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Rural doctors urged to charge complexity loading.

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Tuesday 5 October 2004

Rural Doctors Urged to Charge Complexity Loading

The Rural Doctors Association of Australia (RDAA) is urging rural doctors across Australia to begin charging their patients a loading that reflects the higher costs and complexity of providing rural medical services.

RDAA warned last week that rural doctors would have to self-implement a loading for more complex consultations, if no commitment was made by the major parties to implement such a loading through Medicare (hence enabling patients to be rebated for it).

It will be up to individual doctors to decide on the loading amount they charge their patients, based on factors including the remoteness and rurality of their practice, and the availability of support services such as hospitals and specialists. Doctors will still be able to ‘compassionately discount’ consultations for patients at their discretion. RDAA will provide rural doctors with notices for their surgery waiting areas, to explain why the loading has been introduced.

“The decision to urge rural doctors to self-implement a complexity loading has not been made lightly, as it will increase the cost of some consultations for rural patients” RDAA President, Dr Sue Page, said. “But sadly, neither major party has committed to implementing a complexity loading through Medicare, even though rural doctors have been calling for it for a long time.

“The last thing we want to do is pass to rural patients a cost that should be paid by the Government, but we can’t wait forever for the loading to be implemented. We have been heavily discounting our fees to unrealistic levels for many patients for years, to match what they can afford. This is having a serious impact on whether many rural medical practices remain open—if they close, rural patients will be the ones who lose out.

“Recent RDAA and Monash University research found that approximately 20% of rural medical practices are currently not operating sustainably in meeting the health needs of their community. This is projected to reach 55% by 2008. Any rural business must cover its costs to keep operating, and rural medical practices are no different.

“The costs of providing a medical service are much higher in rural and remote areas—for example, there are higher costs in finding locums, additional costs in purchasing medical equipment that city doctors can access outside their surgeries, and additional freight and travel costs.

“There are also more complex caseloads that require more of a rural doctor’s time and skills, including during after-hours periods—this is because rural doctors have less access to local specialist, allied health and tertiary medical services. Sometimes there is no local hospital at all. Rural patients are also likely to have more complex health needs than those in urban areas. Additionally, rural doctors often have to undertake consultations that city patients would be referred to specialists for. This has a direct impact on their insurance costs and the length of consultations, and yet rural doctors earn less than half per hour what most specialists earn.

“A properly indexed Medicare complexity loading is urgently required to make and keep rural practices viable, and to get and keep more doctors in the bush. Ideally, the loading would be added to the existing Medicare rebate and would apply to consultations involving complex diagnosis and management, such as for chronic and acute conditions. The loading would vary with the extent of rurality, and the available access to specialist and tertiary care.

“Given the major parties haven’t committed to this loading, RDAA urges rural patients who are charged the doctors’ self-implemented loading to contact the next Federal Health Minister, and ask why they have to pay something that the Government should rightly cover. Hopefully this action by rural communities might have an impact.”

Contact RDAA Vice President, Dr Graham Slaney, on (0418) 540 223, or RDAA President, Dr Sue Page, on (0414) 878 385. Media contact: Patrick Daley on tel: (02) 6273 9303 or (0408) 004 890.

The Presidents of the State and Territory Rural Doctors Associations are also available for interview: RDA NSW, Dr Peter McInerney, 0418 452 369 / 02 6545 1600 * RDA Victoria, Dr Andrew Slutzkin (Past-president), 0415 839 333 / 03 5792 1222 * RDA SA, Dr Peter Rischbieth, 0408 813 143 / 08 8532 2322 * RDA Tasmania, (Past-president) Dr Myrle Gray, 0417 713 204 / 03 6254 5030 * RDA WA, Dr Phil Reid,

0417 936 341 / 08 9021 5366 * RDA Qld, Dr Ross Maxwell, 0418 727 255 / 07 4662 2433 * RDA NT, Dr Denis Chew, 0408 076 013 / 08 8987 3044.