Health experts have warned that boosting doctors’ pay should not be the priority for Medicare reforms, saying the focus of the additional funding should be on a broader system overhaul, new funding models and investment in multidisciplinary care.
Victorian Premier Daniel Andrews and NSW Premier Dominic Perrottet want Medicare reform to be the focus of the national cabinet’s agenda when it meets on February 1 and will lobby the Albanese government to pay doctors more in a bid to boost the rate of bulk billing.
Health Minister Mark Butler has declared fixing the country’s primary health network is his top priority and is awaiting a finalised report from a federal government task force about how best to use the $750 million Strengthening Medicare Fund announced in the October budget.
Pre-eminent healthcare economist Stephen Duckett, a member of the task force, said it was absolutely necessary for the Commonwealth to invest more funding in primary care, but there was no guarantee that raising doctors’ fees through the Medicare rebates would lead to more bulk-billing or increase the availability of GP services.
“For example, there is academic evidence that when you increase doctors’ fees, the rebates, often the doctors decide to take the increase not as increased income, but as increased leisure and they reduce their hours. So you’ve got to be very careful how you design any payment increase,” Duckett said.
“You’ve got to put the patient first – what actually will improve access for patients and services for patients. And I wouldn’t start with an increased rebate. I’d actually start with paying more for nurses and physios.”
Health experts have warned that boosting doctors’ fees should not be the priority when it comes to Medicare reform.Credit: Joe Armao
Professor Adam Elshaug, director of Melbourne University’s Centre for Health Policy and a member of the task force, said there was unprecedented pressure on GP practices. He said he supported more investment in primary care, but questioned whether increasing rebates was the most effective use of new funding.
“I do think a singular focus on Medicare rebates will be a missed opportunity for more comprehensive, effective and lasting reforms,” he said.
“I think the opportunity before us is to expand a system where GPs are and should remain at the core [and move] towards a multidisciplinary model that capitalises on all that the nursing and allied health professionals have to contribute to more comprehensive person-centred care.”
The Royal Australian College of General Practitioners, which is pushing for a minimum 20 per cent increase to all rebates for GP attendance, has argued fewer GPs are offering bulk billing because rebates have not kept pace with inflation and the rising costs associated with providing consultation services.
College president Dr Nicole Higgins, who also served on the taskforce, said bulk billing rates would continue to plummet, piling pressure on hospitals and emergency rooms, unless rebate increases were included as part of broader Medicare reform.
“Because GP practices have already seen closures throughout Australia, especially in our rural and outer metro areas, where they actually will have to charge the cost of what it takes to keep their doors open,” she said.
“What that will then mean is increased pressure on the state health system – increased [ambulance] ramping, increased waiting list times and overflowing emergency waiting rooms.”
She acknowledged that a 20 per cent rebate increase could require more than $1 billion in additional funding to be sustained but said the parlous state of the system was the result of chronic underinvestment in Medicare and years of rebate freezes under former Coalition governments.
In the college’s pre-budget submission from October, it estimated that a more modest 10 per increase to Medicare patient rebates for Level C (20–40 minutes) and Level D (40-minute plus) GP consultations, currently set at $76.95 and $113.30 respectively, would cost more than $167 million per year.
The Australian Medical Association (AMA) has not put forward an across-the-board rebate increase proposal but instead has called for the creation of a new “extended Level B” category for consultations between 15 and 19 minutes, with a rebate of $54.66 which it says will require a $1.03 billion investment from government over four years.
Peter Breadon, the Grattan Institute’s program director for health and aged care, said the $750 million funding package, to be spread over three years, should be prioritised for rolling out a new funding model for Medicare, paying for multidisciplinary teams to support GPs in the areas where it is hardest to get an appointment and making sure there is access to care in rural areas.
“Simply increasing doctors’ pay won’t fix the real problems in the system,” he said.
AMA president Professor Steve Robson said governments needed to think creatively about funding models for primary care, but said it would require a “fairly big chunk of money” to make bulk billing financially viable for many GPs.
“We think it’s not so much just a case of ‘pay doctors more money’,” he said, “but are there ways that we can improve the rebates so that we can build a structure where patients are put at the centre, and we can have a lot of other types of services within a general practice – the sorts of things often people have got to go to hospitals to get.”
Cut through the noise of federal politics with news, views and expert analysis from Jacqueline Maley. Subscribers can sign up to our weekly Inside Politics newsletter here.