and only 44% would have waited to see their regular GP the next day.

The report found more than one million Australians use doctor home visits every year and taxpayer savings could be made through their continuation as it costs a maximum of $129 to be seen by an after-hours doctor in your home and at least $368 to be seen in an emergency department.

The average cost for an emergency patient to be seen in a hospital is more than $550.

Family Practice Medical Research Centre medical director Graeme Miller told the Sydney Morning Herald it was difficult to tell what people were using the services for because there had been so many changes to the Medicare Benefits Scheme item numbers.

“There’s a lot of allegations going around that some of these are not emergencies and the patients should go to their GP during the day, but you can make the same allegations about people in the emergency departments,” Associate Professor Miller said.

He said patients were found to use the service 1.5 times a year on average, which implied they were not using it instead of their normal GP.

Further regulations on the amount charged by deputising services could be looked at, but I fear any harsh cutbacks will only impact the elderly and families some of the most vulnerable groups in society.

Let’s hope a balance can be struck so Australians can continue to benefit from home doctor visits and get the help they need, when they need it, rather than returning to the clogged up emergency departments I remember when I was a teenager.

Let’s not undo all the work that has been done to make health services more efficient!