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RACGP President’s Medicare health check
Read what Dr Nicole Higgins said to Australia’s healthcare leaders at last week’s commemoration of Medicare’s 40th birthday.
Dr Nicole Higgins at the ‘Medicare: A Forty-Year Health Check’ event.
Last week, RACGP President Dr Nicole Higgins spoke at an event commemorating 40 years of Medicare. Below, newsGP reproduces an edited version of her speech.
Today we’re celebrating Medicare’s birthday – 40 years.
I want to begin on a celebratory note; Australia wouldn’t be in the enviable position it is today without Medicare. We have one of the best health systems in the world and rank highly on key indicators, including access to care, health outcomes and equity.
Medicare – just like general practice – is the foundation of our health system. Health and consumer leaders are working collaboratively and collectively with government for the future of our healthcare system.
We also have a health minister who has a deep understanding of general practice and the health system.
As the Minister said – before Medicare, many people simply went bankrupt or went without care when they got sick because they could not afford the health services they needed.
It was established to provide free public hospital care and to subsidise the costs of health services, including general practice, for all Australians.
Medicare changed the course of health in Australia.
It’s why we have higher life expectancy, and better health than many comparable countries – and people no longer go bankrupt if they get sick.
But 40 years on, after 10 years of cuts and neglect by previous governments, Medicare itself is sick.
Last year, general practice and primary care got a shot in the arm. It was the first time in decades that any government put money into Medicare.
My grandma always used to say that prevention is better than cure, but just 2% of health funding goes to preventive care and only 6.5% of healthcare funding goes into general practice.
Australian is increasingly falling into a ‘sick’ or ‘hospital system’, versus a ‘healthy’ or a ‘wellness’ system.
After 10 years of neglect by successive governments, the gap has grown too wide. Medicare first covered 85% of the costs of care, but today rebates don’t even come close to covering the full cost of providing care.
And when people can’t afford the care they need, they get sicker, present later and end up in hospital or ramped in an ambulance.
This costs taxpayers more. A typical GP consult costs taxpayers $40, whereas a hospital visit is $600 before a patient is even admitted.
Most importantly, we need to empower our consumers and improve our health literacy.
Funding drives outcomes
Most Australians don’t realise is that the Medicare rebate belongs to you, the patient – it’s your subsidy.
The rebate is the subsidy that the Government gives back to you after you have seen the doctor.
If the healthcare provider accepts the subsidy as the full payment for the service – then that is bulkbilling.
We have seen today with the announcement on bulk billing rates, especially in our rural and regional areas, what happens when you target funding to where it is needed.
The RACGP called for the Government to implement this important budget measure to provide urgent relief to the most vulnerable patients.
Now the data shows a 2.1% increase in bulk billing nationally since the incentives went live in November. There were even bigger increases in Tasmania – 5.7% – and regional Queensland – up more than 4%.
There are also indications that the gap between a patient’s rebates and the true costs of patient care has reduced in some areas – this means smaller out-of-pocket costs for patients.
We called last year’s Budget a gamechanger because it was the biggest investment in general practice care in decades. As I said, funding drives outcomes.
But we knew it was just the first step, a downpayment.
There is a long way to go to repair the decades of underfunding of Medicare and general practice, and more needs to be done to ensure care is affordable for all Australians.
Challenges to reform
Australia’s health reform journey is not without challenges.
We have a health workforce shortage. Currently 2500 pharmacists short, 100,000 nurses by 2025 and 11,000 GPs by 2031.
We spend $850 less per person on healthcare for rural Australians.
Our young doctors are not choosing general practice as a career of choice as it has been devalued and defunded.
Since I have taken on this job, I have found that the majority of our decision makers, funders and public don’t understand what we do or how we do it.
GPs are doctors who have spent at least 11 years of training to become specialists in whole-person care. As family doctors we support our patients physical, mental and social health.
GPs do the same medical training as any other specialist such as a cardiologist, gynaecologist, psychiatrist for the first eight years of study before branching off to do further training in the community.
Most go on to extend their skills in a wide variety of specific interest areas – from addiction medicine to ADHD.
We work collaboratively with other primary health providers to support our patients and funding.
Multidisciplinary care teams are key to managing an ageing population with complex chronic disease.
GPs play the critical role of the conductor.
We provide holistic patient-centred care from birth to death and know when to bring in the other specialists or allied health professionals to play their parts.
Without the conductor, it all falls apart.
But GP scope is held back by red tape and regulation. This means patients often need to pay a lot more and wait a lot longer to see other specialists for things GPs can do. And it costs the Government more.
We must avoid what we all don’t want. We don’t want a system like the UK, or US, where health outcomes are getting worse, because bad funding decisions mean people can’t get the care they need, when they need it and where they need.
The solution: GPs/general practice
We need to get these health reforms right, so we can meet the health challenges of today and the future.
Australia has an epidemic of chronic disease and an ageing population.
Our hospitals and emergency departments are overflowing. So, what’s the solution?
General practice and primary care is the cost-effective engine of our health system.
It helps people live healthier and stay out of hospital.
General practice gives the taxpayer good bang their buck – every $1 spent returns 60 cents of health system savings.
It is the most accessible and well distributed health service across Australia.
Each year, almost nine in 10 Australians visit a GP.
And less than 1% of people said they were unable to see a GP when they needed to, in our last Health of the Nation report.
The general practice workforce is one of the largest, with close to 40,000 GPs, and nearly 6000 GPs in training. And there are well over 7000 general practices across Australia.
So, we have the evidence, and the systems in place.
The Government’s national health reforms need to shift health funding so it’s keeping people healthy.
General practice care needs to be affordable for everyone.
The gap between patients’ Medicare rebates and the full costs of patient care needs to be reduced.
We need to get the funding mix right – fee-for-service, block funding and incentives.
This is vital to ensure vulnerable people can get the high-quality care they deserve and the practices that serve them stay viable.
Our health system needs to support the role of GPs, working in teams with other health professionals for our patients – giving the right care, at the right time.
We need a system where GPs aren’t bogged down in red tape and can spend the time they need with patients, and where once again, most medical students aspire to a career in general practice – and all the challenges and rewards it brings.
While we would love to fix everything in one go, we know we can’t.
We need to get it right.
We need to get it right, for all the Australians waiting too long for ambulances and in emergency departments, for things that could have and should have, been dealt with by a GP.
We need to get it right for our ageing population with more complex chronic disease.
We need to get this right for the health of our children and generations to come.
General practice once again needs to be a career of choice for our graduate doctors.
Just like Medicare, general practice and primary care is the foundation of our healthcare system and we need to invest so our footings are strong so that we can support the rest of the healthcare system.
The Strengthening Medicare Taskforce is a once-in-a-lifetime opportunity to change the system for the better – to be more cost-effective and delivering the care Australians need to live healthier and longer.
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Medicare Nicole Higgins RACGP President
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