Government spending on general practice falls

The Consumer Price Index has been going up at its fastest rate in years – but spending on general practice has fallen in the most recent year, new figures show.
 
As part of its 2023 Report on Government Services (RoGS), the Productivity Commission released Part E: Health on 2 February, which covers primary and community health, mental health and ambulance services, and public hospitals.
 
The RoGs provides information on the effectiveness of key services to the community, including performance reporting and government expenditure within the primary and community health sectors.
 
For 2021–22, expenditure was $11.435 billion for general practice, compared to $11.445 billion in the previous financial year. Meanwhile, public hospital spending increased by almost $3.7 billion in 2020–21 – the last year for which figures are available – to nearly $81.6 billion.
 
Expenditure on ambulance services in 2021–22 was $4.9 billion.
 
These three areas make up the total government recurrent expenditure for health services of $132.3 billion for the latest years covered in the 2023 RoGs.
 
Additionally, $10.1 billion was spent across 2021–22 through the Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS (RPBS) on Section 85 prescription medicines filled at pharmacies, and $45.6 million on funding of PBS medicines to Aboriginal and Torres Strait Islander primary health services in remote areas.
 
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, told newsGP the ‘take-home’ message from the report is that the lack of investment in general practice continues.
 
‘The main thing is there are more GPs than ever, they’re busier than ever, but the government support for patients attending GPs is actually dropping,’ he said.
 
‘With that equation, it’s no wonder that practices can’t afford to keep bulk billing everyone, and unfortunately are needing to pass costs on patients.’
 
In 2021, there were 38,357 GPs nationally – 31,056 on a full-time equivalent (FTE) basis – equating to 120.7 per 100,000 people. That compares to 114.3 in the previous 12 months.
 
However, the figures also highlight an ageing workforce.
 
Of the FTE GPs, 26.3% were aged 60 years or older, compared to 2.5% who were less than 30 years of age – marking the highest proportion of GPs aged more than 60 years and the lowest proportion of GPs younger than 30 years across the reported period of 2015–21.
 
Nationally, rates of GPs per person increased each year between 2014 and 2019, before declining in 2020 and increasing in 2021. Rates of GP-type services used per person increased between 2020–21 and 2021–22 from 7.0 to 7.6 services per person.
 
In 2021–22, 3.5% of Australians who needed to see a GP reported that they delayed or did not see a GP in the last 12 months due to cost. While this is an increase from 2020–21 (2.4%), the percentage is still lower than almost all years over the available time series (5.4% in 2012–13).
 
The RACGP has continued to call on governments to urgently address bulk billing incentives as part of a long-term reform to ensure the future of general practice care and to ease pressure on the hospital system.
 
The RoGs shows that in 2021–22, national expenditure per person on GPs was $443.80, which is a slight decrease in real terms from $445 in 2020–21. In comparison, government real recurrent expenditure on public hospitals per person was $3166 in 2020–21.
 
According to recent figures from the Australian Bureau of Statistics, 83.6% of people aged 15 and older saw a GP in 2021–22, compared to 14.8% who visited an emergency department, and 12.8% who were admitted to hospital.
 
However, cost to government of general practice per person is an indicator that ‘should be interpreted with care’, according to the Productivity Commission, as it does not capture the costs of salaried GP service delivery models, particularly used in rural and remote areas.
 
‘Therefore, costs are understated for jurisdictions where a larger proportion of the population live in rural and remote areas,’ the report states.
 
This indicator can also reflect service substitution between primary healthcare and hospital or specialist services.
 
For the first time, the RoGs includes information on GP-type services separated by in-person attendances and telehealth appointments, showing that nationally 1.6 telehealth GP-type services were used per person in 2021–22.
 
Dr Wright said the increases in GP services further indicates the value of general practice and people having a regular GP.
 
‘We can see that the use of GP services has increased … meaning that more people are seeing their GP more regularly,’ he said.
 
In comparison, PBS total expenditure per person in 2021–22 was $382.4, excluding RPBS and doctor’s bag supplies.
 
‘If you look at expenditure on the PBS, that’s actually gone up by half a billion dollars in the last year, while expenditure to GP services has actually decreased in real terms,’ Dr Wright said.
 
‘There’s been a lot of strengthening with the PBS and it is time to get some strengthening of Medicare.
 
‘There’s been a lot of talk of strengthening primary care … [and we hope this will happen with the] Strengthening Medicare Taskforce.’
 
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