Labor backbencher and doctor Mike Freelander fears his government’s slow pace on Medicare overhaul could send Australia back to a two-tier system in which healthcare is determined by what patients can afford.
Prime Minister Anthony Albanese last Friday presented a blueprint for overhauling general practice to a national cabinet meeting of state and territory leaders but delayed any announcements until the May budget.
Doctors groups were quick to condemn the government’s lack of urgent measures to increase the Medicare rebate or resuscitate the GP workforce amid declining bulk-billing rates, which fell by 3.6 percentage points in the last reported quarter alone.
Freelander, a paediatrician who started his medical career six years before the introduction of Medicare in 1984, said he had expected the Labor leadership to introduce more immediate changes considering the six-month consultation process that informed the Strengthening Medicare taskforce report and long-standing warnings about the ailing primary care system.
“As someone who has worked in the health system for 50 years – who saw firsthand the difficulty people faced accessing care before Medicare, and even [its predecessor] Medibank – I am deeply concerned about the lack of urgency in acting to support general practice, in particular,” he told this masthead.
“The time for urgent action is well passed. Doctors don’t want to have a fight with the government but we are seeing increasingly inequitable access to healthcare. The [health] department has been aware for many years and has not approached [the problem] in any systematic way.”
Freelander said declining bulk-billing rates and rising out-of-pocket gap fees meant the health system was increasingly looking like it did when he started practising. “Your credit card will determine your access to care, which would be a tragedy,” he said.
Labor MP Gordon Reid, a former emergency department doctor who entered parliament last year, said primary care needed to be the government’s top priority. “I think we have a responsibility to be working harder in primary care and general practice,” he said.
“Even with the [Strengthening Medicare] report there, we need and can be doing more as a government.”
Independent MP Sophie Scamps, a former GP, said she welcomed “the fact this government recognises that Medicare is under threat and general practice in crisis” but also wanted rebates raised and measures to attract more doctors to general practice.
Health Minister Mark Butler has begged for patience as the Labor government embarks upon its election promise of strengthening Medicare.
The taskforce report recommends a move towards a blended funding model in which a clinic would receive lump sum payments in addition to Medicare rebates to employ practitioners such as nurses or physiotherapists.
“After nine long years of cuts and neglect to Medicare – particularly that six-year Medicare rebate freeze – I want to tell Australians honestly, it’s not going to be quick and it’s not going to be easy, and it’s not going to be fixed in one budget,” Butler said last week.
But Freelander said several reports and inquiries had given governments the same advice. The 10-year primary care plan developed last year for the Coalition government, for example, also recommended GPs be given extra funding for “multidisciplinary, team-based care”.
Another Primary Health Reform Steering Group appointed by the Coalition in 2019 recommended allied health workers such as mental health nurses, social workers, dieticians and physiotherapists work in GP clinics.
The backbencher called for more urgent interventions to boost the dwindling GP workforce and lift the morale of the profession, such as increasing Medicare rebates, offering free training for GPs in hospitals or waiving university fees.
Eminent health economist and former Health Department head Stephen Duckett, speaking at the National Press Club on Wednesday, said the government should commit to indexing the Medicare rebate and cost-neutral restructuring of payments in the May budget, to show the profession more money would flow.
He also called for more clarity on workforce issues. “We haven’t articulated clearly what our objective is with respect to the health workforce,” he said.
Butler on Wednesday said he would not pre-empt the government’s budget measures around boosting the GP workforce, and he wanted to have further conversations with health ministers and doctors’ groups about distribution.
“We want to make sure we get the supply of the workforce right … I don’t think we’re ready to jump to a particular number of additional graduates added to the existing system,” he said.
His office declined to comment further on the criticisms.
Freelander, who has been the MP for Macarthur in south-west Sydney since 2016, said it was in outer-metropolitan electorates like his, as well as in remote and rural areas, where GP shortages and lack of access were felt most acutely.
“This affects our [Labor] electorates much more than the Liberals. We can’t keep kicking the can down the road,” he said.
“This will increase the difficulties in attracting people in general practice and, because of that, a dire shortage of GPs in the most disadvantaged areas. ”
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