The Australian Government has announced that the final report by the Strengthening Medicare Taskforce will be released in the next few weeks.
The document was developed by the Taskforce over several months, informed by modelling conducted for the previous administration, and will guide the government’s decisions in the May Budget to finalise investment in the Strengthening Medicare Fund, fulfilling an election promise.
Federal Minister for Health and Aged Care, Mr Mark Butler, made the announcement at a press conference held on 23 January 2023, noting that for the first time in Medicare history, the average gap fee for a standard GP consult is now more than the Medicare rebate fee itself.
“It has never been harder to see a general practitioner or a doctor out in the community than it is right now. We have heard that from Australians now for many months, and it has never been more expensive, particularly after six years of a freeze on the Medicare rebate,” Minister Butler said.
“Gap fees have skyrocketed over the last decade… And what this means is that too many Australians simply cannot get the care that they need, when and where they need it out in the community.
Minister Butler said the fact that while nearly two-thirds of Australians were still being bulk billed, the other third had to pay gap fees, was a major focus of the Taskforce.
“And that one third of Australians, a group that frankly appears to be growing and growing relatively quickly, are paying higher and higher gap fees because of that financial pressure on general practice, in particular, on Medicare generally, but particularly on general practice,” he said.
“We are also very focused on the fact it is not only harder to see, not just GPs, but specialists as well. We have seen those waiting lists blow out, and we have seen gap fees for specialists climb even faster and higher than gap fees have climbed for GPs.
“The MBS rebate freeze did not just impact general practice, there is financial pressure right across the healthcare system, and too many patients are feeling that in their hip pocket.”
Minister Butler also stressed that simply increasing Medicare rebates would not be sufficient to address the more complex needs being placed on the system.
“But I have also been clear that more of the same is simply not going to cut it. Strengthening Medicare means also modernising Medicare: we are going to have to look at the structure of the system that was built around much more episodic care, which was more prevalent 10, 20, 30 or 40 years ago than it is right now,” he said.
“What I want to do is be very clear with people: this is not easy; it is not going to be quick; and our government is not simply going to be adding more money to the existing system.
“We are about delivering a better, more modern system. And frankly that is the clear consensus of everyone from patients through the doctors, nursing, and other experts that I have been engaging with over the last several months.”
And while Minister Butler did not give a firm commitment as to whether the government will adopt one of the Taskforce’s known recommendations, to implement a blended model of care, his reply confirmed that for patients with complex chronic disease, the topic was the subject of substantial discussion.
“The idea of moving from a purely fee-for-service model that has largely defined Medicare over the last 40 years to something that’s more blended, that has more wraparound funding, particularly for older patients and patients with complex chronic disease, is not a new idea,” Mr Butler said, noting that the former government’s 10 Year Primary Care Plan also included more blended funding models.
“[They] will deliver better wraparound care for the sort of complex chronic disease that is much more prominent in Australia than it was when Medicare was first designed 40 years ago.”
He explained that, like many other countries, Australia could provide a larger lump sum that has flexible arrangements to treat patients with complex chronic disease.
“Obviously, we are not replacing and there is no one advocating for replacement of fee-for-service. Fee-for-service is still a very effective, efficient way to deal with many, many cases that people will want to go and see their GP about – an episodic level of care,” Minister Butler said.
“[But] the question is whether on top of the traditional fee-for-service system, you add some sort of flexible funding that allows doctors to provide wraparound care – not just directly between doctor and patient – but with nurses, with a range of different allied health professionals as well.
“I am very clear that there is much more that nurses in primary care – practice nurses and nurse practitioners, for that matter – can do. That they want to do, they have the skills and training to do -and our current MBS system is not letting them.
“And I think that will be something that comes through the Strengthening Medicare Taskforce report very clearly. “
Mr Butler also rejected the notion that Australia no longer has a universal health care system, thanks to the skyrocketing out-ot-pocket costs faced by nearly everyone accessing healthcare.
“Although I have been clear that Medicare is in, I think, the worst shape it has been in 40 years, it is also true that we have a healthcare system that is the envy of so many countries around the world.”