Grattan Institute proposes overhaul of Medicare rebates

Medicare is failing to keep up with complex health demands and is leaving Australians behind, a new report has found.

Medicare generic

Australia’s system of providing Medicare rebates for treating specific issues during appointment-based GP care should be overhauled in favour of a system that funds teams of clinicians within primary practice that would be better equipped to manage chronic disease.

That’s the call from the Grattan Institute, which says Medicare is “broken” and leaves doctors unable to spend the time they need with patients who require complex care and who are increasingly burdening the overstretched hospital system.

“Australia is spending more on hospitals while neglecting general practice, the best place to tackle chronic disease,” a report by Grattan’s Health and Aged Care Program director Peter Breadon and policy analyst Danielle Romanes says.

Danielle Romanes.

“Australia needs a new way to fund general practice. The current model is broken, actively discouraging team care and rewarding speed, not need.

“Australia is one of the last wealthy countries to fund general practice this way. Practices should be able to choose a new funding model that supports team care and enables GPs to spend more time on complex cases, by combining appointment fees with a flexible budget for each patient that is based on their level of need.

“Australia must dismantle the regulatory and funding barriers that force GPs to go it alone.”

The Grattan Institute is calling on the federal government to channel the $250m it plans to spend on bolstering Medicare next year into overhauling the funding model and directly employing an extra 1000 clinicians such as nurses and physiotherapists in general practice teams.

Under the proposed model, multidisciplinary teams would be led by GPs and funded by a model that combined appointment fees with a flexible budget for each patient based on their level of need and that would enable those with the most complex needs to receive the level of care they required.

“Since Medicare was created 40 years ago, people have gotten older and sicker, and the system hasn’t changed to keep up,” Mr Breadon said. “So now you’ve got GPs who are trying to cram more and more complex care into the same average 15-minute length of consultation … compared to other countries, they don’t have anywhere near as much support in terms of the team that surrounds them.

“Typically, if a GP wants to share care with someone else in their team, they’ll often lose money, they’re not funded for managing and working with a broader team, and some regulations get in the way and stop GPs from sharing care.

“It’s a rigid, micromanaging funding model that doesn’t pay them more for treating more complex patients, and the end result is some people are missing out on care and a lot of GPs are stressed and burnt out.

“Other countries are managing to reduce their rates of preventable hospitalisations while Australia’s are holding steady.”