Number of claims for Medicare item 597 after after-hours services were expanded in different jurisdictions. Source: Australian Family Physician Credit:Barbara de Graaff and Mark Nelson After-hours services attract a rebate up to $80 more than the standard Medicare item. The industry has argued these services save the health system more than they cost, because many of the patients would otherwise go to emergency departments, which are vastly more expensive. But the taskforce found, in its consultation report released on Wednesday, that the current structure of urgent after-hours items provided low-value care and it was not convinced the growth in home visits had a significant impact on hospital emergency departments. "The growth in provision of after-hours services appears not to be driven by increasing clinical need for these services, but has coincided with the entry of new businesses into the market with models that promote these services to consumers, emphasising convenience and no out-of-pocket costs," the report found.

"Many urgent after-hours services claimed as urgent are not truly urgent, as intended when the items were created, and the distinction between 'urgent' and 'non-urgent' appears not to be well understood by many medical practitioners." It recommended the rebate should only be payable when a GP who normally works during the day is recalled to manage a patient who needs urgent assistance. "Urgent" would be clarified to refer to an assessment that cannot be delayed until the next in-hours period and would require doctors to visit the patient or reopen their rooms. Taskforce chairman Bruce Robinson said after-hours services were important but their current use did not reflect clinical need in Australia. "The Australian medical community recognises the need to remove MBS funding from unnecessary, outdated, ineffective and potentially unsafe services," Professor Robinson said.

"We must ensure that patients get the right test or treatment first time, every time and not be subjected to unnecessary and inappropriate care." But the National Association for Medical Deputising Services said the changes would result in rolling closures of services in regional communities and cost lives. Nearly 80 per cent of doctors employed by the providers are on a training pathway and not registered GPs, so they would not be eligible for the higher rebate and it would not make financial sense for them to do after-hours work. "Emergency departments across Australia will be flooded if these recommendations are pursued by the government because our services will have no choice but to close," association president Spiro Doukakis said. "This would be a death knell for after-hours home visits."

Research published in the Australian Family Physician last month indicated that the growth in after-hours services had not reduced the number of emergency department admissions, which continued to increase along the same trajectory they were on before the services were established. Co-author Barbara de Graaff, a postdoctoral fellow at the University of Tasmania, said medical deputising services had recognised after-hours services were a good business opportunity. "As these companies have set up in new communities that's been followed by advertising, newspaper articles and you've got supplier induced demand occurring," Dr de Graaff said. "And subsequent to that you've got demand induced supply kicking in, where people are demanding access to these services in their homes." The Royal Australian College of General Practitioners president Bastian Seidel said it was appropriate that only GPs who normally worked during the day were eligible for the higher rebate.