The federal health minister talks dental in Medicare (not yet), GLP-1s (an enormous challenge to health authorities), and anti-GP snobbery.
General practice needs a revamp, GLP-1s are the “blockbuster” drug of the moment, but pose a unique challenge, and Labor aims to incorporate dentistry into Medicare … just not yet, says the federal health minister.
Last night, federal health minister Mark Butler was given the third degree by the ABC’s Patricia Karvelas on all things hot in healthcare.
According to new polling, 46% of Australians put off treatment due to cost and 76% have trouble funding a bulk billing doctor.
The problem has been diagnosed – namely access to healthcare is becoming less affordable and thereby less accessible – so what “medicine” does the minister prescribe, Ms Karvelas asked Mr Butler on ABC’s Q+A.
While the “down payment” has been made – tripling of the bulk-billing incentive – more funding was still needed, admitted Mr Butler.
“But there’s a much bigger challenge to convince, particularly junior doctors [and] medical graduates, that there is value in becoming a GP,” he said.
“General practice is in the worst condition it’s been in in 40 years. It’s been under-invested [in], it’s been undervalued in the broader health system, including by other doctors.
“I hear stories of smart medical students training in hospitals and having a consultant look down their nose and say, ‘why would you want to become a GP? You’re smart enough to be a surgeon or an anesthetist’.
“We’ve got to lift the value.”
The financial disincentive to enter general practice reinforces the snobbery, agreed Mr Butler.
“There’s a financial gap between what procedural specialists like surgeons and anesthetists are earning [and GPs],” said Mr Butler.
“There are some other industrial disadvantages that we’re starting to try to work through.”
This included a lack of leave accrual during training for medical students, said Mr Butler.
But things have been looking up, added the minister.
“After the numbers of students choosing general practice declined for years, we’ve seen a big increase this year in the number of people taking up GP training, and we’re on track for another increase again next year,” he said.
“There are some green shoots of recovery of junior doctors seeing that there’s change in the system and taking on GP training.
“But we’re nowhere near the numbers [we need].”
The ABC’s polling also found that 82% of respondents supported expanding Medicare to subsidise visits to the dentist, even if the Medicare levy was increased to pay for it.
When queried as to why dental care remained outside Medicare’s remit, Mr Butler said the basis was historic.
“The question really is a historical one of decisions taken by Gough Whitlam, then by Bob Hawke [40 years ago], essentially around how wide a front you could fight on, given the huge opposition we had at the time to introducing Medicare from doctors who were going on strike and political opposition,” he said.
“The question of what happens now, is something that members of my party have a lot of ambition about.
“It’s in our platform that we would one day move to incorporate dental care into Medicare, which conceptually makes sense. The mouth is a part of the body, and a pretty important part of the body at that.
“I’ve also tried to be as honest and frank with people as I can in saying that my focus right now is on Medicare as we have it right now, because … it is in real trouble.
“We don’t have the ability to [incorporate dental care into Medicare] right now.
“My focus right now is on general practice, on mental health, on securing the hospitals agreement.”
Touching on another significant health problem facing Australia – obesity – Mr Butler spoke of the place for the class of “wonder drugs”, glucagon-like peptide-1 receptor agonists (GLP-1 RAs).
Some GLP-1 RAs are currently PBS-subsidised for their use in type 2 diabetes.
In 2021-22, GLP-1 RAs were the highest expenditure class of medicine on the PBS for the treatment of T2DM, making up 26% of the $194 million yearly spend.
However, while some GLP-1s – such as Eli Lilly’s Mounjaro and Novo Nordisk’s Wegovy – are approved by the TGA for weight loss, none are PBS subsidised, rendering them unaffordable for many patients.
Novo Nordisk applied to the PBAC twice to register Wegovy, but was rejected both times.
Eli Lilly has not applied to the PBAC to list Mounjaro for weight loss, only T2D.
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Speaking on the class of drugs, Mr Butler said they posed a challenge for decision makers.
“[GLP-1s] are a class of drug generally called Ozempic, a bit like tissues are called Kleenex, but there is a range of them and dozens of them in the pipeline.
“These GLP-1s clearly do have an impact on weight and I think this is going to be a really big challenge for authorities to deal with.
“There’s the cost, there is the number of people who are going to be taking them, whether they’re on the PBS or not.
“One in eight Americans have taken a GLP-1.”
Mr Butler suggested that there would be ongoing PBS applications for GLP-1s for weight loss, but deciding who would be eligible would be the challenge.
“This is unlike statins to lower cholesterol and other big blockbuster drugs, this is going to be used by people for reasons that might not be approved by the PBS,” he said.
“This is going to be a very, very big challenge for us.
“[But] this is a bit of a wonder drug.
“It’s early days, but some of the studies are showing impacts on cardiovascular disease, kidney disease, even Alzheimer’s [and] significantly lower rates of overdose and alcohol addiction for people on this [medication].
“A briefing I read on the weekend calls it the Swiss Army Knife of medicines.
“This is going to be coming down the pipeline for health authorities, in terms of how we pay for this, and for doctors, about when you prescribe.”
In his closing statement – with a slip of the tongue – Mr Butler summarised the needs of the health system.
“You need better primary care, you need better aged care support so that older patients can move through the hospital system more quickly,” he said.
“Urgent care clinics, which we’ve been rolling out since last year, are a really important part of the problem … response to the problem. They’re open seven days a week. They’re fully bulk billed, and they’re taking those lower acuity presentations off the hospitals.”
