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Imagine a 70-year-old woman barking her shin on her coffee table. She’s on blood thinners so bleeding is profuse. She goes to her general practice where she is enrolled. She’s immediately seen by a nurse who cleans the wound, and a nurse practitioner checks to see if it needs sutures. It doesn’t and she’s off home with a good dressing. Two days later she is reviewed, and it is clearly infected although it isn’t causing her pain. The nurse practitioner checks her file and prescribes the appropriate antibiotic and she’s home again. She pays nothing but her taxes.

A 70-year-old cyclist falls off his bike almost outside a medical clinic. His elbow is very painful. He is seen almost immediately by a paramedic who organises an Xray nearby and within an hour can tell the full story to one of the GPs who agrees that a non-urgent review by an orthopaedic surgeon is needed along with rest and analgesia prescribed by the paramedic. It takes two minutes of the GP’s time.

What I’m going to talk about I’ve divided into 4 parts. Firstly, what the main changes delivered by Labor in its last term, secondly what has been committed to in the recent budget and election campaign, thirdly what is being considered, and lastly what is ignored or largely ignored.

In Labor’s first term it was noted that bulk billing rates to see GPs were heading south and many patients were struggling to find a bulk billing GP. So, for children, pensioners, and health care card holders an incentive was already offered if the patient was bulk billed. It was only about $7 but increased as one moved away from cities. Labor tripled that incentive in the hope that doctors would not stop bulk billing their most financially disadvantaged patients.

In addition, Labor introduced Urgent Care Clinics which they placed in areas of disadvantage across Australia. All consultations are bulk billed. They are usually open 8am to 10pm. These clinics were not and are not designed to give ongoing care. They are mainly for issues which arise quickly, and the patient can’t easily get access to their usual GP. The stated aim of these clinics was to provide urgent care including afterhours care and to reduce the burden on public hospital Emergency Departments. They appear to have been popular. The Government to date has not revealed any sound data on whether they have had any impact on public hospital Emergency Departments, or on the relative costs of care in these clinics compared to a standard GP clinic. In other words, it is very unclear whether they are value for money.  There may be cheaper ways of addressing the issue. GPs are divided on what they think. Clearly, those GPs who are happy to work in them feel positive. Some GPs think they are an attack on general practice.

Patient enrolment was introduced. This is a scheme whereby a patient enrols with a particular GP or practice. It is voluntary but is aimed, at least in the long run, to improve continuity of care.  There are small financial benefits for patients and practices.

Labor promised to reduce the price of prescription drugs. That promise came prior to the election and interestingly it was made to match an identical promise by Scott Morrison in that election campaign. The copayment was reduced from $42 to $30. The concession copayment was not reduced.  The next prescription drug change was to fund a 2-month supply of many of the more commonly used drugs. Most prescriptions have been for an amount that lasts for about a month if taking a standard dose. Making it a 2-month supply for the same price means it lasts longer, and the patient doesn’t need to get so many repeats. As many of you would know, many doctors require either an appointment or a special fee to give a new script.

Labor introduced some significant improvements in Aged Care. They specified minimum staffing levels and increased the pay of many of the staff. They started the process of working out how to better fund and supervise Aged Care facilities.

Home Care packages for the Aged have been evolving for decades. They are designed to enable people to continue living at home for as long as possible. There are 4 levels, gradually increasing how much care is provided. They are becoming increasingly needed as the population ages. Over the 2 years to March 2024 there was an increase from 215000 to 284,000 packages in operation. That’s a 30% increase. The trouble is that demand is outstripping supply by a long way. There are at least 70,000 on the waiting list and that number is increasing by about 30,000. In 2024 Labor funded an extra 24,000, i.e. it wasn’t keeping up with demand. Waiting times inevitably increased. The standard wait time is about 9 months, longer if it is a higher level.

So, that’s a summary of the main changes in health care in their first term back at the helm. What have they promised this year?

Firstly, that bulk billing incentive that was introduced for children, pensioners, and healthcare card holders will now be extended to all patients who are bulk billed and in addition a practise which bulk bills everyone will receive a 12.5% increase over all rebate items. This means that in a practise where the copayment is about $35 it works out that if they bulk bill everyone, they will break even so this is a clear encouragement to bulk bill everyone for those wanting to bulk bill, but feeling a small copayment has become necessary.

Secondly there are even more urgent care clinics funded.

Thirdly, there is a further incentive to enrol patients in that the bulk billing incentive will apply to longer consultations by telephone or telehealth.

The requirement to have a care plan to access allied health has been removed. It has been observed that many care plans are done without any regular follow up or review of the plan. To increase the reviewing of the care plan the payment for doing one has doubled.

All these changes are making access to GPs somewhat easier and more affordable. Some of the changes will increase the income of GPs.

Every five years since Medicare was introduced the state and federal governments work out an arrangement whereby the federal government funds partly funds public hospitals. Initially for the first decade or so this tended to be a 50/50 split. Under the Howard government the proportion of funding that came from the federal government decline to about 42%. Under the Gillard government there was an arrangement for that to be very gradually increased. This year this agreement was renegotiated but the Federal Government did not agree to a five-year plan. It appears it is awaiting the politics of funding of the NDIS. The Federal Government is passing back to the states some responsibilities that have belonged with the NDIS previously. That’s politics. However, the federal government has promised to fund public hospitals next year, 2026 more than they’re doing currently and they have also allowed for increased use of public hospitals. Previously if a public hospital increased its work throughput by 10% the Federal Government only contributed 6.5%. So, an increased demand was not being met by the federal government. That cap has been abolished. The Prime Minister has indicated a desire to increase the proportion of funding to 45% by 2030 but that’s a long way away.

Despite the figures I mentioned earlier about home care packages where demand is currently outstripping supply, there was no commitment to increasing home care packages in this year’s budget.

So, having inherited a health system structured to deal with healthcare 40 years ago labour has in its first term back applied some very large and welcome band aids but has not introduced any significant structural reforms to cope with the epidemic of chronic disease, and the emergence of increasing technological solutions to healthcare problems.

There are however plans the details of which has not been released. One of the early actions of health minister Butler in his first term was to convene a Strengthening Medicare task force. This task force comprised academics and most of the major players in publicly funded primary healthcare i.e. general practice, including the conservative Australian Medical Association. Its report recommended major changes in how primary healthcare should be funded and organised. Over the last two and a half years various subcommittees have met to take the recommendations further and turn them into policy.

One committee, chaired by a senior public servant, recommended that there should be a fundamental change in how general practices are funded. Currently 90% of the Medicare income is through fee for service, i.e. you have a consultation, and the practice gets paid through a Medicare rebate. The change suggested is that by 2030 this would reduce to 60% by giving block payments of some sort for various services provided. This would include all the allied health the practice provides. The idea behind this change is to directly fund care from professionals other than the doctor, a huge need when dealing with chronic disease. It would also allow individual practices to employ those professionals which they identify are most needed. This is such a major change that will take years for it to be implemented, particularly as the Government needs and wants to bring general practices with it rather than impose change upon them

There has been a significant ongoing investment in digital technology including trying to make My Health Record much more useful. It would be so much easier to provide better care to patients if communication between health professionals was easy. That is the aim of My Health Record, but the Minister is on record as saying it currently is not very good, and we know that. Once again this is part of a long-term major change to how things are done. One legislative step has been made in 2024 to force publicly funded providers to upload data to the record, in this case all pathology results. Radiology will probably be next in the firing line.

What is being ignored and should be addressed. The Minister has stated that dental health is too big an issue to address now. There is no appetite for setting up a National Health Commission independent of all the stakeholders including governments, tasked with determining need and distributing all funding according to need. This would kill off the regular excuses for inadequate funding, ‘that’s not our responsibility’. Patients are still having to pay copayments for prescription medicines, despite long standing evidence that that means some patients cannot afford them and are suffering and probably dying because of those payments. New Zealand recently abolished such payment. Wales and Scotland did that years ago.

Lastly, there is that huge issue of the social determinants of health, the conditions in which we work, live, and play. In a wealthy country like ours these factors are possibly even more important to health outcomes than affordable access to care. Thus, adequate home care packages address these very well. But, whilst ever we have JobSeeker payments below the poverty line we know we are not committing to a fair go. And whilst 13% of Australians live on incomes below the poverty line, we know that our taxation and welfare systems are grossly inadequate. Poverty kills.

The Government has plans for Medicare. It clearly sees that the changes are huge and therefore difficult, but it also sees now that it probably has two terms in which to pursue its agenda which I hope will lead to a better and fairer Medicare.