National Press Club of Australia - Medicare Debate

A debate between health leaders at the National Press Club last week highlighted the need for increased funding for primary healthcare and revealed some challenges facing the government in its bid to reform Medicare.?

Following the recent release of the Strengthening Medicare Taskforce report, representatives of the Royal Australian College of General Practitioners (RACGP) and the Australian Medical Association (AMA) joined health economist Dr Stephen Duckett at the Press Club to debate the future of Medicare and general practice.

One clear area of agreement between the panellists was that general practice was under significant cost pressures, resulting from a 6 year freeze on rebate levels followed by inadequate indexation.

Dr Kerrie Aust, President-elect of the ACT AMA, described how Medicare does not support her to provide high quality care to many of her most vulnerable patients, including those in aged care facilities and people receiving palliative care who need home visits.?

She also expressed her concern that many of the medical students who undertake a placement with her are reluctant to choose general practice as a career due to poor remuneration and bureaucratic barriers.?

RACGP President, Dr Nicole Higgins, echoed these views and discussed how the current Medicare rebate system penalises longer and higher quality consults which are often required to treat patients with complex conditions. She also argued that Medicare has historically favoured procedures over cognitive medicine in its funding structures, putting GPs at a disadvantage compared with many other medical specialists.

Higgins warned that without a major funding boost, Australia is in danger of following the path taken by the National Health Service in the United Kingdom which she said had “traded off continuity of care for access”.?But she also made clear that she did not support a US-style health system in Australia.

Duckett, who has experience both as a health economist and senior manager in the health sector, agreed with the two doctors’ call for additional Medicare funding, arguing that the government will need to contribute more than the $750 million (over three years) allocated in last year’s October budget if it is to see major improvements in the sector.?

However, Duckett cautioned against directing this funding solely into rebate increases, arguing that this may not be the most effective way to increase bulkbilling.?Instead he argued for a net cost neutral restructuring of current payments to ensure they are better aligned with the health needs of the community and suggested that this could be achieved by diverting funding from some procedural specialist items in hospitals. Other measures suggested by Duckett were to restructure existing safety-nets to make them more equitable and to allow GPs to issue more repeat and longer prescriptions.

None of the panellists supported independent prescribing for pharmacists, arguing that it would fragment primary health care, reduce quality and cause potential conflicts of interest between the prescribing and dispensing roles.?However, Duckett did express support for an increased role for other health professionals within primary health care teams, as long as they were integrated into a cohesive system and supported greater continuity of care.??

All panellists rejected the proposal from Private Healthcare Australia for an increased role for private health insurance in general practice.

Minister for Health, Mark Butler, has committed to responding to the Taskforce’s recommendations in the May Budget.?This debate suggests that he will need to find substantial savings in his portfolio to top up the $750 million already allocated if he is to be successful in his bid for Medicare reform.??