Why you deserve Medicare reform

Transcript: AMA Queensland President Dr Maria Boulton, ABC Queensland Southern Drive with Annie Gaffney, Monday 5 December 2022

Subjects: Medicare reform

ANNIE GAFFNEY:  Have you tried to book in to see your GP lately? What was the wait time like and how much did it cost you? Many Australians around the country are struggling to get access to healthcare and as more doctors turn away from bulk billing, it's making it more unaffordable to go to the doctor. The Grattan Institute has released a new report today which calls for an overhaul of the entire Medicare system. So what would that new model look like? And how would it benefit not just doctors but patients as well? Dr Maria Boulton is the President of the AMA in Queensland. Dr Boulton, great to have you with us this afternoon. Why does the Medicare system need a major update?

DR MARIA BOULTON:   Good afternoon, Annie. We agree with the Grattan Institute report. We've been saying for years that the Medicare system has been severely neglected for decades now. The cost of seeing a doctor is a lot higher, of course, than it was 20 years ago, because things go up in price, rent, equipment, wages, etc. And the Medicare rebate - the rebate that goes to the patient to access GP services and other services - has not been indexed to cope with those increases. For example, this year the Medicare rebates were indexed by 1.6 per cent. In comparison, we've seen inflation go up by 7 per cent, the CPI index go up by 7 per cent. And when you look at the Medicare rebates for a standard consultation, which is what most people book, since 1993 there's been such neglect it's fallen so far behind, that it's actually $8.6 billion behind where it should be.

ANNIE GAFFNEY:    Wow.

DR MARIA BOULTON:    Shocking, isn't it?

ANNIE GAFFNEY:   It really is. What were the report's major findings, Maria?

DR MARIA BOULTON:   So with the Grattan Institute, the major findings just confirm the fact that we know that we do need a vibrant general practice system, that our approach of patient-centred, GP-led, multidisciplinary care is the way to go. And you know, many clinics do this already. However, the Medicare system doesn't really allow for that, and doesn't allow for patients to have rebates to access that care.

They also suggested that there needs to be more funding to go into Medicare. They suggested a figure to start with $250 million, which is what is has been allocated by the Commonwealth to general practice in the next 12 months. It's not enough. We need more. It's a good start. But when you're seeing the issues out there, and the fact that there’s general practice clinics closing, especially in rural and remote areas, it's clear that we need urgent funding. Otherwise people will be without a GP.

ANNIE GAFFNEY:  Well, $250 million is a drop in the ocean when you're talking about being $8.6 billion behind.

DR MARIA BOULTON:   Yes, and that's just for one item number. That's just for standard consultation. And that doesn't account for long consultation, short consultations, the cost of providing mental health care services. And the other thing with Medicare is it was established a long time ago, for a system that worked a long time ago.

Nowadays, GPs are seeing far more complex issues. We're seeing a lot of mental health issues, especially post-pandemic, and those issues take a lot longer. And patients deserve a lot longer with their GP so that they can talk about all those issues, whereas the Medicare rebates are set up to pay for shorter consultations. And as we all know, that's just not good medicine. Patients deserve more.

ANNIE GAFFNEY:   How is the current system that we have impacting the care of patients with chronic illnesses?

DR MARIA BOULTON:   It's just making it more difficult for patients to access those services. And, once again, the rebates that they receive from the government to access those services reward those shorter consultations, when in fact the minute someone is in your room really upset and starts crying, you know that's 30 minutes. That's how long that patient deserves. But that's not what the patient will get rebated as because Medicare just does not recognise that long medicine that is what patients need nowadays.

ANNIE GAFFNEY:   Now, the report did suggest that other health professionals like nurse practitioners and physiotherapists could help bear or carry some of the burden of the workload of GPs to have a more clinician team approach to looking after people with chronic illnesses and I guess keep them out of the hospital system for a start or perhaps, you know, just simply reduce the burden on GPs. I did note that the Royal Australian College of GPs today had something to say about that, along that and I'm paraphrasing along the lines of essentially, they didn't think that was such a great idea. What's your view of that?

DR MARIA BOULTON:   I think, you know, a lot of us work in multidisciplinary clinics already. So we do value the input of allied health. I mean, at my clinic, I have a psychologist, an OT, a physio and an exercise physiologist, and there are patients, for example, those with diabetes, those with polycystic ovarian syndrome, that that do need that multidisciplinary care.

I guess the fallacy of the argument is that all healthcare worker professions, be it nursing, be it physio, be it pharmacists, be it doctors, we are all under strain at the moment. So you cannot say that this other health workforce will rescue general practice, because they're all short-staffed. And in fact, if you look at areas like North Queensland, there are more GPs than any other health professional. So, you know, it makes a little bit of sense to support that multidisciplinary care, but it doesn't take away from the need of having more GPs and growing GPs so that patients do have access to the GPs.

And we know from studies in Denmark, and Denmark also has a multidisciplinary approach that is GP-led, we know that the longer that people have access to their GPs, the longer they live, the less they visit their hospitals. So it's like a super drug. I went to a conference in Melbourne held by the College, and they had this GP from Denmark. And that's what he said: Your relationship with your GP is like a super drug, it will keep you out of hospital and it will keep you healthier. And that's where it's important that we don't only support every other healthcare professional, but also ensure that there are enough GPS moving into the future.

ANNIE GAFFNEY:   So where are we headed, Maria, if we don't see major changes to the Medicare system?

DR MARIA BOULTON:   The Australian primary care system is one of the best in the world, and so are our hospitals. The sad reality is that, unfortunately, both areas have been very neglected when it comes to funding over the last decade, at least. We’re seeing ambulance ramping, we're seeing lack of beds, we're seeing people having difficulty affording the private fees that GPs must charge to keep the doors open. And we'll see more of that unless we can turn that around. And it's nonsensical, right? Health is an investment. And it makes sense to invest in health because that keeps us healthy, and it creates that workforce that we need into to the future and it increases productivity, it increases wellbeing.

If I see a child who comes in for their vaccinations at the four-year mark, I’ll speak to that child and it's really easy to pick up whether or not that child has a language delay. And then we can say to that parent, your child has a language delay, let's look at ways of assessing that and treating that so that when that child goes to Grade 1, kindy, they're okay, and they can fully participate in school. There are wonderful things that GPs do. And, you know, we all value GPs. I know our patients are amazing and patients are loyal to us and they really value what GPs do, especially in rural and remote areas. But it's also time for the government to step in and ensure that they fund patients to continue to have access to that valuable resource.

ANNIE GAFFNEY:   Maria Boulton, always great to get your perspective on health.