Who are the winners in the

Medicare health-benefits lottery?

In January, the Grapevine’s story ‘Widening the Gap’ exposed that not all Australians are equal when it comes to health care and medicines. Now we are being told that we have a universal healthcare system, but if Australians think that they now have universal healthcare, then it’s time to ignore what the Minister for Health, Mark Butler and the Prime Minister are telling them – because it is no longer true! Yet everyone is still paying for the privilege of this 'phantom-where-everyone-is-equal' healthcare system through the Medicare levy that is taken from their income - it doesn't mean that they will all be equal and win the Medicare lottery.

6 March 2024

ALAN HAYES

 

ALTHOUGH the Federal Health Minister, Mark Butler, says that he has identified that providing "universal healthcare for all" (Australians) is a key focus on the government’s strengthening the Medicare taskforce, his claims are still in the realm of fantasy and fiction.

 

Let’s be realistic from the get-go – it never was, despite the 'bleating of the political sheep', a genuinely universal health program. Over time it has continually eroded to the point that “universal” is just a catch phrase to appease the masses.

 

There are multiple ways in which Medicare fails the universality test! If you’re under sixteen, a pensioner or hold health card then you’re more than likely going to be bulked bill, providing your GP has accepted the government’s new rebate scheme and if your GP is prepared to bulk bill, at all. High and unpredictable out-of-pocket payments also put many essential health services out of reach of many Australians.

 

Doctor shortages mean that people living in rural and regional Australia often miss out on essential healthcare as Medicare requires a doctor on the ground to either deliver or provide access to these services.

 

Cultural, social and linguistic issues also create access barriers to Medicare-funded services for many Australians. Large sections of the community – including Aboriginal and Torres Strait Islander people, people from non-English-speaking backgrounds, people who identify as LGBTQ+, people who use illicit drugs and people with some types of mental illness – frequently encounter difficulties finding appropriate and culturally safe care from Medicare-funded providers.

 

Medicare also falls short when it comes to services provided by any health professional other than a medical doctor.

 

Dentistry is a basic health service that is not funded by Medicare, despite the fact that dental problems have clear links to systemic health issues, such as heart disease.

 

Premier Chris Minns expressed his disappointment earlier last month that there were still 169 medical practices in NSW that won’t bulk bill – this includes practices on the Central Coast.

 

So, what do the doctors get?

 

If you qualify for bulk billing your GP receives $40.00 from Medicare and around $20.00 from the Federal Government under the new incentive scheme. But is this $60.00 enough for many GP practices to continue opening their doors?

 

The bulk billing incentive is paid on top of the standard Medicare benefit when doctors bulk bill children under 16, pensioners and other Commonwealth concession card holders. The GP bulk billing rate measures the proportion of all GP visits and services under Medicare that involved no patient payment.

 

However, Medicare is failing to keep up with the rising costs of delivering healthcare, as new data reveals medical costs covered by the Medicare Benefits Scheme (MBS) have dropped significantly. So, even if you should qualify for bulk billing, certain GPs on the Central Coast may still require you to make a co-payment for you visit - some doctors charge way above the Medicare and government rebate figure figure making it difficult for patients to seek ongoing medical and dental care.

 

What about those who don’t qualify for bulk billing?

 

Many Australians, including a large number of people living on the Central Coast, are doing it tough. The cost of just living – rising rents and mortgage costs, groceries, fuel and electricity is biting heavily into household budgets, leaving very little money left over, if at all, for medical bills. For those people it’s become a financial mine field! There taxable income may put them above the threshold to qualify for a healthcare card but in reality they are part of the struggling middle-class-poor who just don't have access to surplus income.

 

One Central Coast resident, who works part-time, told the Grapevine that her income barely allowed her to make ends meet, yet she still didn't qualify for a health card. "It's a financial nightmare going to the doctor," she said. "I'm charged $90 for the consult and only get $41 back from Medicare."

 

So, what can these people do that are caught up in no-man's-land? Urgent Medicare clinics are not the answer, because they’re not there for ongoing treatment for a particular condition – you will get treated for an emergency, then referred to your own GP. The vicious merry-go-round continues and hospital emergency rooms continue to be used in lieu of the doctor and the healthcare system lingers in its inability to adequately provide for all Australians.

 

Is there an answer?

 

Late last year Australian Medical Association President Professor Steve Robson said the data from the Australian Institute of Health and Welfare (AIHW) highlighted the need for significant repair to Medicare following years of neglect by successive Governments.

 

Forty years ago, Medicare as we know it today was born. It was the reincarnation of the Whitlam government’s Medibank, introduced in 1975 but dismantled in stages by the Fraser Liberal government.

 

Medibank was developed in the 1960s by health economists Dick Scotton and John Deeble, when disease prevalence was different and the politics of reform were diabolical.

 

But the nation has changed since 1984, and so have our health needs. Medicare is now struggling to ensure access to equal health care for millions of Australians - healthcare Australians were once promised.

 

So, how did we got here? – Three radical changes need to be made to keep the Medicare promise into the future: making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care.

 

But the financial barriers of seeing a GP or a private specialist (out of hospital) have remained. Doctors continue to charge what they like, with Medicare often only covering a portion of their fees. This has left many patients facing significant out-of-pocket payments, especially when it is a necessary procedure, and also having to take loans to pay for the medical charges, adding further to the person’s ability to seek ongoing medical treatment.

 

When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service.

 

The problem we now have is that many of these practices have merged into partnerships or consolidated and corporatised, where profits have become the primary incentive. Couple this with the fact that since the 1980s state governments have reduced public outpatient services, leaving patients with no other choice than to rely on private medical specialists referred by their GP. The new 'middle-class-poor' fall further into penury - yet because of an income that would have previously allowed them to cope, they are now adding to the burden of the public hospital system in attempt to get medical treatment.

 

Even though health care needs have changed the cost of living pressures remain, which lies at the heart of the problem – because GP care is not affordable for all.

 

Medical fees aren’t regulated and so Australians’ face a lottery – not knowing whether a fee will be charged and having no control over that decision. Only about 52% of all Australians were always bulk-billed in 2022-23, down from 66% a year earlier.

 

To add further to patient woes, rebates are currently subject to political whim. The Liberal government (in office from 2013 to 2022) froze rebates, leading to increases in average out-of-pocket payments and reduced bulk-billing.

 

The first step in reducing costs as a barrier to GP care should be the introduction of independent fee-setting.

 

Canadian Medicare – which was the model for Australia’s system – mostly has no out-of-pocket payments. Fees are set by negotiations, not politicians’ whims, and this is enshrined in legislation.

 

With independent fee-setting in place, a new scheme of “participating providers” could be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs.

 

This type of system could also include additional grants for participating practices to employ other health professionals to provide a more comprehensive range of services – such as physiotherapists and psychologists – to meet the contemporary needs of a population with increasing chronic illness.

 

If successful, these changes would mean all Australians can access a GP and other primary care services without any out-of-pocket costs.

 

Prime Minister Anthony Albanese says that his government has developed a targeted approach to achieving health equality, because all Australians should be equal and have access to better health care and medicines, yet there is still a widening gap when it comes to winning the Medicare health benefits lottery.