Medicare disadvantages Indigenous communities.

Medicare rewards efficiencies of time ... current rebate for 6 minutes is $34.30, and it just happens to be the same for 19 minutes. That's $343 per hour with the old "6 minute medicine" policy implemented. For somewhere between 20 and 40 minutes of time the medicare rebate is $66.45 or lets say x3 for just under $200 per hour. For over 40 minutes the medicare rebate is $97.80 or less than $100 per hour.

No this is not another rant about equal pay for equal time, this is background for what I am about to say.

Indigenous health requires opportunistic care ... for example, someone comes in for management of a dog bite, you check their blood pressure, check their immunisation status (no not just their latest tetanus shot), check their urine for blood and/or protein, check their random blood glucose, review their medical past history and make sure their health check items are up-to-date (eg. HbA1c in diabetics), check their skin for other lesions (scabies, secondary infections with GpA strep etc.) look in their ears (chronic suppurative otitis media and cholesteatoma are not uncommon), check their drug and alcohol use, check their domestic situation is clean to return to, and then get on with cleaning and dressing the dog bite (at your own cost) AND then decide on whether or not a prescription of antibiotics will be filled (pension day is in five days time), whether the full course of antibiotics you provide (again out of your own funding) will be actually taken and completed, or you give a shot of long acting penicillin as the best of a not ideal treatment situation.

See where I am heading ?

The service at Yarrabah where I am currently working is funded by Queensland Health. Any attempt to fund the service primarily by medicare rebates will be doomed to a financial disaster.

Nicola's proposal to "voluntarily" register diabetic patients for block funding is another point of discrimination against the indigenous community. The whole care of a diabetic patient will be case managed by a GP (or will it be redirected to "Medicare locals"??) and all the care will be paid for by a single block fund. Block funding will be dependent on meeting outcomes, as yet unknown, but say for example, acceptable HbA1c levels (virtually impossible in a significant number of the indigenous community) perhaps even no admissions to hospital.

If the plan to hand over the medical services management to the community has in its hidden agenda switching over from Queensland Health funding to primarily self funding through the generation of medicare rebates, then this will be a disaster for Yarrabah and all communities like it.

*sigh* ... can I ever work somewhere and not get involved in the local politics and patient advocacy? probably not.

Otherwise .. working at Yarrabah has been a delight. The community has been appreciative, the staff a delight to work with and a medical and personal experience to not pass up. I have seen "medicine" I have not seen for years, I have done things I thought myself not capable of because I have not done the same for decades.

I have seen "the good, the bad and the ugly" and have had my own complacency challenged. I am most appreciative of the the opportunity of working here, and I will be back.