Healthcare reform debate heats up ahead of National Cabinet

Anastasia Tsirtsakis

24/01/2023 4:27:53 PM

The RACGP has warned against the use of ‘band-aid’ solutions to fix Medicare, amid calls for private insurers to cover GP gap payments and ‘empowering’ allied health to extend their scope of practice.

Private health insurers are pushing for reform.
Private health insurers are not permitted to fund any health service that receives a Medicare rebate, according to current legislation.

Healthcare in Australia will soon undergo its biggest overhaul in 40 years, with the Strengthening Medicare Taskforce expected to release a raft of new recommendations in the coming weeks.
A draft of the report will likely be presented at National Cabinet and its final version will guide decisions made in the May Budget, with at least $750 million due to be invested by the Federal Government over the next three years via the Strengthening Medicare Fund.
Amid the rising cost of living and increasingly complex healthcare needs, the RACGP has been a vocal advocate for the need to increase Medicare rebates for patients. But recent comments from the Federal Health and Aged Care Minister Mark Butler have signalled a shift away from a purely fee-for-service model, making an increase in rebates far from certain.
Other healthcare stakeholders and lobby groups have also presented suggestions, many of which the RACGP has warned may increase fragmentation and result in worse patient outcomes.
Push from private health funds
With an increasing number of general practices introducing a mixed billing model to combat Medicare’s poor indexation, private health funds have seen an opportunity to lobby Government.
Private Healthcare Australia (PHA) and nib Health Insurance are leading a renewed push to allow health funds to be able to cover general practice gap fees. Under current legislation, consumers cannot claim a health service under their health fund for which they have received a Medicare rebate.
The push comes as a million Australians – mostly young, lower-and-middle-income families – have taken out private health insurance, with the trend ‘entirely driven by waiting lists’, according to PHA’s Chief Executive Rachel David.
‘Public hospitals aren’t offering the services that they used to, particularly in some outer suburban and inner regional areas, where a lot of sea change and tree change populations have moved during the pandemic,’ she told The Australian.
‘What we need to do is look after people on lower incomes who are struggling with cost of living at the moment, who are trying to do the right thing and pay something towards their healthcare.’
The RACGP, however, has previously warned against similar proposals, noting that a change to the current legislation poses a risk that would ‘threaten equitable patient access to essential care’.
Expanded scope of practice for nurses and allied health
Another reform that appears to be gaining greater traction within the halls of Parliament relates to increasing scope of practice for nurse practitioners and other allied health professionals.
On Monday, Minister Butler cited a desire for a ‘much more liberated ability’ for all healthcare professionals to work to ‘the top of their scope of practice’, similar to a proposal originally laid out by Melbourne-based thinktank the Grattan Institute.
‘There are too many regulations, too many constraints within the MBS system, too many turf wars that constrain the ability of people who want to deliver their full range of skills and training – training delivered by taxpayers to hundreds and hundreds of thousands of healthcare professionals,’ he said.
‘I want to see out of this Strengthening Medicare process, a much more liberated ability for all health care professionals – doctors, nurses, allied health professionals – to be able to contribute to the need that we have out there to deliver world class healthcare to Australian patients.’
Focusing on practice nurses and nurse practitioners, Minister Butler said there is ‘much more’ they can do in primary care.
‘[Things] that they want to do, they have the skills and training to do, that our current MBS system is not letting them do that well,’ he said.
‘And I think that will be something that comes through the Strengthening Medicare Taskforce report very clearly. But it won’t be the first time it’s been said – it was also a clear recommendation out of the 10 Year Primary Care Plan.’
While the Minister noted that the reform is ‘not going to be easy’, he said he senses a greater consensus around the change than ever before.
However, this has been disputed by RACGP President Dr Nicole Higgins, who disagreed with the characterisation of the debate as a ‘turf war’ and pointed out that GPs already work closely with their health colleagues. Rather, she says GPs’ main concerns related to fragmentation of care.
‘Because that leads to poor patient outcomes and harm, and going down another path of uncontrolled spending like the NDIS [National Disability Insurance Scheme],’ she told Nine Newspapers.
‘Medicare reform must have the GP as the steward of patient care. We have the continuity of care, we understand the complexity. Breaking it into parts and siphoning it off can be wasteful, lead to duplication and inefficiency.
‘Band-aid solutions won’t work. That means serious investment in general practice care and building the role of GPs as the stewards of patient care in multidisciplinary teams.
‘All the evidence shows that this will improve the health of Australians and reduce spending on expensive hospital care.’

RACGP President Dr Nicole Higgins says GPs are concerned about any reforms that may lead to fragmentation of care.
Increased rebates appear unlikely
Despite consistent calls from medical groups like the RACGP and AMA, Minister Butler appears reticent to increase patient rebates, saying the Government is about delivering a ‘modernised Medicare’.
‘More of the same is not going to cut it,’ he said.
‘And I think a range of commentators have also reflected on the fact that simply adding more money to the existing structures is not going to deliver the quality, wraparound care, particularly people with complex chronic disease need and deserve.’
Instead, Minister Butler said delivering a system to respond to the changing healthcare needs of Australians requires less of a focus on episodic care.
‘What I want to do is be very clear with people: this is not easy, it’s not going to be quick,’ he said.
‘Our government is not simply going to be adding more money to the existing system. We’re about delivering a better, more modern system. And frankly that is the clear consensus of everyone from patients through the doctors, nursing and other experts that I’ve been engaging with over the last several months.’
However, President Higgins is apprehensive.
‘While it’s great that our nation’s leaders recognise the need for reform, I am concerned the Government’s proposed new model to overhaul Medicare will not go far enough to improve the situation for patients and may make matters worse,’ she said.
‘There are simple measures Government can implement quickly to improve access to care, particularly for those most in need, including tripling bulk billing incentives, and increasing Medicare rebates for longer consultations for complex care by 20%.
‘We are also calling on governments to act now to boost the GP workforce by fast-tracking entry for international doctors to work in rural communities and re-instating the subsidy for their training to be a specialist GP in Australia.’
Government to tackle taxing GP issue
Dr Higgins has flagged payroll tax as one of the greatest threats to Medicare reform, warning it could reduce the number of bulk billed consultations and increase the cost of seeing a GP by up to 15%.
While Queensland has generated a lot of recent attention thanks to a new revenue office ruling, there are concerns it could become a national issue, and the RACGP is calling for a nationwide payroll tax exemption for practices.
Minister Butler said on Tuesday that he is aware of the issue, which has been developing at different state levels over the past 12–24 months, and that he will be consulting with the college on the matter.
‘I’ve been watching those developments,’ he told News Corp.
‘I’ve had some communication with the [RACGP] … we’re trying to make time to speak over the next few days.’
A recent newsGP poll found only 3% of general practices would be in a position to absorb the costs associated with GPs becoming liable for payroll tax.
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A.Prof Christopher David Hogan   25/01/2023 10:47:56 AM

Governments are refusing to pay GPs their worth & are opting for the cheapest up front option- regardless of the COST to the health service.
Yes folks the no cost to the patient system is too damn expensive.

General Practice looks easy from the outside- until you try to do it !
Nurses & paramedics DO not cost less per patient overall than GPs- time & time again they are proved to be slower, over investigate, over treat & over refer.
The cost per patient is MUCH higher- which is why many EDs are hiring GPs to improve the efficiency of their throughput
If we are expanding into NPs, nurses, pharmacists & paramedics let us establish the referral pathways NOW.
We need teamwork & NPs, nurses, pharmacists & paramedics should report to the next level of skill ie GPs. Unless it is clearly an emergency

If we are trying to unblock EDs there is NO point increasing their workload with GP stuff or uncertain stuff- which is GP stuff.
Even if GPs work in funded clinics

Dr Petrus Weenink   25/01/2023 12:09:29 PM

A simple solution to change the funding debate would be to have either the states or federal government take over ALL funding for ALL of health. As long as there is a state and Federal divide there will always be underfunding either way. IF one Source of funding is assigned for Community and higher level health care it will almost be inevetable but to increase funding to primary care.

Additionally, I think that patients should be tiered perhaps into 2-3 tiers of complexity depending on how many health conditions they have and if they are more complex then a co payment of more money should be able to be billed that way we can fund more complex patients. Of course the exact mechanics of this needs to be worked out but I'm sure it is doable. That way Doctors can be rewarded for treating complex clients and less complex clients will attract less payment.

Two Ideas that I think may help the current situation but of course they both require political change and will to change.

Dr Brendan Sean Chaston   25/01/2023 2:18:59 PM

Hi President Higgins. You’ve been placed in a situation of historical significance in regard to the future of General Practice.. I’m sure you’re well versed in dealing with public servants/ bureaucrats. I’m obviously in no position to offer advice. However my experience has been that a firm, uncompromising and assertive position achieves the best outcome. It’s not the natural affect for a GP. Don’t be afraid to escalate/walk away. In the end there is nothing to lose. The government/medicare are dependent upon us. I’m sure Mr Albanese/Chalmers won’t be off to their local nurse/pharmacist next time they feel under the weather. Regardless of who you are, people want to see a doctor when they are sick. This is a generational inflexion point for general practice. For too long the GP has been undervalued.

The concept of collective bargaining is a powerful tool. The college is 40000 doctors strong - let them know it.

Dr Ailsa Mary Carole Laidlaw   25/01/2023 4:14:51 PM

The federal health department bureaucrats are phillisophically opposed to funding MBS sustainably. The only way MBS rebates will increase is if most GPs keep billing privately and there is a community backlash to pressure the politicians into recognizing the grossly inadequate MBS rebates.
$750 million over 3 years is peanuts and will not resolve this problem. And the practice -based "employment" of allied health and more nursing is a cynical attempt to appear to provide primary care , whilst trying to find the cheapest mish-mash.
The RACGP should be ashamed of itself for supporting a model which will further erode general practice and disadvantage its members ( GPs).

Dr RS   25/01/2023 9:03:04 PM

This is a huge slap in the Face of GPs
Maybe the Health minister and all of the the committee members that he chooses to listen to( not to mention groups unqualified to practice medicine who sense an opportunity to do so) wants the destruction of general practice. What happened to making general practice an attractive specialty for new graduates? I mentioned the proposals put forward by the Minister to my patients and they just shook their head in disgust! The don’t want task substitution!
I don’t think any politician understands the issues at stake here. Rebate rise is not a priority for us! What a joke! So disappointing!
Minister , the GPs are fed up! But this is typical!

Dr Mulham Daas   27/01/2023 12:01:13 PM

Quite honestly, closing the GP gap by private insurance is a great idea. I dont know why nobody thought about it a long time ago. It can solve many problems.