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Hundreds and thousands of the sickest and poorest Australians are missing out on healthcare because of gaps in Medicare coverage and high fees charged by medical specialists, according to a recent Grattan Institute report.

The report, Not so universal: How to reduce out-of-pocket healthcare payments, found that in 2020-21, nearly half a million Australians did not see a specialist because they could not afford it, while even more deferred or did not fill a prescription because of cost.

Australians spend about $7 billion a year on out-of-hospital medical services and on medications listed on the Pharmaceutical Benefits Scheme (PBS).

Grattan argues bulk-billing rates are too low and out-pocket payments too high for some services, meaning the poor and chronically ill often miss out on care the most.

The report’s policy blueprint for a better Medicare includes:

  • State governments expanding outpatient services to reduce wait times and the federal government funding bulk-billing specialist services in private clinics
  • The federal government paying specialists for giving GPs over-the-phone advice about patients, without actually seeing the patient, to cut down referrals
  • The government lowering the co-payment for people on multiple medications to slash pharmaceutical costs
  • The government eliminating out-of-pocket payments for diagnostic services, such as scans and blood tests, and radiotherapy services, by funding them directly through a commercial tender

The report concludes that if state and federal governments invested an extra $710 billion per year on the reforms, Australians could save $1 billion in out-of-pocket payments each year, and more people would receive vital care.