Medicare turned 40 this week, and like many Australians the same age, the system is showing signs of strain.
It is struggling to cope with the soaring costs of healthcare within the wider context of global and national inflation – a fit for purpose mid-life crisis.
A brand-new commemorative card has been announced by the Government, attracting the ire of political figures and health commentators, such as Greens leader Adam Bandt’s commentary that with the current cost of living crisis, “people just want accessible healthcare.”
“Imagine rolling out a novelty Medicare card on an easel, when under your government people can’t afford to see the doctor or buy the medicine they need,” he said on social platform X. “Honestly. The disconnect.”
However, a piece published in The Conservation by the Grattan Institute’s former Director of Health and Aged Care Program, Professor Stephen Duckett, outlined that given the history of Medicare, the system deserves the same hard-won respect as any Aussie battler.
He said it needs three key reforms to save it: “making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care.”
“One of my first jobs in the health system, in the days before Medicare and Medibank, was acting in charge of revenue collection for three public hospitals. A small subset of people could get free, albeit stigmatised, care,” he wrote.
“We had bad debts, because some people couldn’t afford to pay their hospital bills and I was allowed by policy to recommend that some be written off, but for others I had to seek court authorisation to seize their wages to pay off their hospital debt.
“Medibank changed that – now all Australians can get public hospital care without any financial barrier.”
However, he noted, corporatisation has had as negative an impact on Australian’s affordability and access to healthcare as the gradual dismantling of the Whitlam government’s Medibank, by the Fraser Liberal government.
“When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service,” Professor Duckett said.
“Over time, general practice evolved into group practices organised as partnerships. Next, they consolidated and corporatised. A handful of corporates now provide all private pathology (which tests blood and other tissues) and radiology (which provides imaging services) and a large proportion of GP care.
“Corporates have not made the same inroads into most other specialties.”
He recommended that the first step in reducing costs as a barrier to GP care should be introduction of independent fee-setting, such as the Canadian model.
“With independent fee-setting in place, a new scheme of “participating providers” should be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs,” Professor Duckett said.
“It is anticipated most practices would agree to participate. In Canada, the participation rate is roughly 100%, and bulk billing in Australia is still over 75%.”
Second, the uncapped fee-for-service model for pathology and radiology needs to be replaced with a payment model already used in the corporate world.
“Private and public providers could be invited to tender to provide these services in certain areas, with conditions around geographic access, quality, and no out-of-pocket payments for consumers. The same model could also apply to other technology-intensive types of health care, such as radiotherapy for cancer,” Professor Duckett explained.
“[Finally], a new scheme to slowly expand universal protection against the costs of oral health care should be phased in over the next decade.
“This would require a parallel expansion of the oral health workforce (dentists and oral health therapists) and development of new payment models based on a participating practice model rather than simply introducing another unregulated schedule of oral health fees paid via Medicare.”
Please follow the link to read the original article, Medicare turns 40: since 1984 our health needs have changed but the system hasn’t. 3 reforms to update it.