Workforce measures have emerged as biggest all-round win for general practice out of Labor’s $8.5bn Medicare pledge.
While the funding is impressive, general practice representative groups have been wary of backing the lofty Labor predictions of boosting bulk-billing rates to 90% with its $8.5 billion package.
Labor has centred its first big pitch for re-election around Medicare, revealing the plan which it hopes will restore the public insurer to its former glory-
Prime Minister Anthony Albanese officially launched the promise at a rally in Launceston on Sunday.
The aspect of the plan which made the biggest splash was that the tripled bulk-billing incentive – which currently only applies to healthcare card holders and people under 16 years of age – would be expanded to cover all Australians.
In metropolitan areas, the bulk-billing incentive rebate is worth 150% of the value of the bulk-billed item; rural loading takes it to 160% for Modified Monash level 3 to 4 locations and up to 190% for the most remote locations.
The expansion to the bulk-billing incentive applies to all items covered by the bulk-billing incentive – i.e. not just time-based consults, but also mental health care plans and chronic disease management items.
Under the Labor plan, practices that commit to universal bulk billing would also receive a 12.5% loading payment based on their total Medicare billings via a new quarterly Practice Incentive Program payment.
According to federal health minister Mark Butler the combined investment will result in nine out of 10 GP visits being bulk billed by 2030, while the number of universal bulk-billing practices will triple to 4800 nationally.
“No more wondering if you need to reach for your Medicare card or your credit card: Labor will put back into Medicare every dollar that Peter Dutton’s rebate freeze took out,” he said.
Here’s what GPs had to say about that.
Who: Dr Michael Wright, RACGP president
Top line: “Because the Medicare rebate still doesn’t cover the cost of care, many practices will not be able to participate in this program.”
Dr Wright welcomed the investment into general practice, but said it was unlikely to fix the structural issues in Medicare.
“Because the bulk-billing incentive, which is being tripled, is the same [additional proportion of the rebate] whether you do a normal consultation [or a long one], the greatest incentive still comes from doing shorter consultations,” he told The Medical Republic.
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“That is a different direction to what the college has been pushing, because we think that complex care is what we need to do more of in general practice.
“That’s what I’ve heard from people; we’ve been trying to make that systemic change and to give better access to the people who need it most, but also to reduce the gender pay gap.
“And, potentially, this [investment] does not do that at all.”
Dr Wright also warned of “perverse incentives” and the potential issues for equity when a CEO and a healthcare card holder are both eligible for the same incentive payment.
Part of the funding package which did not get much airtime over the weekend was the $617 million going toward various workforce initiatives.
This includes adding an extra 2000 Commonwealth funded GP training places per year, a $30,000 salary incentive for GP registrars, a paid parental and study leave program for GPs and additional primary health rotations for junior doctors.
Dr Wright told TMR that this area was what the RACGP was most excited about.
“Paid parental leave and sick leave for GP registrars is way overdue, so is getting more pre-vocational training places and allowing junior doctors to experience general practice,” he said.
“We know they’re more likely to go into general practice if they’ve had that exposure.
“The incentives will basically top up the pay drop that you get when you leave the hospital to start general practice placement, and we know that incentive has worked really well in Victoria, so that’s massive.”
Who: Dr Danielle McMullen, AMA president
Top line: “While this will help some practices and some patients in some areas, it won’t help everyone … we recognise that for a lot of private billing practices, this won’t change billing behaviours.”
The biggest winners, Dr McMullen said, were the practices that have been maintaining universal bulk billing and were consequently on the fringes of viability.
“For all of us who, even in private practice, have the odd patient here and there who we do bulk bill because we know they’re really doing it tough, this makes it a little bit easier – but it’s not what we called for,” she said.
“It’s not what the other peak groups call for, and it does nothing for longer consultations or chronic and complex disease.
“We’re still pushing really hard for reform of the underlying Medicare … where we smooth that curve, incentivise longer consultations, ease the gender pay gap and address chronic disease and mental health care.
“This announcement won’t stop us fighting for those underlying reforms.”
Dr McMullen was slightly more positive about the workforce funding, which she said was “really excellent”.
Who: Dr John Deery, Australian General Practice Alliance president
Top line: “GPs aren’t going to start deciding to voluntarily take home less.”
According to the GP practice owners’ association head, it will be a hard sell to convert practices that have already made the move to private billing back to bulk billing.
“The government is fixated on bulk-billing rates, and this isn’t going to … fix their perceived problem,” he told TMR.
“There’s no mention of how this is getting funded … and, as practice owners, we think there should be an independent pricing authority put in place for Medicare.”
Dr Deery said none of the practice owners he had spoken to were willing to go back to bulk billing.
Who: Dr Rod Martin, ACRRM president
Top line: “We’re small businesses in the business of providing care, and if we can’t get the business open, then the care goes with it.”
Despite the rural loading increasing the cash value of bulk-billing rebates in the bush, Dr Martin was still sceptical that the $8.5 billion investment would result in sky-high bulk-billing rates.
“Practices are definitely going to need to do the modelling and work out what [is best for them], because there’s been a lot of energy and effort spent changing models of practice to accommodate the two masters – the offices of state revenue and Medicare,” he told The Medical Republic.
“At the same time, it’s fantastic to see that the Department of Health and Aged Care and the government recognising that Medicare isn’t keeping up with real-world costs.”
Like his AMA and RACGP colleagues, Dr Martin was more enthusiastic about the money to expand training and introduce new initiatives for GP registrars.
He called for 500 of the 2000 additional yearly places to be earmarked for ACRRM, which has consistently been filling its allotted rural generalist training places.
Who: Dr RT Lewandowski, RDAA president
Top line: “Medicare fee for service, especially in rural areas, historically hasn’t worked to achieve the health outcomes or the access to primary care that we want, and I don’t know that increasing the monetary value of a visit … is actually going to change that.”
Dr Lewandowski told TMR that, while he wasn’t “griping” about increased reimbursements, he would have liked to have seen more structural change to Medicare.
“We need to actually look at the structure of how payments go to rural and think about things like block funding mixed with fee-for-service, as opposed to pure fee-for-service,” he said.
“You probably need someone more clever than me to figure out exactly how to do it, but I’m clever enough to know that what’s happening right now isn’t working.”
The funding for workforce, he said, was a true boon.
“It doesn’t matter how inexpensive your GP visits are if you don’t have a doctor,” he said.
Who: Professor Karen Price, former RACGP president
Top line: “We’ve been down this road before, where carrots have been dangled but no indexation occurred, and it was a huge issue for general practice.”
Perhaps best known for encouraging RACGP members to move away from bulk billing, Professor Price said that the prediction of 90% bulk-billing rates had left GPs feeling upset.
“It was suddenly flagged that healthcare at the GP was going to be ‘free’,” she told TMR.
“Now, no healthcare is ‘free’.”
While there may be some who pick bulk billing back up, Professor Price was of the opinion that it would be limited without an independent pricing authority.
She also questioned whether the $30,000 incentive for GP registrars would be worth it.
“[I am not sure] whether it makes up for a lifetime with a potential noose around the neck of free healthcare anytime that politicians have an election,” Professor Price said.
“This is removing doctors’ abilities to manage their practices, which are private businesses.
“It’s a real problem in the way it’s been communicated, and now receptionists all across Australia are going to have to field these questions from patients, who may be feeling very cheated that the government of the day is announcing free healthcare, and yet there’s still a gap for you to pay.”
