The Government’s decision to clamp down on ultrasound tests for pregnant women will impose a burden on poorer women and their doctors.
At present women who have an ultrasound in the first 17 weeks of pregnancy qualify for an $85 Medicare rebate on an average fee of $150. Now the Government wants to limit the rebate in the first 17 weeks to women displaying one of 30 listed conditions and cut the subsidy to $65 for these woman and for women referred after 17 weeks. Women without one of the 30 conditions in the first 17 weeks would get no subsidy.
This will reduce costs to the public purse in the short-term. But those affected will be the poor or the doctors of the poor who charge at reduced rates. It will not immediately stop those who can afford it having ultrasound. It will add to inequity in the health system.
Inequality can never be eliminated. Some people will always pay over the top for every procedure going, but are there any grounds to deliberately add inequity?
Doctors are in the invidious position of being accused of over-servicing if they routinely order scans, or being sued if they have not ordered a scan and something goes wrong. This change will not help
But is there an agenda other than cost here? The restriction on the scans in the first 17 weeks is suspicious because that is precisely the time when an abortion would still be a reasonable option in cases of fetal abnormality. Could it be that the Government is responding to religious concerns by limiting ultrasounds so as to limit the resulting abortions. If so, it will only affect those who cannot afford the scan, compounding the inequity of this measure.
Routine ultrasound in early pregnancy has several benefits. Expected birth dates are predicted more accurately. This means doctors are less likely to order drug-induced births on the ground that birth is overdue. It means mothers do not carry on in the false knowledge that birth is a week away. Risks are reduced.
Ultrasound enables earlier detection of multiple pregnancies (and better preparation) and earlier detection fetal malformation at a time when termination of pregnancy is possible.
They are costly but the costs may be justified given the long-term costs of bring up deformed babies and the costs of induction other poor outcomes from poor prediction without ultrasound.
Against that is a small possibility of false negatives: where ultrasound indicates (it can never conclusively show) abnormality where there is none.
Costs are of concern, but the Government has chosen the wrong procedure in ultrasound to rein them in. Given some of the other things the Government spends money on, in this instance it would be better to err on the side of overservicing than inequitable underservicing.
When it comes to health, people are willing to pay more. The Medicare levy should be raised, rather than benefits cut. That the levy could be raised for Timor indicates that it was possible to raise it for health. After all that is what it is supposed to be for.
The Government is mindful that universal, subsidised medicine through Medicare is electorally very popular so it cannot dismantle Medicare and the pharmaceutical benefits scheme without the loss of many votes. But it appears to be willing to erode Medicare by stealth — by not keeping scheduled fees up with inflation, or even reducing them as in the case of ultrasound.