Whilst there were no surprises unveiled in the Strengthening Medicare Taskforce report, the key messages were clear.
Australia needs to improve access to general practice and primary care, as well as non-hospital-based services after hours, and any reforms should aim to strengthen the relationship between patients and their primary care team, according to a new report.
The Minister for Health and Aged Care, Mr Mark Butler, released the report on Friday 3 February 2023, drawing attention to the fact that Australia’s healthcare system is currently dealing with much more chronic disease, ongoing need, and an increasing number of older Australians who tend to have more than one healthcare condition.
“Medicare is one of this country’s shining stars, and it is the backbone of our healthcare system. But it is simply not delivering the sort of care that Australians need in the 2020s,” Minister Butler said.
“Our government has no higher priority than strengthening Medicare and rebuilding general practice to ensure that Australians get the care they need when and where they need it in the community to take pressure off our deeply stressed hospital systems.
“After nine long years of cuts and neglect to Medicare – particularly that 6-year Medicare rebate freeze – I want to tell Australians honestly, it is not going to be quick and it is not going to be easy, and it is not going to be fixed in one Budget.
“But this report sets a very clear challenge to Government about how we start to turn things around in general practice and primary care more broadly. And this Government is up for that challenge.”
Minister Butler did not rule out increases to the Medicare rebate, however, he noted that most commentators and stakeholders are very clear that the current system does not fit the needs of Australians.
“As I think the National Cabinet said, it is not just about more money – it is about getting the settings right, it is about getting the policy right. Those are the clear messages in this report. There needs to be reform,” Minister Butler said,
“Affordability is a clear challenge and, of course, as a Labor government, we are considering a whole range of options about the Medicare rebate as well as all these reforms. There are quite specific recommendations here, and they will now go into a Budget process to determine how we spend that $750 million.
“And that will become clear on Budget night (1 July 2023).”
Minister Butler acknowledged that the figure was not enough to fix things in and of itself.
“I know this is not a single Budget challenge, I know there will be more to do. As National Cabinet said, though, this is not a question of just chucking money at the existing system: the system needs to change to reflect the care needs of the Australian population,” he said.
“Yes, you need more investment, but you need to sequence that [system change correctly], to make sure that people do not fall between gaps as you are changing from a system that is overwhelmingly fee-for-service, to one that delivers much more wraparound care with the possibility of blended funding models.”
However, one exception was the recommendation to improve the ability of GPs to be able to bill for longer consults, reflecting the more complex nature of so many presentations by their patients, particularly around mental health.
“We know from advocates who have talked to us over so long that particularly women dealing with family violence and a whole range of associated health issues often need to spend more time with their general practitioner than just 40 minutes,” Minister Butler said.
“Longer consults are a clear recommendation of this report.”
Significantly, the report also recommended much better support for general practices and other primary care businesses to be able to employ and use nurses and allied health professionals.
“[This was] a very clear, and perhaps the most significant recommendation from the Taskforce report,” Minister Butler said.
“There is a critical need to use our health workforce more fully, and to allow all our healthcare professionals who are trained – at vast community expense – to operate at the full scope of their practice, to use all of their skills and all of their training rather than being restricted by outdated regulations and, frankly, too often, turf wars between different groups within the healthcare system.
“The third message from the Taskforce is we have got to do better on digital health in this country: we have almost countless different clinical information systems operating at state level, Commonwealth level, and in different parts of the private sector. And they generally do not talk to themselves at all or, if they do, they do not talk to themselves very well.”
He said that while My Health Record is now used by 23.5 million Australians, if it is genuinely going to be the centrepiece of a connected digital health system, there is an urgent need to improve its functionality.
“Currently, it is a pretty outdated, clunky, pdf format system that needs to be able to underpin a real-time, fully-integrated digital health system,” Minister Butler said.
“We recognise that the Commonwealth has the first responsibility to move here and to upgrade the nature of the My Health Record.
“But we also need other health professionals to connect to it: GPs and pharmacies are particularly good at this and about 99% of them or more are connected to My Health Record and upload to it regularly, [however], only 11% of specialists do, and only about 20% of diagnostic imaging (X-rays and CT scans) are uploaded.
“So, time and time again, a patient goes to their doctor, talks about their conditions, and their tests are not available for the GP to look at and use as part of their diagnosis and treatment decisions. We have got to do better there.”
“And finally, in terms of access, we need to strengthen the relationship between patients and their primary care team – really strengthening and, in many ways, formalising that relationship.”
The Minister also pointed out that there were around 200 measures in the Health and Aged Care portfolio that were not fully funded through the forward estimates.
“These are not pilots, these are ongoing programs that have been operating for years and, in some cases, even decades that were simply not properly funded by the former government,” Minister Butler said.
“We might not accept every single recommendation right now, but this is a really good set of [suggestions] that the ERC and the Cabinet can get their teeth into, and we recognise the need to deliver on this Budget with funding flowing from the 1st of July 2023.”
But as one journalist at the press conference lamented, there is still a lack of specific details available – doctors and reporters will both have to wait for the new Budget to be released to find out more.