EEG and equity in health care

Abstract

On the 4 hours drive to Albury, to do a paediatric neurology outreach clinic, I recently had a phone call with a colleague. ‘How many patients did you refer for tests in Melbourne?’ she asked. ‘How many of your patients will you see on the Hume driving back to Melbourne with you?’.

Like many of my colleagues I do outreach clinics to regional and remote areas. I feel welcomed by the clinicians, the clinic, and the community. I like to think that every patient I see in a clinic regionally is a patient who does not have to commute to a capital city, with all the visible and invisible costs incurred.

The rapid adoption of telehealth, during the pandemic, has gone a long way in addressing some of the equity and access issues that our regional and remote patients have experienced. After 4 years, it is clear that some things can be done well over a video call, but most things can be done better face to face, which is why I still do the outreach clinics. For all the gaps that telehealth has addressed, our patients still have to attend medical investigations and interventions in person.

So I send my patients 4 hours down the road to Melbourne to have neurological investigations, primarily EEG.

As a paediatric specialist I am mostly blind to the economic forces that dictate where my patients have investigations. Health-care economics is a jumble of federal and state funding, private health insurance gaps, and patient co-pays.

There is an EEG service in Albury, but it needs to charge a gap to remain viable. The EEG Medicare rebate is $119.25. Each paediatric EEG takes an hour for an experienced scientist to set up, record and disconnect. The Medicare rebate is expected to cover the cost of the rent, the staff, the consumables, the hardware, the software, the scientist's time, and the neurologist's time. To cover these costs the Medicare rebate would, at least, have to double. This is why many of my patients cannot afford the gap, and instead choose the cost of travel to Melbourne, where there is no charge to them at the public hospital.

As paediatricians, we lobby for our patients all the time. We work with our departments to create specialty and subspecialty clinics, to provide state-of-the-art care. We work with patient advocacy groups to promote funding. Some of us work with industry to promote the adoption of life-saving medications and procedures.

While there are multiple regional services in Victoria offering paediatric EEG services, none offer EEG services for children under 2 years of age. Some centres, such as Bendigo, Ballarat and Shepparton, offer EEG for older children through the state-funded public hospitals. For patients who live near the Murray, no state government-funded EEG services are available.

Four hours is a long time to sit in a car. On my next trip to Albury in August, I am going to call my colleague back and tell her that I know what the solution is to save my patients the 8-h return trip to Melbourne: Increase the Medicare rebate for EEG so clinicians are incentivised to offer more services locally to increase equity, accessibility and affordability to regional and remote patients.

As specialist paediatricians, we are not trained to think of how we work within a market economy. Increasing one rebate for one investigation will unburden patients with one need. A broader review of the way incentives interact with our clinical work will have lasting implications and improve the lives for all of our patients.