Medicare cap plan endangers Health Care Homes

The idea of a cap on Medicare services threatens to undermine the Health Care Homes initiative even before it gets off the ground, the Consumers Health Forum has warned.

“The surprise revelation that the Government is planning to cap non-chronic care visits to GPs to five a year will discourage both doctors and patients from signing up to the Health Care Homes (HCH)  initiative which is scheduled to start next July,” the CEO of the Consumers Health Forum, Leanne Wells, said.

“This unilateral announcement is a most unfortunate setback.  We believe the HCH concept offers huge potential to transform and modernise Medicare into a consumer-focused arrangement of particular benefit to those with chronic and complex conditions.

“The patient centred health care home approach offers a long overdue solution to the contemporary issues our health system is facing: growing complex chronic conditions, poor care and service coordination and the need for better service integration.   It needs to be embraced with enthusiasm and careful change management. 

 “The overriding concern is that a negative response provoked by the prospect of a cap would doom HCH.  The success of HCH will clearly rely heavily on consumer confidence as well as  a positive response from GPs and their willingness to discuss the benefits with their patients. From the reaction of the GP community over the weekend, that seems problematic now.

“It makes no sense in terms of consumer centred care to separate out and cap the number of conditions not related to chronic illnesses. Surely the purpose of HCH is to treat the whole person and provide them with a medical service which tailors their care to their needs?

“Upholding the principle of universal access in the implementation of HCH is fundamental to maintaining our health system.     

“The Consumers Health Forum would also have to think twice about recommending enrolling in HCHs if it meant that consumers faced higher out of pocket costs which is a clear implication of the published plan.

“We note that today the minister’s spokesperson is quoted as saying of the plan that it should be remembered this is a trial and that “no patient’s access to Medicare will be restricted or capped”.   We would urge the Government to clarify their policy around the cap given the statements in official documents released on Friday.  

“If there is to be a cap in the trial then we would need to see it carefully evaluated.

“Placing a cap on non-chronic care visits, as stated in the official document released late last week, is at odds with the spirit of Medicare, would place a fresh bureaucratic hurdle on access to the doctor and have unknown impacts on health services.

“The Consumers Health Forum wants the principle of HCH to work because we believe it can deliver more coordinated, team-based and consumer-friendly services.

“We want to see a system change. But the Government proposal reads more like a limited funding model with a fresh attempt at savings measures.  Attention needs to be paid to all dimensions of a patient centred health care home including the integration of evidence based patient-self management services.    

“HCH should not be about moving financial risk from government to patients and doctors.   Yet a truly flexible and patient-centred HCH offers long term budgetary benefits in reduced hospitalisations,’ Ms Wells said.

A July 2016 report from a Roundtable hosted by CHF, the RACGP, The George Institute of Global Health and the Menzies Centre for Health Policy outlining HCH implementation imperatives can be read here:


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