Latest news with #MedicareBenefitsSchedule
The Advertiser
22-07-2025
- Health
- The Advertiser
Emergency departments are bursting. Why don't we use the workforce who can prevent this?
We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be. There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities. The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system. The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce. While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right. Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both? I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention. They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health. The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past. So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability. We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses. Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available. We need to look at regulations that hinder nurses from delivering safe and quality care in their communities. This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities. Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP. The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure. But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments. We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible. This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs." These are areas for which nurses are educated and eager to enhance. Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services. Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks. It is about giving access to care where little to no care exists and delivering care where the people live. We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions. At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort. We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be. There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities. The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system. The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce. While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right. Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both? I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention. They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health. The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past. So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability. We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses. Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available. We need to look at regulations that hinder nurses from delivering safe and quality care in their communities. This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities. Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP. The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure. But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments. We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible. This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs." These are areas for which nurses are educated and eager to enhance. Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services. Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks. It is about giving access to care where little to no care exists and delivering care where the people live. We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions. At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort. We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be. There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities. The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system. The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce. While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right. Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both? I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention. They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health. The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past. So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability. We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses. Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available. We need to look at regulations that hinder nurses from delivering safe and quality care in their communities. This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities. Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP. The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure. But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments. We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible. This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs." These are areas for which nurses are educated and eager to enhance. Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services. Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks. It is about giving access to care where little to no care exists and delivering care where the people live. We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions. At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort. We cannot continue to delude ourselves: the health and health care of our population is less than it could and should be. There are alarming rates of obesity and diabetes; faltering immunisation rates; great difficulty in the regions accessing a doctor's appointment, even for urgent matters; nurses and doctors labouring under increasing emergency department presentations; and bed-block for want of community placement for the elderly and those with disabilities. The highly visible issues of long waiting times and staff shortages in the hospital system are linked to less visible failures at the prevention and primary care end of the healthcare system. The current model of healthcare is not working for Australians, and despite governments at federal and state level giving strong public commitments to prioritising primary healthcare, there is yet to be a harnessing of the skill and expertise of our nursing profession - a profession making up 54 per cent of the health workforce. While pharmacists have successfully lobbied for greater access to service provision, nurses are still perceived to be an adjunct to doctors, rather than a collegial health provider in their own right. Is it that the public have a long-outdated understanding of nursing and the capability of the modern nurse? Is it that medicine/doctors have so successfully captured the centre ground? Or both? I recently directed a project for renewing the global definitions of a nurse and nursing for the International Council of Nurses (ICN). While the old definitions tended to focus narrowly on hospital care and jobs, the renewed definitions have a greater emphasis on the nurse as having a much broader role in healthy communities and illness prevention. They emphasise the scientific knowledge, ethical standards, therapeutic relationships and compassion that underpins all nursing, but go further to explain the role nurses play in shaping policy, and in healthcare innovation, in disaster response, and in population health. The issue is that patients are unable to reap the benefits of the advanced skills and knowledge of nurse because of funding roadblocks and antiquated regulations that mean the structure of the primary health care system is stuck in the past. So, what needs to be done? We need to provide better access and payment systems for nurses to deliver the holistic care of patients for which they are educated - to manage chronic disease; to ensure immunisations are current; to provide health checks and to provide aged care that maximises capability. We need to reduce our reliance on fee-for-service medicine - Medicare Benefits Schedule rebates - and fund primary healthcare differently to enable patients to access nurses. Nurses must be better supported to help people to manage their conditions, such as diabetes, or chronic wounds, working with GPs and specialists both directly and via the increasingly digital patient management options available. We need to look at regulations that hinder nurses from delivering safe and quality care in their communities. This very year, we have seen the government insist that nurse practitioners providing telehealth care to remote and marginalised communities be subject to the same rules as general practitioners, many of whom would be working in more stable urban communities. Nurse practitioner-led practice is further marginalised by the rule that "MyMedicare" funding can only be accessed if the program is led by a GP. The $8.5-billion injection to Medicare that preceded this year's election campaign was a massive injection into primary health care, to be sure. But increasing bulk billing rates is not going to address the issues of poorly managed chronic disease in our community, which in turn leads to acute exacerbations of illnesses that themselves lead to unplanned visits to hospital emergency departments. We may well need targeted investment in hospitals, but if we prioritise that over the complex but necessary, innovation that is needed to improve our primary healthcare system, we are effectively giving up on the support our communities need to live their lives as healthily and as well as possible. This is not professional posturing, as even Professor Fiona Stanley recently said, "the last thing we need is more doctors and more hospitals. We need to invest in social supports, early intervention, community-led programs." These are areas for which nurses are educated and eager to enhance. Far from replacing general practice, this is about working across multidisciplinary teams to enhance and complement existing primary healthcare services. Nor is it about fragmentation of care. It is not possible to fragment care that doesn't exist. It is about strengthening nursing's presence within primary healthcare practices and having multidisciplinary caring arrangements, including with nurse-led clinics in primary health networks. It is about giving access to care where little to no care exists and delivering care where the people live. We nurses have known and written and argued for many years about who ought to be at the centre of healthcare. It should not be a health professional or any one profession: it must be about people-centred care, which is a cornerstone of the new nursing definitions. At the moment, it is not happening, and individuals, communities and our hospitals are paying the price. It's time for change, and nurses must be considered an important part of the effort.
The Advertiser
02-07-2025
- Health
- The Advertiser
Doctors dispute billions being lost in Medicare fraud
Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment. Overcharging on medical bills and rorting the public health system is costing taxpayers up to $5000 a minute, a health union says. But the peak professional body representing doctors says the numbers don't add up in a Health Services Union (HSU) report that paints a picture of fraud in the $30 billion Medicare Benefits Schedule scheme. Leaning on previous analyses, the report estimated fraud and non-compliance rates to range from five-to-30 per cent. It described one estimate of $10 billion in bogus claims as a figure that "cannot be definitively disproven" due to no effective system to measure fraud and non-compliant billing in the first place. The report published on Wednesday found about three-in-five medical professionals referred to the Medicare-related watchdog in 2024 were GPs. But the union said it suspects the watchdog was not adequately investigating specialists and other non-GP billers, representing nearly 70 per cent of all Medicare claims. "Billions of taxpayer dollars are being siphoned away from healthcare through fraudulent Medicare billing," HSU NSW Secretary Gerard Hayes said. "It's got to stop. Government and regulators have to hold people to account." "This is public money. Medicare has to be delivering for all of the community not just a certain few." The union said upcoding was a common fraud tactic, with medical practitioners inflating consultation times to increase reimbursements. Nearly two-thirds of Professional Services Review case outcomes in 2024 involved upcoding, while 38 per cent involved incorrect use of GP management plan and/or team care arrangement item numbers. AAP has sought comment from the Royal Australian College of General Practitioners. The union, which represents more than 50,000 health workers including in hospitals and pathologies, also surveyed 110 healthcare workers in billing, finance, and compliance. Survey respondents reported witnessing doctors billing for services they did not provide, unnecessary procedures performed purely for billing purposes and systematic manipulation of billing codes to inflate Medicare claims. One-in-three healthcare workers said they had witnessed or suspected improper billing practices but only 17 per cent understood how to report Medicare fraud. Half of those surveyed said they faced pressure to maximise profit from Medicare billing and more than 93 per cent of healthcare workers said they were too afraid to report fraud because of fears of retaliation. The union also pointed the finger at the medical doctors' group, the Australian Medical Association (AMA) for deflecting and resisting meaningful oversight. "Too many practitioners treat Medicare as an unlimited funding source, structuring their operations around maximising claims rather than responsible spending of public funds or optimising patient care," the 28-page-report published on Wednesday said. But the association lambasted the union's claims as "baseless" insisting that it was getting on "with the job of pursuing meaningful reforms". The government-commissioned Philip review in 2023 found Medicare compliance issues were overwhelmingly caused by the complexity of the system, it said. AAP has approached federal Health Minister Mark Butler for comment.
The Sun
28-04-2025
- Health
- The Sun
Transparency in medical billing vital
IN January 2025, chief executive of Galen Centre for Health and Social Policy Azrul Mohd Khalib highlighted that an estimated 70% of private hospital charges remain unregulated. This means that hospitals have the liberty to set arbitrary prices for a range of items and services, including essential medical equipment such as wheelchairs, heart monitors and even emesis basins. Only 30% of hospital bills are regulated, primarily covering specialist fees and medication. This lack of oversight has led to numerous cases where patients unknowingly pay excessive sum of medical bills for items that should otherwise be reasonably priced. Hidden hospital charges, often labelled as profiteering, are a widespread problem in Malaysia. For example, a simple medical glove that costs RM5 per pair may be billed at RM20. In most cases, patients pay these inflated charges without question. This is because patients rarely scrutinise their medical bills, either due to a lack of knowledge or because they assume that everything charged is legitimate. As a result, they end up shouldering excessive costs without the ability to challenge these expenses. One of the most alarming aspects of hidden hospital charges is the suppression of information. Some hospitals use this tactic to increase their revenue without the patient's awareness. Malaysia's current healthcare system lacks a clear mechanism for patients to challenge inflated or hidden costs, unlike in countries that have implemented price transparency regulations. For instance, the US introduced the hospital price transparency rule on Jan 1, 2021, which makes it a requirement for hospitals to publicly disclose a list of their standard charges for various services. This enables patients to compare hospital prices before seeking treatment and allowing them to make informed financial decisions regarding their medical care. Similarly, Singapore was set to introduce the Health Information Bill in mid-2024, which would improve transparency in healthcare pricing and data management. The country also has a robust regulatory system where medical costs in public hospitals are monitored and pricing is often published online, allowing patients to compare treatment costs across different hospitals. Australia follows a different but equally effective approach. The Australian government regulates healthcare pricing through the Medicare Benefits Schedule, which ensures that citizens and permanent residents receive subsidies for hospital services. Private hospitals in Australia are required to provide financial consent before treatment, meaning patients must be informed about the estimated costs and any out-of-pocket expenses they may incur. This allows patients to plan their finances accordingly and prevents hospitals from imposing hidden charges after treatment. Additionally, the Australian Competition and Consumer Commission closely monitors healthcare pricing to prevent exploitative billing practices. The right to know the cost of medical treatment is a fundamental consumer right that is often overlooked in Malaysia. Patients should be entitled to an itemised bill that details each charge, allowing them to identify any unnecessary or excessive fees. Hospitals should also be required to disclose pricing structures upfront so that patients can make financial decisions with clarity. In instances where patients identify unethical billing practices, they should have a legal avenue to dispute the charges. Many patients are unaware of the steps they can take to protect themselves from hidden charges. One of the most effective ways to safeguard against excessive billing is to demand an itemised bill. By requesting a detailed breakdown of all charges, patients can scrutinise their medical expenses and challenge any discrepancies. Furthermore, patients should not hesitate to dispute unethical fees. If a hospital bill contains unjustified charges, patients should engage with the hospital's billing department to seek clarification. In cases where disputes remain unresolved, patients should report the matter to the Health Ministry or the National Consumer Complaint Centre (NCCC). This organisation plays a crucial role in advocating for consumer rights and ensuring that unethical hospital billing practices are addressed. Insurance also plays a crucial role in managing medical expenses. Patients must have a clear understanding of their insurance coverage, including which procedures and treatments are included and which are not. Many insurance policies require pre-authorisation for specific treatments, making it essential for policyholders to obtain the necessary approvals before undergoing medical procedures. Patients should communicate with their insurance providers to ensure they are fully aware of the coverage limitations and potential exclusions in their policies. Key takeaways for understanding insurance include: Always review the policy's terms and conditions to understand claimable and non-claimable expenses. Verify whether a guarantee letter from the employer or insurer fully covers all medical treatments. Ask for a pre-treatment estimate and clarify any potential additional costs before proceeding with medical procedures. Ensure that any required pre-authorisations are obtained before undergoing hospital treatments. To improve transparency and prevent hospitals from imposing unreasonable charges, the government should consider implementing several key reforms. Firstly, the government should introduce regulations that mandate hospitals to disclose their pricing structures publicly. This would allow patients to compare costs across different hospitals and make informed decisions regarding their medical care. For example, legal fees for lawyers are strictly regulated by the Solicitors' Remuneration Order 2023. Secondly, an independent regulatory body should be established to oversee private hospital pricing and ensure that all charges are fair and justifiable. This body could also act as a mediator in billing disputes, providing patients with a channel to contest excessive fees. Thirdly, greater public awareness initiatives should be launched to educate consumers on their rights in relation to hospital billing and insurance coverage. Many patients remain unaware of the steps they can take to protect themselves. If faced with hidden charges, patients have several avenues for recourse. The first step is to file a complaint with the hospital's patient relations officer. If the issue remains unresolved, patients can escalate the complaint to the Health Ministry. Additionally, consumer protection groups, such as NCCC, can assist in addressing cases of overpricing and unethical billing practices. By taking collective action, patients can play a significant role in pushing for greater transparency in the healthcare system. The issue of hidden hospital charges is a growing concern and by looking at international best practices and adopting measures to regulate hospital pricing, Malaysia can move towards a more transparent and fair healthcare system. It is crucial for the government and consumers to work together in addressing this problem, ensuring that patients receive the medical care they need without being subjected to unjust financial strain. The time for change is now and concrete steps must be taken to protect the rights and financial well-being of patients. In response to these systemic issues, Fomca (Federation of Malaysian Consumers Associations) has been lobbying for the establishment of an independent oversight body to regulate managed healthcare insurance third-party administrators (MHIT) and private hospitals. This body would play a vital role in ensuring accountability, transparency and fairness in billing practices, and it would also serve as a mediator in dispute resolutions between consumers, insurance providers and healthcare institutions. Fomca believes that such a regulatory framework is long overdue. The absence of regulatory safeguards has allowed MHIT and private hospitals to act with near-impunity, often leaving patients helpless in contesting exorbitant medical bills. NCCC
Yahoo
26-03-2025
- Health
- Yahoo
Budget fails on new money for violence against women
Organisations working to end the scourge of family violence in Australia have condemned Labor for the federal budget containing almost nothing new in funding during a national emergency. Ending gender-based violence and addressing the burden of unpaid care shouldered by women, were placed front and centre of the women's budget statement, released on Tuesday. The statement pointed to previous announcements, including savings on newer contraceptions, more affordable access to IVF and an uplift in wages in feminised industries. No to Violence chief executive Phillip Ripper said if the federal government was serious about addressing the issue, it should have shown it. "The budget ignored the cost of men's family violence and the cost of women and children living in fear," he said. "This week we saw more women dying by men's violence. How many more will we accept and at what cost? "The cost is immeasurable to some families, for the women and children who have lost their lives and others their health, safety and wellbeing." Minister for Women Katy Gallagher said women were now earning an extra $217 a week since Labor was elected in 2022. "We've made women's economic equality a key feature of the work we do when putting budgets together, they're not an after thought," she said. "They're there at the table, we're thinking about it ... and you will see continued effort in that area." New funding included $2.5 million in the 2025/26 financial year for emergency accommodation for women and children experiencing all forms of violence under an existing program. Labor has since committed more than $4 billion in women's safety and delivering the national plan to end violence against women and children since its launch three years ago. Women will have improved access to healthcare and contraception under funding announced before the budget. More than $134 million over four years will be allocated to increase the schedule fee for four long‑acting reversible contraception items on the Medicare Benefits Schedule. Clinics providing specialist care to women suffering from pelvic pain and endometriosis will be given a $20.9 million boost over the next three years. IVF treatment will be made more affordable from April this year, with some women able to get earlier access to combination therapy through the pharmaceutical benefits scheme. 1800 RESPECT (1800 737 732) Lifeline 13 11 14
