Medicare will undergo its biggest overhaul since its inception by paying nurses and pharmacists directly to perform primary care.
Prime Minister Anthony Albanese on Monday said the Medicare system was ‘struggling to keep up’ as GPs charged higher fees and patients struggled to get appointments.
Bulk billing rates plummeted by seven per cent in the past year, and keep falling as general practices charge higher fees to supplement Medicare rebates.
Waiting times for GP appointments have blown out to more than a month for some doctors, as demand rises due to population growth while the number of GPs falls as more doctors move into more lucrative specialist fields.
Medicare is due to undergo its most significant overhaul since its inception. Above, Prime Minister Anthony Albanese at a pharmacy
Australia’s population is also rapidly aging, leading to more patients living longer but needing treatment to manage chronic conditions.
As a result, many people are going to hospital emergency departments for routine issues because they cannot get access to a GP.
Rising gap fees meant experts and the government feared that without serious reform, access to primary healthcare would become out of reach of millions of Australians.
Medical experts also worried the whole Medicare system could collapse under the weight of fewer GPs, higher running costs for surgeries, and a population that is increasingly expensive to keep healthy.
‘What we know we need to do is fix primary health care,’ Mr Albanese told Sunrise.
‘The big thing we are looking at is how do you take pressure off the system, and we are doing that – talking to the AMA, talking to the Royal Australian College of GPs, talking with experts because we want to make sure that this Medicare task force is listened to.’
Health Minister Mark Butler told The Australian the system was in ‘real trouble’, stuck in the 1980s and 1990s, and no longer made sense.
He explained that in past decades, when the system was designed, healthcare was mostly about treating acute conditions like injuries and one-off sickness.
But as Australia’s birth rate slowed and its population aged, doctors spent more and more time treating chronic conditions in older patients.
Australia’s population is also rapidly aging, leading to more patients living longer but needing treatment to manage chronic conditions
Australians are also living longer, so the time they need access to this kind of care increased, instead of them dying before they became an issue.
Chronic patients have vastly different needs to the acute ones Medicare was designed to treat, including longer consultations and more frequent visits.
They also need access to allied health practitioners like dieticians, physiotherapists, and chronic disease experts to adjust their lifestyle and and provide specialised care.
All this is more expensive and requires greater coordination between medical practitioners that is not well supported by Medicare’s funding system.
Nurses, who have the training to perform a wide variety of treatments without the involvement of a doctor, are also under utilised.
Medicare funding rules require patients to be seen by a doctor, or the treatment will not be covered by Medicare and the practice has to absorb the cost.
‘There’s a lot of care that nurses can give that can meet patients’ needs on the day, but currently with fee for service they have to see the doctor otherwise no one gets paid,’ Australian Primary Health Care Nurses Association president Karen Booth explained.
The government admitted the system of government subsidising individual consultations through GPs alone was no longer fit for purpose.
‘We need doctors working hand in glove with practice nurses, allied health professionals and pharmacists,’ Mr Butler said.
‘The system is not well designed to allow them to do that. Clearly an expansion of multidisciplinary care is key to managing chronic disease.’
Nurses will be relied upon to take a greater role in primary care as there are fewer GPs and a rising, and aging, population
The new model would allow nurses and allied health practitioners working in teams to deliver complex care and receive the subsidy payments in the same way GPs do.
Instead of a strictly ‘fee-for-service’ model, practices would get blocks of funding to pay nurses, pharmacists, and allied health under one roof.
Nurses could then take the load of doctors by providing more simple treatments, and various allied health providers could manage chronic conditions – without fear of no one getting paid until a doctor walks in the room.
Royal Australian College of General Practitioners president Nicole Higgins said the new system needed to be designed correctly the first time, or so many surgeries would abandon bulk billing that ‘the whole system [could] fall over’.
‘We’re seeing more complex patients, older patients with multimorbidity. Team-based care is the best model to support those patients, but GPs need to continue to be the stewards of the multidisciplinary care team, because they’re the ones that have the whole patient picture,’ she said.
Details of the new funding model are yet to be finalised and several models are being discussed.
Most developed countries have already made the switch to a different system so there are examples the government will look into.
Denmark has about 70 per cent of its health funding still provided as fee-for-service, and the rest as block funding and the UK made a similar switch.