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Health Minister Mark Butler has exposed the simple problem with Medicare that is causing GPs to abandon mass billing en masse, while announcing a total overhaul of the 40-year-old universal healthcare system.
Amid fears from some doctors that Medicare will completely collapse, Butler said Monday that the problem is that “the average gap fee is now more than the reimbursement from Medicare itself.”
‘What this means is that too many Australians simply cannot get the care they need, when and where they need it, in the community.’
Bulk billing rates plummeted seven percent last year and continue to fall as general practices charge higher fees to supplement Medicare reimbursements.
Wait times for GP appointments have skyrocketed to over a month for some doctors as demand increases due to population growth, while the number of GPs declines as more doctors they move on to more lucrative specialized fields.
Medicare will undergo its most significant overhaul since its inception. Above, Prime Minister Anthony Albanese in a pharmacy.
Australia’s population is also aging rapidly, meaning more patients are living longer but need treatment to manage chronic conditions.
As a result, many people go to hospital emergency departments for routine problems because they cannot access a GP.
The increase in gap fees meant that experts and the government feared that without serious reform, access to primary health care would be out of reach for millions of Australians.
Medical experts also worried that the entire Medicare system could collapse under the weight of fewer general practitioners, higher operating costs for surgeries and a population that is increasingly expensive to keep healthy.
“What we know we have to do is fix primary health care,” Mr. Albanese told Sunrise.
“The biggest thing we’re looking at is how to take the pressure off the system, and we’re doing that: talking to the AMA, talking to the Royal Australian College of GPs, talking to experts because we want to make sure that this Medicare group is heard. worked.
Health Minister Mark Butler told The Australian the system was in “real trouble”, stuck in the 1980s and 1990s, and no longer made sense.
He explained that in the last few decades, when the system was designed, healthcare was mostly about treating acute conditions like injuries and unique illnesses.
But as Australia’s birthrate dropped and its population aged, doctors were spending more and more time treating chronic conditions in older patients.
Australians are also living longer, so the time they need to access this type of care has increased, rather than dying before it becomes a problem.
Chronic patients have very different needs than the acute ones Medicare was designed to meet, including longer visits and more frequent visits.
They also need access to allied health professionals such as dietitians, physical therapists, and chronic disease experts to adjust their lifestyle and provide specialized care.
Australia’s population is also aging rapidly, meaning more patients are living longer but need treatment to manage chronic diseases.
All of this is more expensive and requires more coordination between doctors that is not well supported by the Medicare funding system.
Nurses, who have the training to perform a wide variety of treatments without the involvement of a doctor, are also underutilized.
Medicare financing rules require that patients be seen by a doctor, or the treatment will not be covered by Medicare and the practice has to absorb the cost.
“Nurses can provide a lot of care that can meet the needs of patients in the day, but currently, with a fee for service, they have to see the doctor, otherwise nobody gets paid,” explained the president of the association. Australian Primary Health Care Nurses Association, Karen Booth.
The government admitted that the government system that subsidizes individual consultations through GPs is no longer fit for purpose.
“We need physicians to work hand-in-hand with nurses, health professionals and pharmacists,” Butler said.
“The system is not well designed to allow them to do that. Clearly, an expansion of multidisciplinary care is key to managing chronic disease.’
Nurses will be trusted to play a greater role in primary care as there are fewer GPs and a growing and aging population.
The new model would allow nurses and related health professionals to work in teams to deliver complex care and receive subsidy payments in the same way that GPs do.
Instead of a strictly ‘fee for service’ model, practices would get blocks of funding to pay nurses, pharmacists and allied health under one roof.
Nurses could take on the burden of doctors by providing simpler treatments, and multiple allied health providers could handle chronic conditions, with no fear of getting paid until a doctor walks into the room.
Butler said he wanted all healthcare professionals to be “freed up” to contribute as much as they could to provide first-class care.
‘At a time of skyrocketing demand for healthcare and labor shortages, it makes no sense not to have each and every one of our healthcare professionals working to the best of their scope of practice, whether they are doctors, nurses, healthcare professionals, related health, pharmacists, paramedics and others,’ he said.
“We just don’t have that happening in Australia – there are too many regulations and restrictions… too many turf wars limiting the ability of people who want to provide their full range of taxpayer-provided skills and training to hundreds of thousands of industry professionals.” Health.’
Royal Australian College of General Practitioners President Nicole Higgins said the new system needed to be designed right the first time, or so many surgeries would abandon mass billing that “the whole system [could] fall down’.
“We are seeing more complex patients, older patients with multimorbidity. Team care is the best model to support those patients, but GPs need to continue to be the managers of the multidisciplinary care team, because they are the ones with the whole picture of the patient,” she said.
Health Minister Mark Butler said the system was in “real trouble”, stuck in the 1980s and 1990s, and no longer made sense.
Details of the new funding model have not yet been finalized and various models are being discussed.
For several months, the federal government has been working with medical associations and patient advocacy groups to find ways to strengthen the Medicare system.
The report is expected to be published within a few weeks.
Butler said measures such as limiting out-of-pocket expenses were being considered as part of the process.
“The question is whether, in addition to the traditional fee-for-service system, you add some kind of flexible financing that allows doctors to provide comprehensive care,” he said.
Most developed countries have already switched to a different system, so there are examples that the government will look at.
Denmark has around 70 per cent of its healthcare funding still provided as fee-for-service, with the rest as block funding and the UK made a similar change.