- by Anna Pha
- The Guardian
- Issue #2078
Photo: Anna Pha
The public health system is in crisis. Bulk billing GPs are hard to find and non-existent in some regional and rural areas. In fact, some areas do not have a GP. Waiting lists for public hospitals remain long, with alarming reports of people dying while waiting for a procedure.
Since the Gillard government froze rebates on bulk-billed consultations in 2013 successive governments have failed to index in line with inflation. As a result, rebates have not kept up with rising costs such as rent, insurance, and staff. Many doctors have either ceased bulk billing or signed up with corporate medical centres that bulk bill and churn out patients like a McDonalds fast food outlet churns out hamburgers.
“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,” Health minister Mark Butler says. The $750 million is over three years – peanuts relative to the massive underfunding of Medicare.
On a positive note, rebates for doctors treating Commonwealth concession card holders and children under 16 years of age are tripled – with around 11 million people benefiting. Hopefully this will be an adequate incentive for doctors to bulk bill them. The remainder of the population will go without.
This is evidenced by the paltry increases in Medicare rebates for doctors who bulk bill and take fee-paying patients. Rebates were increased on 1 November by around 3.6 per cent, nowhere near enough to even meet most recent CPI rises and hardly reducing the gap patients pay non-bulk billing GPs.
The rebate for a short consultation was increased by 65 cents from $18.20 to $18.85 – hardly likely to persuade a doctor to bulk bill.
For a longer consultation, between six and 20 minutes, the increase was $1.45 from $39.75 to $41.20. Depending on the GP and geographic location (higher fees in wealthier suburbs) the fee might be anything up to $80, $100 or more. That leaves the patient making a gap payment of $40 to $60 or more per consultation. For longer consultations, the gap is even larger, rising to $100 or more.
The Albanese government’s Strengthening Medicare Taskforce Report, tasked with finding ways of increasing access to primary health care, recommended new funding models for the public health system. The government’s reforms that came into force on 1 November take a first step towards implementing its recommendations.
Notably, the report’s recommendations do not include universal access to bulk billing which was the cornerstone principle of Medicare and the government’s reforms are clearly not intended to reinstate bulk billing.
BLENDED FUNDING MODELS
The report recommended the management of complex chronic disease through blended funding models integrating fee-for-service with funding for longer consultations and “incentives that better promote quality bundles of care for people who need it most.”
These ‘blended funding models’ individualise funding for patients based on a mix of fee-for-service and flexible specific budgets for each patient depending on health status. GPs and patients would be able to opt into such a system. These specific budgets could be spent on multidisciplinary teams working alongside GPs with greater role for nurses and pharmacists in prescribing medications and other responsibilities.
On 1 October the government introduced MyMedicare, a system where patients can register with a particular GP and clinic with a regular care team such as nurses and physiotherapists. The government is promising additional funding to medical centres that sign up to MyMedicare.
Signing up with MyMedicare comes with the promise of rebates for longer telehealth consultations and bulk-billed telehealth consultations at a new higher rate for children under 16 and Commonwealth concession card holders.
MyMedicare appears to be a vehicle for a blended funding model. The concept is similar to the privatised NDIS model where each participant is supposed to be assessed according to needs, and a dollar allocation made for services which are contracted out to the private or not-for-profit sector. In the case of healthcare, it would be for PHI funds. It is hardly a coincidence that Medibank Private had a representative on the taskforce.
Once the PHI sector got its grubby hands on Medicare the outcome would be disastrous both cost-wise and in meeting the needs of patients. It would add an additional layer of profits and fail to restore universal bulkbilling.
The government correctly recognises that the GP is at the heart of primary health care. They know their patients’ medical history and in cases where patients have a number of chronic conditions, which is increasingly the case, the role of the GP becomes even more important. Pharmacists do not have the necessary medical training.
The warmongering Labor Albanese government talks about reining in spending on the NDIS, social security and health care. It does not flinch at committing $368 billion on nuclear submarines to serve US imperialism in the region and beyond. It is determined to throw away $254 billion in tax cuts for the rich.
But it is not prepared to fund universal access to bulkbilling or include cover for dental care under Medicare.
The CPA advocates for a nationalised health scheme providing quality primary care with GPs, nurses, allied and community health workers, working together on the frontline for maintaining people’s well-being with emphasis on preventative care.
Such a nationalised health system should be under local control, with high quality, and free at point of delivery care, according to need rather than the ability to pay. It should include dental treatment bulk billed under Medicare and funded through progressive forms of taxation and focused on the needs of working Australians and their families, the elderly and the sick.
Cancel AUKUS! Cancel the tax cuts!
AUKUS will cost lives. Medicare saves lives.
Fully fund Medicare!