Senate Committee pushes for ‘substantial’ Medicare rise

Jolyon Attwooll

4/04/2022 12:12:55 PM

The inadequacy of MBS rebates, which have tracked well below health service costs, is a key focus of a new report.

Australian money with stethoscope
A Senate Committee report describes Medicare rebates as a 'disincentive' for medical students to become GPs.

A cross-party Federal Senate Committee has said the Government should consider ‘substantial’ increases to Medicare rebates.
The Community Affairs Committee made the recommendation in its interim report on the provision of general primary health services in outer metropolitan, remote and rural Australia.
The report was published last Friday, with authors acknowledging that the current environment is ‘actively playing a role in dissuading individuals from becoming a GP and living and working in outer-metropolitan, regional, and rural locations’.
Its proposal for the Federal Government to investigate ‘substantially increasing the Medicare rebates for all levels of general practice consultations’ was welcomed by RACGP President Clinical Professor Karen Price.
‘Medicare rebates for patients simply haven’t kept pace with inflation and the cost of providing high-quality general practice care,’ she said.
‘For too long, general practice care has been taken for granted.
‘By increasing patient rebates and boosting general practice funding, we can give primary care a much-needed shot in the arm and relieve pressure on the nation’s health system.’
GPs have consistently stated the level of Medicare Benefits Schedule (MBS) rebates, which were frozen for four years from 2013–14, are a major problem threatening the future of general practice and primary care in Australia.
In its report, the committee expressed a deep concern at hearing of a structure that ‘does not recognise [GPs’] skill and expertise, nor provide appropriate renumeration for their services’.
It said the existing level of Medicare rebates acts as a ‘disincentive’ for those looking into a career as a GP, and noted the long, ongoing decline in the number of medical students choosing general practice.
Only 15.2% of medical students were considering general practice as a first option in 2019, the RACGP’s most recent Health of the Nation report shows.
The committee also describes the financial issues facing primary health providers as ‘deeply entrenched’ and suggests the return of MBS indexation is not enough to address the problems.
Challenges facing general practice viability appear ‘exacerbated’ in non-metropolitan areas, the report states.
The recommendation to increase Medicare rebates is one of nine put forward (see full list below).
The report, released in the final sitting week of this Parliament, also calls for a review of the Modified Monash Model and urges that outstanding exceptional circumstances applications for Distribution Priority Areas be looked into ‘as a matter of priority’.
According to the committee, the Department of Health (DoH) should work out a benchmark for the ‘optimal distribution of primary health professionals’ and review the effectiveness of the Stronger Rural Health Strategy.
Changes to medical education to ensure general practice is ‘a core component’ of the curriculum are also suggested, along with measures designed to bring more medical students to rural and regional general practices.
The final recommendation suggests the Government look into the adequacy and suitability of the Australian General Practice Training placements allocated to training colleges.
The Senate inquiry was called in August 2021, and attracted a wide range of submissions from academics, advocacy bodies, individual GPs, general practices, other medical practitioners and patients.
Six public hearings have also been held last November, including appearances from Clinical Professor Price and RACGP Rural Chair Dr Michael Clements.
Clinical Professor Price noted the report is not the final version and more work remains before the recommendation for Medicare increases is put in place.
However, she called the document a ‘small but important step forward for general practice’.
The committee, in the meantime, noted the shortage of primary care providers in some areas as a long-standing and complex issue, and said the Government had already provided a significant amount of funding to address the problem.
‘However, it is not appropriate that Australians living in outer-metropolitan, regional, and rural areas are suffering the consequences of this maldistribution,’ the report reads.
It also states that current policies are not helping communities with an immediate need for primary healthcare workers.
The committee’s final report is scheduled to be delivered by the end of June this year.
Recommendations in full:
Recommendation one
The committee recommends that the Federal Government further investigates the provision and distribution of general practitioners in rural and regional Australia.
Recommendation two
The committee recommends that the Government’s review of the Modified Monash Model is open to public consultation, including from communities themselves, and is progressed as a matter of priority.
Recommendation three
The committee recommends that the Department of Health and the Distribution Working Group assess the outstanding exceptional circumstances review applications as a matter of priority.
Recommendation four
The committee recommends that the Department of Health develops benchmarks for the optimal distribution of primary health professionals.
Recommendation five
The committee recommends that the Department of Health conducts a comprehensive and holistic review of the Stronger Rural Health Strategy and that performance benchmarks be established to assess the effectiveness of the overall strategy and of its programs.
Recommendation six
The committee recommends that the Federal Government investigates substantially increasing the Medicare rebates for all levels of general practice consultations, as well as other general practice funding options.
Recommendation seven
The committee recommends that the Department of Education, Skills and Employment, in collaboration with universities, reviews the primary care components of the medical education curriculum, with a view to ensuring that general practice is a core component of the curriculum.
Recommendation eight
The committee recommends that the Department of Health expands the John Flynn Prevocational Doctor Program and re-instates the John Flynn Placement Program aimed at attracting medical students to rural and regional general practice.
Recommendation nine
The committee recommends that the Government investigates the adequacy and suitability of the Australian General Practice Training placements allocated to the relevant general practice training colleges.
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Dr Suresh Gareth Khirwadkar   5/04/2022 7:22:45 AM

But why do we still have antiquated time based numbers rather than non time based like other specialists? It causes much consternation at the front desk when patients, admin not GPs know how much a patient’s consultation is going to cost them in advance. It’s not fair on anyone. It also creates a system that is hugely open to abuse from PSR whereas a much more simple rebate system would be more transparent, less unwieldy and would create fewer problems and complaints. Patients can choose where to go and they can choose based on quality of care and service provided with more transparent costs all around.

Dr Christopher John Hazzard   5/04/2022 8:39:24 AM

There is no doubt that the lack of funding for general practice makes it la less desirable option for young doctors.
I am at the end of my career as a GP and now work for the love rather than the money. I have worked in rural medicine and it was a fantastic experience but hard and at times I felt very isolated and unsupported.

Dr Akash Samtani   5/04/2022 9:47:48 AM

Unfortunately the Australian health system encourages and rewards 'procedures' far more than 'words'. That's what most of us ordinary GP's do during our working day-'talk'. The extreme discrepancy in remuneration between a GP and a Specialist will ensure that very few young graduates choose it as a specialty. When I graduated in the UK in 1990, 70% of my cohort chose General Practice as a career. Nowadays, cutting out lots of skin lesions at the many pop up skin clinics, cosmetic procedures are far better paid for young doctors. Fragmented, piecemeal healthcare where the wealthy hop from specialist to specialist and private hospitals with the occasional trip to their private 'GP' will become the norm. The middle to lower socio-economic groups will continue to rely on bulk billed GP's for the majority of their healthcare in addition to public emergency departments and long public sector waiting lists. Us oldies will just aim to retire as soon as we feasibly can.