- by Anna Pha
- The Guardian
- Issue #2049
The demo near Anthony Albanese’s office in Marrickville on 24th February. Photo: Denis Doherty
Medicare as a public health insurance scheme offering universal access to bulkbilling, and funded through central revenue is becoming a distant memory. GPs are fully booked, public hospitals are in crisis, and health care is increasingly unaffordable for many families.
GP practices have been sending out letters to patients who have a Centrelink Health Care or Pension Card saying they will no longer bulkbill them. While they might be offered a concessional fee with a smaller gap payment than other patients, these patients still take a hit. Many of them have chronic conditions and will face putting off visits which could see a worsening of their health, and even put pressure on public hospitals.
The crisis in health care was taking its toll before COVID and the cost-of-living crisis hit millions of struggling families.
A survey of more than 4000 practices covering around 21,000 GPs by Cleanbill found that “Just 42.7 per cent of these clinics offer bulk billing (no out-of-pocket fee) consultations to all of their patients. Outside of Sydney and Melbourne, fewer than 1 in 3 GP clinics will bulk bill all patients, while in Tasmania and the Australian Capital Territory, this number approaches 1 in 20.”
Cleanbill found that the average out-of-pocket cost at more than 55 per cent of GP clinics that do not bulk bill all their patients is $40.25 for a standard 15-minute consultation. This amount, paid by the patient, is on top of the $39.75 Medicare rebate paid to the GP by Medicare.
Out-of-pocket expenses are even larger for longer consultations. These can be double or even triple the amount for a 15-minute consultation. How can a family, an unemployed person or age pensioner afford such costs? They can’t.
Medical practices are finding it increasingly difficult to absorb rapidly rising costs with Medicare rebates failing to keep up after being frozen or stagnant for decades.
There is a serious shortage of GPs and medical graduates are turning to other areas of specialisation. Cleanbill found that almost one in ten clinics were not taking on new patients, further limiting people’s ability to access primary care in their area.
As a result emergency departments at public hospitals are having to deal with thousands of additional patients requiring care but unable to access a GP. Public hospitals are overstretched, with long waiting lists, understaffing and lack of resources. The Guardian has heard stories of a major hospital running out of cannulas used by doctors for draining fluid and administering medication.
Mental health services are in short-supply and unaffordable. Dental care is not even included under Medicare, although it is an integral part of a person’s health.
In rural and regional Australia there are some communities where there are no GPs, let alone bulkbilled services.
Wait times to see medical specialists run into months and bulkbilling specialists are a rare commodity.
The recent Strengthening Medicare Taskforce Review chaired by Labor Minister for Health and Aged Care, Mark Butler, does not give much hope for the future of bulkbilling. Its only mention of bulkbilling was to say it was in decline.
Treasurer Jim Chalmers offers little hope of providing the necessary expenditure when he says Australians must steel themselves for potentially rocky times ahead and refers to “choppy waters to navigate” in the budget context.
“Our government has committed $750 million to the Strengthening Medicare Fund, which will be the start of a major revamp of the primary care system,” Butler said.
$750 million is peanuts and will hardly scratch the surface. This is from a government that remains committed to the $254 billion in tax cuts for the rich and to $386 billion (before cost blow-outs) on AUKUS.
The tax cuts should be cancelled. Apart from being regressive, cutting them has popular support. As for AUKUS it will not bring security. The nuclear-powered submarines, hypersonic missiles and other materiel will only increase tensions in the region and lead Australia into yet another US war.
AUKUS will cost lives. Medicare saves lives.
Fully fund Medicare! Cancel AUKUS and the tax cuts!
Footnote: There is one positive development. As of 1st January, 2023, the maximum price of most PBS medicines for non-concessional patients was reduced from $42.50 to $30. But it is still too high. However, the concessional fee has been increased from $6.80 to $7.30.