Blueprint for Medicare reform needs to be enacted

After Friday’s national cabinet, Anthony Albanese declared health reform would be the “first-priority issue” this year. So far so good. But as the Australian Medical Association noted, for all the talk of urgency from political leaders going into national cabinet, all that was agreed was a commitment by the federal, state and territory governments to work on policy options and discuss the issue again in April. As foreshadowed by The Australian for the past fortnight, the Strengthening Medicare taskforce report, presented to the meeting, recommended the introduction of a new “blended” funding model to replace the fee-for-service system of providing Medicare rebates for single consultations with GPs. The report envisages the introduction of block funding for preventive care and chronic disease management from nurses and allied health professionals. As the report said: “High-quality primary care delivery depends more and more on healthcare teams – harnessing the full strengths and skills of the diverse health workforce, including GPs, nurses, nurse practitioners and midwives, pharmacists, allied health professionals, Aboriginal and Torres Strait Islander health workers and others.’’

Health Minister Mark Butler is right when he says expanding urgent care clinics, recommended by the report, was an “innovative way” to provide free, bulk-billed medical services that would not clog up hospital emergency rooms. “We need to improve access after usual office hours. The needs of patients today were very different to community needs 40 years ago when most presentations to GPs were episodic and relatively short. Now we’re dealing with much more chronic disease, ongoing needs and older Australians who tend to have more than one healthcare condition,’’ Mr Butler said.

The principles outlined in the report and national cabinet’s response, as far as it goes, are sound but funding will be crucial, with the Royal Australian College of General Practitioners questioning how the Medicare reforms would be paid for with only $250m a year for the next three years on the table. Mr Butler has described that as a “down-payment”. RACGP president Nicole Higgins said the promise of reform without proper investment to back it was hollow. AMA president Steve Robson warned “if we don’t invest now in general practice, by the time all of the reforms that are in the Strengthening Medicare Taskforce come to fruition, we’re all going to be standing around a rotting carcass of what used to be Medicare. We need to resuscitate things now if we’re going to have scope to deal with the other things in the taskforce report.”

As national cabinet continues its work through the year, private health funds should also be drawn into the reform process on issues such as covering doctors’ gap fees for private hospital patients. That change would improve benefits for policy holders and relieve pressure on public hospitals.

Healthcare costs are rising, as the population ages and new treatments and pharmaceuticals emerge. Such advances are ongoing and constant. Recent changes include the widespread use of diabetes medication Ozempic to treat obesity and the TGA’s approval of two psychedelic drugs for mental health treatment. Whatever the benefits for patients and relieving health costs in the mid to long term, they cost money. With the virtual demise of bulk billing in recent years, patients are already paying $50 to $60 or more to see a GP. There is no good reason why a modest element of user-pays, means-tested to protect the disadvantaged, should not be factored into the funding model for more comprehensive GP clinics. The public purse is not a bottomless pit, given competing interests such as defence, returning the budget to the black and repaying debt to reduce the interest costs of servicing it. Strengthening Medicare is a pragmatic start in preserving the hybrid public-private health system that has served the nation well.