Primary health care urgently needs reform – not just more money

Bulk-billed doctor visits, where the federal government’s Medicare rebate covers the full cost of an appointment, are down because the federal government froze the rebate amount for nearly a decade while the cost of running a clinic continued to rise. Fewer medical graduates are choosing a career in general medicine, with many opting for higher-paying specialties instead.

Butler says money can’t solve the problem. Do we agree. The whole system has to change. As he points out, Medicare was developed 40 years ago with a different disease profile than it is today. Older Australians are more likely to suffer from more complex chronic illnesses that require multidisciplinary care to keep them away from hospitalization.

Former civil servant John Menadue has long campaigned for a thorough overhaul of Australia’s health workforce structure. He urges governments to take bolder action against powerful lobbying groups of doctors and pharmacists who tightly monitor restrictive labor practices. The healthcare system is hampered because it focuses on the demarcation of healthcare workers and not on the needs of patients.

Menadue suggests giving nurses and pharmacists more responsibility for prescribing, diagnosing, and some other tasks that are typically handled by GPs. He accuses the Australian Pharmacy Guild of retaining pharmacists as shopkeepers instead of offloading them for blood tests, injections and repeat prescriptions. Paramedics are also restricted in their own silo, and the powerful AMA opposes other health workers entering their turf.

dr Bruce Willett, vice president of the Royal Australian College of General Practitioners, says Medicare penalizes GPs for spending too much time with a patient. He points out that a doctor who performs, for example, five sessions of less than 20 minutes in one hour would receive $198.75 from Medicare ($39.75 rebate per patient). But seeing two patients in those 60 minutes for about half an hour each would make $153.90 ($76.95 discount per patient) — a difference of almost $50 from their hourly rate.

The federal government’s report on strengthening the Medicare taskforce has called for primary care physicians to be funded to work after 6 p.m. and paid more for longer consultations. This makes sense and would help keep patients with basic care needs away from hospital emergency rooms after they leave work.


Earlier this year, Victorian Prime Minister Dan Andrews and former NSW Prime Minister Dominic Perrottet called for changes to Medicare rebates to improve GP pay and ease the pressure on state hospitals. The Australian Medical Association and the Royal Australian College of General Practitioners support similar guidelines but have said billions in additional funding would likely be needed.

The Sun Messenger agrees that the Medicare rebate is insufficient and should be increased. But paying doctors more is only part of the solution. A larger package of Medicare reforms is needed. Consideration should also be given to better paying nurses, pharmacists and paramedics so that they shoulder a greater share of the primary care burden. Ridiculously high payments to medical specialists may also need to be cut to bring them into line with the Medicare payment plan.

Simply increasing the Medicare rebate for doctors isn’t enough. Primary care and prevention need to be better integrated to keep more people away from hospitalization.

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Justin Scaccy

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