$750m Medicare reform ‘not enough’

The $750m to fix Medicare fails to address the crisis facing patients and practices of declining bulk billing, escalating gap fees and difficulty accessing a GP, a taskforce warns.

Federal Health Minister Mark Butler. Picture: NCA NewsWire / Martin Ollman

The $750m the federal government has allocated to fixing Medicare fails to address the crisis facing patients and practices of declining bulk billing, escalating gap fees and difficulty accessing a GP.

That’s the warning from members of the Strengthening Medicare taskforce awaiting the final version of a report that lays out how to reform general practice with the expansion of multidisciplinary, team-based care.

With the latest Medicare figures revealing a steep drop in bulk-billing rates and more patients unable to afford gap fees, there are warnings that a new payroll tax ruling could see gap fees rise a further $5 for a standard consultation.

The Queensland Revenue Office released a ruling on Monday that means GP practices will be slugged with payroll tax if two or more full-time-equivalent GPs work under their umbrella. It follows a NSW tribunal ruling that the remuneration of GPs working in practices amounts to wages even though they work as contractors. The position is likely to be adopted nationwide. Medical groups are now fiercely lobbying for a payroll tax exemption.

Royal Australian College of GPs president Nicole Higgins described the development as “another nail in the coffin of general practice” at a time when Medicare was on its knees.

Dr Higgins said the RACGP believed the national bulk-billing rate could plunge to as low as 60 per cent some time this year. “The worry is, if the government doesn’t do something now, it’s going to be really hard to pull back from this steep decline,” she said.

Federal Health Minister Mark Butler commissioned a taskforce to help decide how to spend the $250m a year Strengthening Medicare fund that Labor has earmarked to bolster Medicare.

The central recommendations after six months of discussion are understood to be around funding reform to allow for more team-based care incorporating nursing and allied health alongside GPs and the introduction of a voluntary patient enrolment scheme in which patients could sign up to a practice, which would receive extra funding to co-ordinate and integrate their healthcare.

The report will be released by the government, which is currently editing it and incorporating feedback, in coming weeks.

Dr Higgins said although the reforms and the $250m that will flow this year were welcome, they would not address the immediate crisis in general practice. “The funding works out at $10 per Australian per annum, that’s a couple of cups of coffee. It’s a good start, but it’s insufficient. The Medicare freeze took $2bn out of general practice.”

The government says it is providing a total of $2.9bn to boost primary care, including a $220m GP grants program, and acknowledges further money will be needed in future budgets to implement the national 10-year primary care plan.

“The former government froze the Medicare rebate for six years, ripping billions of dollars out of ­primary care and causing gap fees to skyrocket,” Mr Butler said.

“The Albanese government is committed to investing in general practice and strengthening Medicare,” he said.

Australian Medical Association vice-president Danielle McMullen, a member of the taskforce, said. “There’s a need for more flexible funding models to make sure that patients get access to the wraparound care that they need. The $750m that is promised, we see as a down payment.”

The Primary Care Business Council (PCBC) said the need to ensure the sector’s sustainability was much more urgent than systemic reforms.

PCBC executive director Jeremy Stone said at least 40 per cent of practices in the network were now running at a loss. “We’re already at breaking point,” he said.

Australian College of Rural and Remote Medicine president Dan Halliday said the rural sector had appreciated being part of the ­discussion on Medicare reform, but addressing inequality would take billions.