Socrates adds another caveat to the "Better Access" program additional to the concerns raised by Professor Hickie. That concern is whether the newly formed "Medicare Locals" will have the capacity to restrict the businesses of those private practitioners who operate within the jurisdiction of the Medicare Local.
It would seem that even the current Divisions of General Practice, through their control over member general practitioners, have the ability to determine who they will promote and who they will not, within their current jurisdictions. It is not unknown that some CEOs of current Divisions will promote their own staff to general practitioners over any other private practitioner so as to, as one CEO put it: "I will promote my staff member to provide the medicare funded services because if they didn't get the work I would not be able to pay them." Perhaps, the staff member should have been expected, like every other private practitioner to promote themselves, in a competitive market. Such competition, obviously, might lead to bulk-billing and therefore improved access for persons with a low socio-economic status.
Mental health access program failing the needy
15th Mar 2011
A SENIOR Government adviser and mental health expert has warned that the contentious Better Access to Mental Health Care program has failed to meet its aims despite its ballooning costs.
Professor Ian Hickie, a member of the Government's National Advisory Council on Mental Health and executive director of the University of Sydney's Brain & Mind Research Institute, has called on the Government to urgently overhaul the program.
His comments, made on the ABC's AM program this morning, come as Mental Health Minister Mark Butler was set to release a long-awaited review of the program today.
Professor Hickie told the ABC patients in greatest need were getting the least services through the program, labelling its results a "travesty".
"The probability is that those in higher-income areas who have a capacity to pay are also getting the most money back from the Government for common mental health services," he said of the program, which was initially allocated $500 million over four years.
"It's now cost over $1.5 billion and it costs over $500 million a year and over the next five years it's likely to grow to being almost $1 billion per year. We won't have any money left for other essential mental health programs unless we restructure this particular program."
Professor Hickie also suggested the Medicare fee-for-service-based system had "allowed the professionals to set up lots of small businesses in the well-off suburbs of our major cities and to charge higher rates for their services".
"So that they can get both the co-payment... plus the Medicare rebate. And that's what the Government's essentially encouraged them to do."
"Nicola Roxon said in opposition that she would change this. A different payment system would see those same professionals providing services in other suburbs - in the outer suburban areas and the regional areas where they're desperately needed."
In response, Minister Butler conceded that there were "some limits to this program in terms of its capacity to apply equitably across the population and to reach the harder-to-reach groups".
"There's no question that it demonstrates the need to balance the fee-for-service arrangement that you see in the better access program that we've just evaluated with targeted programs that deliberately go out to reach the harder-to-reach population [such as] younger people, people who live in rural and regional Australia and people living on our urban fringes in lower socio-economic areas," he told the ABC.
15th Mar 2011
5:30pm
On a positive note, the program has raised interest, awareness and acceptance of mental health issues. It is something we do not want to lose however with some refining and tweaking such as means tested access and taking the services to the people this program could truly be sensational.