Medicare structure worsens healthcare in deprived areas: RACGP

Jolyon Attwooll

23/02/2023 4:33:41 PM

The ‘systematic underfunding of general practice’ is contributing to poorer outcomes, the college has said.

Elderly man with crutches
There are access issues to general practice and other health professionals in deprived areas.

The structure of Medicare is hampering healthcare in Australia’s most poverty-affected communities, according to a new RACGP submission.
In its contribution to a Senate inquiry into ‘The extent and nature of poverty in Australia’, the college has outlined structural shortcomings that hold back optimum care in more deprived areas. 
Multimorbidity is much more prevalent in the lowest socioeconomic areas, the RACGP points out, with people much more likely to have high psychological stress.
‘The way that Medicare is structured means that where most people are unable to afford a co-payment for general practice care, longer consultations are required to manage the complexity, but this results in worse Medicare rebates per hour,’ the submission reads.
Noting that MBS patient rebates are used to pay staff and manage overheads, it then states these ‘have failed to keep up with the costs of business for many years now’.
‘Clearly, the income for GPs themselves is also reduced compared to their peers,’ it states.
‘The result is systematic underfunding of general practice, making it unviable in low [socioeconomic status] communities.’
The college also highlights access issues with other health professionals in the same locations, including those working in allied health and psychology, ‘again, because Medicare rebates don’t keep up with the cost of care and patients can’t afford co-payments’.
For there to be affordable care in areas of most need, substantial investment into primary care is required, according to the RACGP.
Targeted funding for patients with complex needs is one recommendation, as is a tripling of the Medicare rebate for bulk bulling incentives, which the college believes ‘would allow more general practices to bulk bill more patients who may struggle to afford care’.
The submission also outlines the impact of social determinants on health, including housing, education, the influence of secure work, air quality, and social inclusion.
‘The health consequences of poverty are well described the world over, and are no different in Australia,’ the authors wrote.
‘Poverty causes ill health through a range of social circumstances – so-called adverse social determinants of health, through limiting the choices and agency that people have over their own lives, and through reduced access to health services for a range of reasons.’
According to the RACGP, the inequities evident from the effects of COVID-19 are a recent example that ‘shows in concrete fashion how poverty impacts health in Australia, in a way that is predictable and preventable’.
The submission noted ‘a clear difference’ in how the disease spread in different communities, with the pandemic going ‘through the poorest areas of Sydney, enabled by poor overcrowded housing with limited ability to social distance’.
The report also cites data from the Australian Bureau of Statistics in 2010 which indicates that 11% of GPs at that time worked in the most deprived areas, while 24% worked in the least deprived areas.
‘Surprisingly, this data does not seem to have been collected since,’ they note.
The RACGP also backs improving and developing multidisciplinary and multi-agency care to address the complexity of the health issues involved.
‘GP stewardship of patient care in the community needs to be central to any health approach to poverty,’ the submission states.
While the college believes more equitable healthcare access can make a positive difference to outcomes in deprived areas, it also warns that the impact will be limited if unaccompanied by wider change.
‘Without broader action to alleviate poverty, healthcare services just become an unsustainable band-aid to treating the effects of poverty,’ the submission states.
The Senate inquiry is due to report by the end of October 2023.
Drs Tim Senior and Liz Sturgiss are the co-founders of a new Deprivation and Poverty Specific Interest Group. Members can join the group and other RACGP Specific Interest groups via the online membership form.
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MBS Medicare poverty Specific Interest Groups

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