Federal Budget a Saviour, but not a vision for Australian Healthcare

A comment on the recent Federal Budget

Saving Australia's Healthcare System

The 2023/2024 Budget is showing a promising first step towards changing the foundations of our healthcare system to something more sustainable. New bulk billing incentives of $3.5b are coming to the rescue of our primary care system, $732.9m is put towards improving the NDIS which includes better fraud control, and the $11b funding of the 15% wage increase for aged care workers is certain to save a lot of residential aged care homes.

While all this is a massive effort in making sure our existing healthcare system continues to work under the strains of an ageing population, a mental health pandemic, and increasing chronic illnesses, there are very few movements towards a digitally enabled modern healthcare system.

Enter MyMedicare

The only indication for real change is the introduction of voluntary patient registration with GPs, under the term "MyMedicare". This is supposed to encourage stronger relationships between patients and their primary care teams - though the details of this are still pretty vague. It says that in return for registering with a GP practice, patients and their care team will be able to access additional funding packages, tailored to their health needs.

MyMedicare is supposed to include easier access to telehealth consultations. I’m going to speculate here that this probably means that registered patients can receive telehealth consultations even if they haven’t seen their GP in person once in the last 12 months. There are some positive aspects related to this. It might lead to rural and remote patients registering with a GP of their choice in order to not have to travel to a GP practice for receiving care. But it also means that they cannot get reimbursed for services by other GPs where they are not registered, limiting patient choice.

MyMedicare might also be useful for patients with chronic illness where clinicians want to use approaches that are not currently covered by Medicare reimbursements. I'm speculating again, but maybe they can make use of remote patient monitoring where medical devices or mobile apps are being used by the patients themselves to keep track of their health and share their data with their GP. This would be quite a step forward in digital care.

But unless there is guidance as to how GPs should use MyMedicare with patients to offer them better care, I doubt it will lead to the stronger GP-patient relationships that the government is envisaging. It didn't work in the previous similar experiment of Healthcare Homes . Hopefully, we have learnt from that experience and don't repeat the same mistakes.

I suggest we give MyMedicare a visionary goal such as: it should demonstrate the digital transformation of care. We can then support the GP practices in achieving this goal through different approaches.

Telehealth Regression

One area where we have gone backwards in telehealth is in the provision of patient-end support during telehealth consultations. Before the pandemic, patients would be able to sit with their GP while receiving a telehealth consultation with a specialist and both the GP and the specialist would get reimbursed for it. This led not only to better access to care for people that are finding it difficult to deal with technology, but also to better team care between the specialist and the GP and therefore better health outcomes and in fact more efficiencies in the system. People that cannot access digital care now more often than not end up in emergency rooms of hospitals.

MyMedicare might enable such a team care model with patient-end support services provided by GPs. Note that I am speculating again and I dearly hope that the government has put a lot of thought into how MyMedicare will actually help patients and not just create more documentation effort for clinicians.

Aged Care Regression

The lack of availability of patient-end support services also applies to patients in residential aged care facilities whose nurses are often overwhelmed with the needs of patients and don’t have enough time to help them through a telehealth consultation. These nurses urgently need Medicare reimbursements for their patient-end support services to allow scaling of telehealth in residential aged care. This is not covered by MyMedicare or by any other scheme that the government released in this budget.

Where To From Here?

In summary, my observation is that the introduction of MyMedicare and the help for RACF staff salary increases are a great step in the right direction and will provide some relief for practitioners but the impact on patients will be one of maintaining existing services rather than digitally transforming healthcare.

I'm holding out hope that the next budget will be a budget for a digital future of our healthcare system!