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Should primary care be free for everyone?
New research has put a pricetag on offering free general practice care for all, but while seemingly within reach the authors caution any changes would also need to primary care more sustainable.
Fewer than 1% of Australian patients said they were unable to see a GP when they needed to.
Amid a cost-of-living crunch which shows no sign of easing, researchers have proposed a radical policy shakeup which would see the Federal Government foot the bill for all GP visits.
Australian researchers say this plan is possible, but should it be done?
In a new study, they question whether primary care should be free for all, as well as what role private health insurance (PHI) should play given all Australians have access to Medicare.
According to the study’s calculations, it would cost $950 million each year for the Commonwealth to cover the cost of all non-bulk-billed primary care visits.
They say this would decrease to $700 million if only accounting for face-to-face visits.
That is compared to this year’s total Federal Budget health spend of $8.5 billion, with around 7% of this allocated to general practice.
‘Does the Government have the capacity to do this? Yes, the current Government has committed to investing $3.5 billion in the next five years, to pay general practitioners through the recent triple bonus incentive program, which amounts to $700 million a year,’ the research said.
‘Can the current triple bonus policy get us there? The answer is no, by current design.’
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, told newsGP the research shows the ‘bang for buck’ GPs are currently providing.
‘The figure of $950 million to cover all of the out-of-pocket costs for GP services I think is pretty amazing considering GPs provided over 165 million visits last year,’ he said.
‘The cost will no doubt have gone up in the last year or two, but I think it’s a pretty good indication of the cost restraint that GPs show for our patients.
‘There is a real cost-of-living crisis for general practices, as there is in the community, and these figures are really showing how GPs are trying to be responsible and providing care for the community while keeping their out-of-pocket costs to a minimum.’
According to the paper, which uses the greater Melbourne area as an example, patients pay between $46 and $56 if they live in areas with the highest quartile of out-of-pocket costs, while in the lowest quartile, they pay between $30 and $37.
‘For some people, especially the poor and those with multiple chronic conditions, this becomes too expensive, so patients forego primary care and wait until conditions worsen to use free public hospital and emergency room care which are covered by Medicare,’ the paper said.
Last year, it was revealed that the number of patients who delayed or did not see a GP doubled last year, and it is young people who are most likely to skip care.
In an accompanying analysis, author Professor Yuting Zhang said introducing these free GP visits for all would require careful consideration, as it would most likely bring with it extra consultations.
‘This might be a good thing, particularly if people had previously skipped beneficial care due to high costs,’ she said.
‘However, it may encourage more people to see their GP unnecessarily, taking away limited resources from those who really need them.
‘This could ultimately increase wait times for everyone.’
Dr Michael Wright says it is important to minimise the barriers people face when trying to access general practice care.
The proposal comes at the same time as bulk billing rates are beginning to bounce back, with last year’s tripled bulk billing incentive leading to a 2.1% increase in subsidised visits.
Almost 78% of GP consultations in March involved no patient payment.
And while this is proof that ‘funding gets results’, according to the RACGP, it also comes at a time when GPs are busier, more burnt out, and more stressed than ever.
Already, around 90% of Australians visit a GP each year and less than 1% are unable to see a GP when they need to.
But as practices close at an alarming rate across Australia and 71% of GPs report feelings of burnout in 2023, is there room for an influx of consultations?
Dr Wright said many GPs would like to offer cheaper visits for patients, but that is often contingent on greater government support.
‘General practice is essentially the front door to the health system for most Australians, it’s where we get our primary care, it’s where most of us get our initial assessment and diagnoses, so it is important that people are able to access that care with the least possible barriers,’ he said.
‘The inadequate Medicare rebate is the real barrier, so if governments could invest more into supporting GPs to provide the comprehensive care we need, that’s going to reduce these gaps for patients, make it more affordable, and support the financial viability of practices.
‘When you look at the whole of general practice , it’s charging a relatively small amount for its out-of-pocket fees and it means GPs are not passing on great costs to patients. With some proper government support, those out-of-pocket costs could be even further reduced.’
Turning to PHI, researchers found its rebates are most effective for the bottom 25% of earners, and not effective for others currently receiving rebates.
Currently, the Commonwealth spends $6.7 billion each year as rebates to encourage individuals to buy PHI.
‘One of the main arguments for encouraging Australians to buy PHI is to free up capacity in the public system, so even those who cannot afford and do not buy PHI can still benefit from more people having PHI,’ the paper said.
‘Is this true? No, not really, partially because surgeons are paid much more in private hospitals than public hospitals; if they spend more time in private hospitals, they will spend less time in public hospitals.
‘We recommend that the Government reduce public support for PHI in the long run.’
Ultimately, the research concluded that low-income people and children should get free primary care regardless of where they live, that the copayment for the general population could be lowered to $20, and called on the Government to design a policy to reduce unnecessary GP visits.
It also said that if Medicare covers all primary care services, the Government should have a role in negotiating prices with healthcare providers, including GPs, as is done in other countries.
However, the researchers stressed that any changes must strike a balance to make primary care more affordable, but also more sustainable.
Dr Wright said if governments say they cannot afford to give free GP visits to all patients, funding should be targeted to those who have the highest needs.
‘We talk about this idea of having universal health coverage, and in the ideal world, everyone would have access to care that they need without costs,’ he said.
‘But with the gradual defunding of general practice services, we’re increasingly seeing a two-tier system where, unfortunately, those who can afford to pay out-of-pocket costs are paying them, and those who can’t are potentially getting worsening access.
‘We know that investing in general practice services keeps people out of hospital, keeps them well in the community, reduces use of emergency departments, reduces use of hospitals, and improves mortality, so by investing in general practice, you get all these benefits.’
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