Misleading VPR reforms will restrict equitable access to health care

From July this year, Australia’s MBS telehealth system is going to change once again, and this comes after two years of constantly evolving rules and regulations regarding the delivery of healthcare services in this country. In a few short months, the controversial new voluntary patient registration (VPR) laws will come into effect.

According to the 10 Year Health Plan, MBS telehealth will not be available to a patient unless they’re registered with the GP practice. In application, the reforms will extend the “existing relationship rule” GPs currently experience with telehealth consultations and a number of other healthcare arrangements. Although the new laws are described as ‘voluntary’, patients will be unable to access a doctor or seek medical treatment via telehealth unless they’re registered with the practice.

This leaves patients with no other option but to register, leading to industry concerns about practical compulsion in Australia’s healthcare system.

Here, we explore why Australia’s misleading new VPR reforms will restrict equitable access to healthcare and how this will hinder our nation’s healthcare outcomes.

Voluntary patient reforms and the MBS

In line with the 10 Year Health Plan, the government will invest $69 million in Services Australia to create the VPR mandate. The scheme will be open for registration from July and MBS telehealth for general practice would be contingent on the patient being registered from 1 July 2023.

To be eligible for registration, patients must visit a practice at least three times during a two-year period, followed by one visit every two years thereafter to preserve registration. Once these reforms come into effect, only registered patients will be able to access MBS-funded telehealth. Whereas, currently for patients to access MBS subsidised telehealth with a GP, they must have had at least one fact-to-face consultation in the last 12 months with a treating doctor or practice.

The VPR scheme won’t just affect MBS telehealth, but will also impact chronic disease management plans and medication reviews such as the simple act of requesting a script refill. As part of the 10 Year Health Plan, the government anticipates that payments related to ‘quality and outcome measures’ will drive 40% of primary care funding, rather than fee-for-service payments.

Understandably, there’s significant concerns about the reforms, including how the scheme will act as a barrier for the fair access to health care in Australia.

What this means for patients

It’s suggested that VPR will strengthen the relationship between the patient, the practice and the practitioner. But ultimately for Australians to be able to access a doctor for MBS items like telehealth, they have no other option than to be registered and must meet registration criteria, which has the feeling and characteristics of practical compulsion.

The High Court has confirmed that doctors and patients enter private contracts. This means that doctors can charge what they want and patients have a reciprocal legal right to choose their doctors. In the case of VPR, the sanctity of this contractual relationship appears breached by a type of third line forcing, whereby patients will essentially be forced to deal exclusively with one doctor or medical practice. In any other area of law, businesses who forced customers into exclusive relationships, or marketed their offering as voluntary when it is really mandatory,  would come to the attention of the Australian Competition and Consumer Commission (ACCC) for engaging in misleading and deceptive conduct.

However, in the healthcare system we seem to be turning a blind eye and the reality is that patients’ health outcomes will be restricted as a result of the new VPR scheme. Already, it seems the government has invested some of the $69 million in taxpayer money into building the technological infrastructure required to support the new controversial reform. Yet, this approach to primary care does not seem to be focused on improving patient outcomes, rather accelerating bureaucratic control with red tape.

A new era of healthcare reform and coercion 

There’s talk of the VPR mandate being modelled on Britain’s National Health Service (NHS). The key difference is that under the NHS, no money changes hands. In fact, healthcare consultation is free at the point of need and it’s completely illegal for patients to pay when seeing a GP. In Australia, payment schemes are the polar opposite, and GPs can charge whatever they want.

The concern is that the Australian Government is forcing patients to register, which goes against the right to health care, is out of touch with the modern digital healthcare system and ultimately feels paternalistic. The VPR scheme will compel patients into a relationship with the practitioner and into an environment where the practice can still charge what they want.

For example, Aussies will no longer be able to visit their local bulk billing clinic on the weekend to get a last-minute script renewed when their regular GP has a lengthy waiting list, and will instead only be able to see their registered GP where they may still be charged $90.

From a telehealth perspective, any administrative obstacles introduced to limit patients’ access to health care will be the cause of a return to pre-pandemic clinician and patient behaviour, including a reduction in enabling fair and equitable healthcare. People in rural and remote areas will be particularly disadvantaged as they won’t have the ability to see their practitioners or avoid out-of-pocket costs.

As we approach July and the rollout of the new VPR scheme, we’re left feeling uncertain about how this will affect the future of Australia’s healthcare system. What we do know is that access and equitability to critical healthcare services such as telehealth, chronic disease management and medication reviews will become restricted under the new reforms. The Australian Government must reassess the VPR scheme and consider how putting these reforms into effect will restrict equitable access to health care and ultimately hinder Australia’s healthcare outcomes.

**Dr Silvia Pfeiffer, CEO and Co-Founder, Coviu. Pfeiffer has more than 15 years’ experience with web video and has worked for Accenture, Google, Mozilla, NICTA and CSIRO. Coviu is her second start-up. She has a PhD in computer science, a masters in business management and has published two books on HTML5 video and one on video consultations for healthcare businesses.

*Dr Margaret Faux, CEO, Synapse Medical. Faux is a Solicitor of the Supreme Court of NSW and the High Court of Australia, having practised law for over two decades. She is also an academic scholar of Medicare and health insurance law, who recently completed her PhD on the topic of Medicare claiming and compliance, and has published in peer reviewed journals on the topic of Medicare compliance.

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