5 April 2023

Cash now, reform later, as $4bn missing from Medicare

Medicare Political

The AMA says the Medicare freeze has stripped $3.8 billion from general practice and the president of the RACGP says if cash isn’t injected into the system now, there will be nothing left to reform.

Speaking in the wake of Health Minister Mark Butler flagging good news for GPs in the upcoming federal budget, Dr Higgins said the minister had recognised he “needs to stem the bleeding”.

“If he doesn’t the system will fall over, there will be more closures of general practices and less people entering the system,” Dr Higgins told TMR.

“It’s a challenging time. There are so many fires on so many fronts, but unless there’s cash injected into general practice now, there is not going to be a system left to reform.”

AMA president Professor Steve Robson the Medicare-freeze chickens were coming home to roost.

“Years of frozen indexation means that a patient’s Medicare rebate is permanently lower that what it would have otherwise been had the freeze not been put in place. This is one of the key reasons why patients are facing larger out of pocket costs when they visit their GP,” he said.

The AMA released the analysis along with the general practice chapter of its 2023–24 budget submission which calls for a significant and urgent investment in general practice beyond the $1 billion the government has previously committed over a four-year period.

“The current government has inherited a significant problem and, while it is not of its own making, the reality is that the buck stops with it — we need to see a shift to repairing the damage that has resulted in general practice barely surviving,” Professor Robson said.

“We are calling on the government to invest back into Medicare what’s been stripped from the system as a result of the lasting, and growing impact of the Medicare freeze.”

Dr Higgins told TMR that the recent announcement of the closure of trailblazing Canberra clinic Hobart Place General Practice had brought the problem to the government’s “own backyard”.

“What we hope is that the government will inject funds into general practice to support patients’ access to care through increasing the rebate and bulk-billing incentives,” she said.

“Mr Butler realises that he can’t shift the deckchairs on the Titanic, and that you can’t substitute for the role of the general practitioner with other workers.”

Both Dr Higgins and Dr Dan Halliday, president of ACRRM, have been in Canberra this week in talks with the Department of Health and Aged Care, and while both were tightlipped on the details, word is further meetings with the Finance Minister next week may provide more clarity on just what the budget will do for general practice.

“We have asked to receive updates and early notice of any planned measures in the budget,” Dr Halliday told TMR.

ACRRM’s pre-budget submission called for blended funding models, flexible funding pools to support the rural generalist model of practice, as well as a doubling of the Medicare rural bulk billing incentive for practices located in MMM 3-7, additional funding for ACRRM to expand its Rural Generalist Training Scheme, additional funding for the Medicare General Practice Grants program for general practices located in MMM 3-7, promotion and support for rural medical careers from secondary school to tertiary and prevocational levels, and specific programs to provide wellbeing and support for doctors and doctors-in-training in MMM 3-7.

Conversations with other Canberra insiders this week suggest general pessimism about whether anything other than already announced reforms will feature in the budget.

“The major reforms won’t come until 2024-25,” said one source. “There’s going to be a transition period, with some immediate funding to keep practices afloat until then.”