Health Secretary Mark Butler has exposed the simple problem with Medicare that is causing primary care physicians to phase out bulk bills while announcing a major overhaul of the 40-year-old universal health care system.
Amid some doctors’ fears that Medicare will collapse completely, Butler said Monday the problem is that “the average gap reimbursement is now more than the Medicare rebate itself.”
“What this means is that too many Australians simply can’t get the care they need, when and where they need it, in the community.”
Bulk billing rates have fallen seven percent in the past year and continue to fall as family practices charge higher fees in addition to Medicare rebates.
Waiting times for GP appointments have increased to more than a month for some doctors as demand increases due to population growth, while the number of GPs is declining as more doctors move into more lucrative specialties.
Medicare will undergo the most sweeping overhaul since its inception. Above, Prime Minister Anthony Albanese at a pharmacy
Medicare revision explained
Why is Medicare in trouble?
Medicare was designed decades ago when most people only needed treatment for injuries or if they contracted a virus or infection.
But now that the population is older and living longer, so far more people have chronic diseases.
These are more expensive to treat and require longer, more frequent consultations and paramedical support.
Fewer doctors become general practitioners, because a specialist pays better, and the rest have more patients with more time-consuming needs.
But surgeries can’t get Medicare funding unless a doctor is involved in the treatment because the rules are too rigid.
So GPs stop bulk billing and charge higher rates, or can’t see as many patients.
How can Medicare be solved?
By changing the funding system, practices can cope with the new reality.
Nurses could perform many more treatments without a doctor, freeing up GPs’ time for more complex cases.
Practices could also employ a wide variety of allied health professionals to help treat chronic patients.
These can be dietitians, physiotherapists and diabetes experts.
Practices would receive block funding for all of this, rather than just getting a discount for individual treatments charged to patients.
Australia’s population is also aging rapidly, with more patients living longer but requiring treatment to manage chronic conditions.
As a result, many people go to hospital emergency rooms for routine problems because they cannot access a primary care doctor.
Rising gap payments led experts and the government to fear that without serious reforms, access to primary health care would be out of reach for millions of Australians.
Medical experts also feared that the entire Medicare system would collapse under the weight of fewer primary care physicians, higher ongoing costs for surgeries and a population that is becoming increasingly expensive to stay healthy.
“What we know we need to do is get primary health care,” Mr Albanese told Sunrise.
“The main thing we’re looking at is how you take the pressure off the system, and we’re doing that — talking to the AMA, talking to the Royal Australian College of GPs, talking to experts because we want to make sure that this Medicare is there the task force is being listened to.’
Health Minister Mark Butler told The Australian the system was “really in trouble”, stuck in the 1980s and 1990s and making no sense anymore.
He explained that in the past few decades, when the system was being designed, healthcare was mostly about treating acute conditions such as injuries and single illness.
But as Australia’s birth rate fell and the population aged, doctors spent more and more time treating chronic conditions in elderly patients.
Australians are also living longer, so the time they need to access this kind of care increased, rather than dying before they became a problem.
Chronic patients have completely different needs than the acute ones Medicare was designed for, including longer consultations and more frequent visits.
They also need access to paramedics such as dieticians, physiotherapists and chronic disease experts to modify their lifestyle and provide specialized care.
Australia’s population is also aging rapidly, with more patients living longer but requiring treatment to manage chronic conditions
All of this is more expensive and requires more coordination between doctors that is not well supported by the Medicare funding system.
Nurses, who are trained to perform a wide variety of treatments without a doctor’s intervention, are also underutilized.
Medicare funding rules require patients to be seen by a physician, otherwise the treatment will not be covered by Medicare and the practice must bear the costs.
“There is a lot of care that nurses can provide to meet the needs of patients on the day, but currently they have to go to the doctor for a fee or no one gets paid,” explains Karen Booth, president of the Australian Primary Health Care Nurses Association , from.
The government admitted that the system of government subsidies for individual consultations via GPs alone was no longer valid.
“We need doctors working hand-in-hand with practice nurses, allied health professionals and pharmacists,” said Mr Butler.
“The system is not well equipped for that. It is clear that an expansion of multidisciplinary care is essential for the management of chronic diseases.’
Nurses will be relied upon to play a greater role in primary care as there are fewer GPs and an increasing and aging population
The new model would allow nurses and paramedics in teams to deliver complex care and receive the subsidy payments in the same way GPs do.
Instead of a strict fee-for-service model, practices would receive financial blocks to pay nurses, pharmacists and paramedics under one roof.
Nurses could then take over the burden of doctors by providing simpler treatments, and several allied health care providers could treat chronic conditions – without fear that no one will get paid until a doctor comes in.
Mr Butler said he wanted all health workers to be ‘liberated’ to contribute as much as possible to deliver world-class care.
“In a time of skyrocketing healthcare demand and labor shortages, there is no point in not raising all of our healthcare professionals to the top of their fields – whether that be physicians, nurses, paramedics, pharmacists, paramedics, and others. ,’ he said.
“That just isn’t happening in Australia – there are too many rules and restrictions… too many territorial wars limiting the ability of people to provide their full range of skills and training, delivered by taxpayers to hundreds of thousands of healthcare professionals.”
Nicole Higgins, president of the Royal Australian College of General Practitioners, said the new system had to be designed correctly the first time or so many operations would forego bulk billing that “the whole system [could] falling over’.
‘We see more complex patients, older patients with multimorbidity. Team-based care is the best model to support those patients, but GPs should remain the stewards of the multidisciplinary care team because they are the ones who have the whole patient picture,” she said.
Health Secretary Mark Butler said the system was ‘really in trouble’, stuck in the 1980s and 1990s and no longer right
Details of the new financing model are still to be finalized and different models are being discussed.
For several months now, the federal government has been working with medical associations and patient advocacy groups on ways to strengthen the Medicare system.
The report is expected to be published within a few weeks.
Mr Butler said measures such as hedging cash benefits are being considered as part of the process.
“The question is, on top of the traditional fee-for-service system, do you add some kind of flexible funding that allows physicians to provide wraparound care,” he said.
Most developed countries have already switched to another system, so there are examples that the government will look at.
Denmark has continued to provide about 70 percent of its health funding as fee-for-service, with the remainder as block funding, and the UK has made a similar switch.