Forty years on, Medicare is at a crossroads

Medicare, the nation’s universal healthcare insurance scheme, chalks up its 40th birthday this week. While it has undeniably served Australians well, providing equitable and affordable access to healthcare, it is now struggling and in need of urgent reform.

Launched on 1 February 1984, by the then Hawke government, the iconic green and yellow Medicare card has given Australians access to a wide range of essential healthcare services, with the cost partially or fully covered. Fast-forward to today and the glaring problem is that as the country’s health needs have inevitably changed, the system hasn’t, leaving it no longer fit for purpose.

“Medicare is a vital scheme and has been the foundation of our health system, providing Australians with equitable access to healthcare when and where they need it,” says Australian Nursing and Midwifery Federation (ANMF) Federal Secretary Annie Butler.

“But after 40 years, Medicare is broken and must evolve to meet the growing health needs of our fast-aging population. Meaningful reform is crucial as we strive to deliver a healthcare system that is patient-centred, affordable, and accessible for all Australians.”

In 2022, in a bid to modernise the system, the Albanese Government established the Strengthening Medicare Taskforce, consisting of a number of Australia’s leading health policy leaders, including Ms Butler. The Taskforce set out to improve patient access to GPs and GP-led multidisciplinary team care, including nursing and allied health, boost patient affordability, better manage ongoing health conditions, including chronic conditions, and decrease pressure on hospitals.

The subsequent final report of the Strengthening Medicare Taskforce, released in February 2023, outlined a vision of a primary healthcare system where “all Australians are supported to be healthy and well, through access to equitable, affordable, person-centred primary care services, regardless of where they live and when they need care”.

The Taskforce found that strengthening primary care with a greater range of health professionals working to their full scope of practice would optimise use of the health workforce across a stretched primary care sector, delivering increased access to healthcare and improved equity of outcomes, especially in rural, regional and remote areas.

It recommended supporting this with new blended funding models, integrated with the existing fee-for-service model, allowing teams of GPs, nurses, midwives and allied health professionals to work together to deliver the care people need.

ANMF Federal Secretary Annie Butler

Importantly, one of the key recommendations to emerge from the Taskforce was the independent Unleashing the Potential of our Health Workforce – Scope of Practice Review, currently underway, which is examining the barriers and incentives health practitioners face working to their full scope in primary care.

“Medicare succeeded, because it was the right reform for the health needs of the time,” Health Minister Mark Butler said, in his May National Press Club address last year, outlining reforms for a Medicare “that’s fit for the 21st century”.

“A fee-for-service rebate schedule that reimbursed small local doctors and specialists for the procedures they did was just what the Australia of 1984 needed.

“But Australia has changed, thanks, in some part, to the success of Medicare.
Universal healthcare, world leading tobacco control and a revolution in cardiac health, among other innovations, means we now live almost nine years longer.

 “Our health problems are increasingly chronic and complex. General practice is no longer just a small cottage industry. And our health workforce is now among the best educated in the OECD. But while Australia has changed a lot, Medicare hasn’t changed much at all.”

Delivering on its commitments, the Government invested $5.7 billion over five years to strengthen Medicare in its 2023-24 Budget. This included $445.1 million over five years to enable GPs to have nurses and allied health professionals working with them in cooperation for better care, and tripling the incentive paid to GPs to bulk bill consultations for families with children under 16, pensioners and Commonwealth concession card holders, at a cost of $3.5 billion.

For nurses and midwives, some of the biggest reforms have included $46.8 million to fund Medicare rebates for care provided by nurse practitioners, increasing the rebate by 30%, as well as the removal of collaborative arrangements. Regrettably, however, NPs are being forced to wait until July 2024 for the change to come into effect.

“It’s disappointing that the increased rebate for nurse practitioners couldn’t happen straight away, like it did for doctors,” Ms Butler points out.

“That delay is just simply unnecessary and it’s almost as if it’s an oversight, and that’s because there’s not enough awareness of the importance of other health professionals in ensuring access to quality healthcare for everybody.”

According to Ms Butler, at the heart of Medicare’s shortcomings lies a broken structure. With the foundations crumbling, Medicare has become increasingly diluted, she says. One flaw, for example, is that under the fee-for service model, it’s not about who is delivering care, but rather, who is billing for the care, Ms Butler points out. So, a nurse could be delivering care, but the GP bills for it.

“Medicare, and the way it’s been set up, with the GP being the gatekeeper and controlling that access, is just no longer viable,” Ms Butler argues.

And while a number of positive recommendations have emerged out of the Strengthening Medicare Taskforce, reform is simply happening far too slowly, she declares.

“The Scope of Practice Review, which is a critical piece of work, will take time, and hopefully lead to significant reform of the health system so that the workforce is equipped, funded and supported to actually deliver the care that they can, to the people who need it, when they need it. The concern, however, is that recommendations from these sorts of reforms don’t just sit gathering dust. These key areas need to be fixed as soon as possible.”

Ms Butler is supportive of the government’s move towards more blended funding models, suggesting that they can allow health professionals such as nurses to lead genuine chronic disease management programs that tackle issues, such as asthma. Last October, the government introduced MyMedicare, its new voluntary patient registration model, which aims to formalise the relationship between patients, their general practice, GP and primary care teams.

Positively, as Medicare undergoes a long overdue health check, Ms Butler believes that with enough political will to action reforms, the nation’s world-class universal healthcare insurance scheme can grow into a modern, robust and sustainable system capable of meeting the country’s healthcare needs for another 40 years and more.

“It’s going to require some bravery and some courage to do the right thing,” says Ms Butler.

“It’s going to take courage to implement a new system that is better for everybody, as it’s going to make people who have significant vested interests disaffected.

“We can’t allow that to continue to happen when we’ve got young Mums who can’t afford to go and see the GP. When we’ve got people who can’t get into the Emergency Department because of waiting lists, or ambulance ramping, because EDs and hospitals are so blocked with people that shouldn’t even be there.

“If the primary health system were better, and providing accessible care to people whenever and wherever they need it, we wouldn’t have these bottlenecks. We can’t wait anymore – we’ve got to fix it.”

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