Medicare Benefits and Digital Health Division, Commonwealth Department of Health, Disability and Ageing
The National Association of Psychiatrists (NAPP) is concerned about the Australian Government’s decision to cease Medicare cheque payments under the Pay Doctor Via Claimant (PDVC) arrangement. While NAPP supports the transition to electronic claiming and payment systems, it is seeking further consultation and revision of key aspects of the plan.
NAPP’s primary concern is the decision to cap eligibility for gap-only billing to services with an MBS fee above $697 (indexed annually), excluding services below that amount. It argues that this cap will make most psychiatric consultations ineligible for gap-only billing, disproportionately affecting vulnerable and socioeconomically disadvantaged patients. As a result, access to necessary psychiatric assessment and trauma-informed, continuity-of-care treatment may be reduced or delayed.
NAPP warns that reduced access could lead to clinical deterioration, increased symptom severity (including depression, suicidality, and psychosis), treatment resistance, and potentially avoidable hospital admissions. Some patients may be unable to access appropriate first-line or long-term treatments, which could have severe consequences, including suicide. The burden of care and associated costs may shift to public mental health services, families, carers, and possibly the forensic system.
The association argues that defining “high cost” services as those above $697 is unrealistic, as many patients experience financial hardship even for lower-fee consultations due to mental illness-related unemployment or reduced functioning. Survey data suggests psychiatrists bulk bill selectively to support vulnerable patients, and lowering the gap-only eligibility cap is unlikely to change their bulk billing decisions but may further restrict patient access.
Overall, NAPP believes the proposed cap is a backward step that risks increasing barriers to psychiatric care and shifting costs and risks to patients and the public system.
The proposed cap of eligibility for gap-only billing to services with an MBS fee above $697 should bechanged to a much lower amount, or removed, so the most vulnerable and disadvantaged patientsare not prevented from accessing the full range of psychiatric consultation services. NAPP recommends that the Government does not impose a consultation fee value eligibility cap, but instead monitors use of gap-only billing with appropriate review and consultation regarding impact(s).
NAPP Executive: Professor Philip Morris AM, Dr Melinda Hill, Dr Viv Elton OAM, Dr Arjun Khaira
