Fears ‘forgotten middle class’ may soon be unable to afford a GP

Although bulk-billing has stabilised in the wake of last November’s Federal Government incentives, there are growing concerns about people being priced out of general practice care.
 
According to the Government’s own calculations, the incentives are targeted at the 11.6 million Australians deemed most in need – children under 16, pensioners and other Commonwealth concession card holders.
 
However, that means more than 15 million people have not received any kind of relief when it comes to reducing the cost of seeing a GP.
 
‘There’s this sort of forgotten middle class in Australia now, with people who are struggling to make ends meet on average incomes who don’t fall into the targets under the Government with Medicare,’ RACGP Vice President Associate Professor Michael Clements told newsGP.
 
‘So for this middle class, which makes up an extremely large part of our population, they haven't been looked at all and are facing increasing costs.’
 
Recent figures from the Australian Bureau of Statistics show household spending on health grew by 15.7% in the 12 months up to April, placing more strain on family budgets than any other category during this period.
 
Meanwhile, per capita household disposable income has fallen 6% over recent years and household saving income is down from 1.6% to 0.9%.
 
According to the ABS, the median personal income in Australia is $789 a week, with a household income of $1770.
 
Finance platform Money.com.au has the average mortgage repayment at $938.75 a week and researchers at CoreLogic have estimated the median weekly rent at $601 per week, up from $437 in August 2020.
 
With these figures alone, not including the rising rates of fuel, food and electricity, it is hard not to see the squeeze on average income earners.
 
And while Associate Professor Clements said recent changes to the Pharmaceutical Benefits Scheme may have helped medication affordability, the Medicare rebate is ‘still less than half what it used to be’.
 
‘With what we know about the cost-of-living pressures, people are checking to see whether they can afford to see a GP,’ he said.
 
‘Perhaps using some of the free services like the urgent care clinics or online services, which is not preventive, so they’re not getting the wraparound care.
 
‘They’re having to make choices about their healthcare based on cost now, but … if they’re not getting access to preventive care that’s going to increase their health risks.’
 
Sydney GP and Chair of the RACGP Expert Committee – Funding and Health System Reform, Dr Michael Wright, who has a PhD in health economics, told newsGP the health system responded positively to last year’s tripled bulk-billing incentive, but a lack of attention has been paid to the bigger picture.
 
‘I think they targeted a group that really needed support,’ he said.
 
‘But what we’ve seen in general practice is patients needing more support more broadly and we notice our patients are really worried about the costs of any of the healthcare that they get.’
 
Dr Wright said patients relying on bulk billing in general is becoming more unsustainable.
 
‘Potentially we’ll end up with a two-tier system,’ he said. ‘From a GP point of view, [it’s] really concerning because we’re trying to provide access to the whole of the community.’
 
In March this year, the Government said Australians were getting ‘value for money’ with private health insurance costs rising lower than wages, stating that they would provide $7.3 billion this year to policy holders through the tax rebate.
 
The bulk-billing incentives for Medicare were a $3.5 billion spend.
 
Associate Professor Clements called this move out, asking why the Government hasn’t invested the same amount into universal healthcare as it does for private health insurance.
 
‘It’s been improving the health insurance charge, but it obviously hasn’t been doing the same in Medicare,’ he said.
 
‘It’s quite a staggering difference.’
 
These kind of announcements, Associate Professor Clements says, are indicative of a fundamental shift he sees happening.
 
‘We’re seeing a move away from universal healthcare, a shift away from everybody having so called “free access” to care and leaning more towards a US-style system,’ he said.
 
‘Where we’ve got Medicare as an insurer, which is going look after the most vulnerable, and then everybody else has to pay [for private health insurance] and people caught out in the field won’t get care.’
 
The Department of Health and Aged Care and Health Minister Mark Butler were contacted for comment.
 
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