Medicare wellbeing scrutinised at National Press Club

A wide-ranging discussion on the challenges facing Medicare took place at the National Press Club on Wednesday, with RACGP President Dr Nicole Higgins telling reporters how more investment in general practice will help ensure no patient gets left behind.
 
One of three guest speakers, Dr Higgins appeared on a discussion panel considering the question ‘Medicare – is it fit for purpose?’ alongside University of Melbourne health economist Dr Stephen Duckett and the President-elect of AMA ACT, Dr Kerrie Aust.
 
The event was arranged to follow the release of the Strengthening Medicare Taskforce report last week.
 
Dr Higgins began proceedings by warning that while Australia’s healthcare system is ‘one of the best in the world’, that position is at risk following years of primary care being ‘sadly neglected’.
 
‘We are being asked to do more for less,’ she said.
 
‘GPs can no longer afford to subsidise patient care. The Medicare rebate hasn’t kept up with the cost of providing that care.
 
‘We reward procedural medicine over cognitive medicine, we spend a fortune on hospitals, and we starve general practice.’
 
The RACGP President said there is a ‘vast difference’ in expenditure per person on general practice compared to the hospital system, with just over $443 per year spent per person in general practice, compared to more than $3000 per person on hospital care.
 
Dr Higgins also highlighted the pressures on rural general practice, referencing clinic closures particularly in rural and remote areas such as the Northern Territory.
 
She called the proposed payroll tax on tenant doctors ‘the biggest threat to any Federal Medicare reform’.
 
‘What this will do is force GPs to uncouple from Medicare, and that’s already happening, and pass that cost on to patients,’ she said.  
 
‘This will hit our most vulnerable and bulk billing will be killed off overnight.’
 
According to the RACGP President, whole health sector reform is necessary, with an injection of general practice funding needed for multi-disciplinary healthcare stewarded by GPs, which would also help to reduce gap fees for patients.
 
She also called for an increase in the number of GPs and remarked upon the declining interest in general practice since she had qualified.
 
Many of the same concerns were expressed by Dr Aust, who emphasised workforce shortages and the recruitment issues general practice faces.
 
‘I was reading this morning about a doctor who used to have 14 GPs in his rural practice, and now there is one,’ she said.
 
‘And when he retires, that community is going to be left without a GP.
 
‘I see medical students in my clinic each week, and some of them have a real affinity for general practice. It’s beautiful to see.
 
‘And then I say, “Hey, how about general practice? I love it. Come join us when you’re done.” And they say, “no, there’s too many barriers, it’s too hard”.’
 
The final speaker was Dr Stephen Duckett, a University of Melbourne health economist who was one of the members of the Strengthening Medicare Taskforce, along with Dr Higgins.
 
Dr Duckett said he agreed with the other panellists that primary care ‘should be the foundation of the health system and it is under threat’.
 
‘More money needs to be invested in primary care – significantly more than the $250 million per annum that the Government put on the table in the last election,’ he said.
 
However, he queried whether increasing Medicare rebates – a move that GPs have said will make the most difference to fix the system – will have the desired effect.
 
‘Simply increasing rebates may not end up with increased bulk billing rates and does not progress the structural form necessary for contemporary primary care,’ he said.
 
According to Dr Duckett, the bulk billing decline has led to governments considering alternatives such as autonomous pharmacist prescribing, a development he described as ‘unfortunate’, along with ‘telehealth disruptors’, given his preference for ‘an integrated primary care system’.
 
‘Again, unfortunate in my view, but the horse has bolted on both changes,’ he said.
 
He called for ‘an immediate down payment’ towards primary care in the May Budget as well as ‘very clear signals’ that more will come in the very near future.
 
In response to a reporter’s question about what it would take to fix the system, Dr Higgins called for an immediate rebate rise of 20%.
 
She cited a Pricewaterhouse Coopers report outlining the potential benefits of greater general practice investment.
 
‘Now, just a little bit of context,’ she said.
 
‘There [was] $2 billion ripped out of general practice during the Medicare freeze. The cost of running the hospital in the Gold Coast – one hospital in all of Australia – is $2 billion per annum, so we need to get some perspective around what investment looks like and how much money we’re spending.’
 
The RACGP President said that tripling the bulk billing incentive – a key advocacy request from the college – would lift bulk billing rates and help more vulnerable patients access care.
 
Another question probed at the influence of the rise in rise in corporate ownership of general practice, with Dr Duckett saying it is having an impact.
 
‘In corporate ownership, the bottom line becomes extraordinarily important,’ he said. ‘And so response to the divergence of the cost of providing care, and the revenue you’re getting through bulk billing becomes more and more important.
 
‘I think the corporate ownership makes the situation way more acute.’
 
Dr Higgins said she opened her own clinic in Mackay to give fellow GPs in her area the opportunity to conduct the type of medicine they wished to practice. She referenced the college’s call for longer consultation funding, which was one of the headline recommendations from the Strengthening Medicare Taskforce.
 
‘There’s different corporates, and there’s different styles,’ she said. ‘But that model that we’re describing is actually driven by the funding of the system which rewards high throughput, rapid medicine.
 
‘Because … the longer you spend with a patient, you’re penalised as a doctor. So it’s the model that’s actually the problem, and that’s part of the reform that we’re asking for.’
 
The full National Press Club speeches and panel discussion are available on ABC iView.
 
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