Medicare Reform, Surgery vs. Physio led Exercise
There’s been a lot of talk about Medicare reform lately, and I certainly think there’s a great deal to be done in the space of GP rebates, which are dire in comparison to the rising costs that doctors clinics have seen over the past 20-30 years. In my domain, it is so frustrating to see that Medicare have not kept up with changes in modern healthcare. I would say that most people are aware that prevention is better than cure, except Medicare.
If we look at knee arthroscopes for example, these clean ups – which have no evidence in reducing knee pain in the long term, and may in fact accelerate damage to the knee joint - are more supported than a few visits to a physiotherapist. This doesn’t sound right?! A great article in SMH outlines the issues (link below)
A knee replacement might cost the taxpayer $25,000. “But we wouldn’t spend $1000 on an exercise program to prevent that from happening,”
I trained in delivering the GLA:D program a few years ago, which stands for Good Life with Arthritis: Denmark. This program is a physiotherapist led education and exercise program aimed at reducing the impact that hip and knee arthritis has on your life. I have seen consistent positive outcomes and progress that patients have made, both pre and post-operatively. I certainly have had many participants delay or cancel replacement surgery as a result of getting involved. The disappointing part is that Medicare will only rebate participants on their initial and review sessions (with a GP referral), but there is no rebate for the supervised exercise sessions which make up the bulk of the program.
I can understand how patients would choose to see a surgeon and get their knee “fixed” with it all covered by Medicare instead of having to fork out $500 to do some hard work with me over 3 months, but I wish there was more education on their options before choosing surgery.
Under Medicare rules, patients are entitled to only five subsidised sessions a year with an allied health provider – such as a physiotherapist or dietician. Medicare does not cover exercise programs.
There’s a lot to be done with Medicare reform and I know we are lucky to have universal healthcare in this country, but it does feel like it is slipping away and less people are finding the support they need in our healthcare system. I think the key is supporting doctors with good quality allied health.