Proposal to deny self-referrers Medicare

DOCTORS’ health experts have dismissed suggestions that blocking access to Medicare rebates for doctors who refer themselves for investigations and specialist consults would encourage them to visit their own GP instead.

Writing in the MJA, retired gastroenterologist Dr Kerry Breen, who helped establish the Victorian Doctors Health Program, argued that denying doctors rebates in these circumstances could deter them from self-referring.

He noted that estimates indicated that during their career up to 15% of doctors would become ill in ways that led to impairment, such as mental illness and drug dependency. Despite the high numbers, many did not seek help and were picked up in the later stages of their impairment.

Dr Breen noted mandatory reporting laws introduced as part of the national registration and accreditation scheme would not help, and that impaired doctors may avoid seeking help from other health professionals for fear they would be reported.

“I don’t think the profession would respond well to being over-regulated, but they may respond to [dis]incentives,” Dr Breen told MO. “[Lack of Medicare rebates] might be a factor that would change a doctor’s pattern of behaviour.”

GP Dr Margaret Kay, who works with the Doctors’ Health Advisory Service Queensland, said these measures could have unintended consequences. 

“If we prevent self-referral, then there is a possibility that we will reduce the chance that a doctor will seek an independent opinion for their illness,” she said. 

But she added that in these situations, when a doctor-patient clearly self-referred, it was appropriate for a treating doctor to ask who else the results could go to. 

NSW Doctors’ Health Advisory Service president, Associate Professor Jill Gordon, also disagreed with the strategy, saying doctors would continue to self-refer regardless of the absence of rebates, especially those who were time-poor.

MJA 2011; 194:191-92