Health experts are pleading with both sides of politics to commit to increased funding for GPs after figures reveal lower-income areas are among those most disadvantaged by the Medicare gap.
In the face of doctor shortages and rising patient fees, new data reveals some of the most disadvantaged electorates have among the highest average out-of-pocket costs for a consultation.
Medicare funds a rebate of $39.10 for a standard consultation, however aside from indexation rises, this amount has been frozen since 2013, with the Royal Australian College of General Practitioners (RACGP) warning that a disconnect between the rebate and real cost of delivering services is forcing GPs to either increase out-of-pocket costs for patients or, increasingly, shut down entirely.
Moreover, the RACGP and other industry experts are concerned that unless the government overhauls how GPs are funded, increasing numbers of medical graduates will opt for a career in higher earning specialties, which in turn would worsen health outcomes for lower income earners who could not afford rising out-of-pocket costs.
Commonwealth data broken down by electorate shows that the average out-of-pocket costs for a GP consult range from $27.11, in the South Australian seat of Spence, to $52.05 in Wentworth, home to some of Sydney’s wealthiest suburbs in the city’s east.
Several inner city and suburban seats such as Melbourne’s Higgins and Macnamara – third and fourth most expensive at $50.65 and $50.29 – as well as Sydney – the fifth most expensive at $49.55 – also feature as some of the most expensive electorates for out-of-pocket costs.
However, out-of-pocket costs in the Northern Territory are among the most expensive in the country, with Solomon – the electorate that is home to Darwin – recording the second highest average out-of-pocket costs in Australia, at $50.78, while Lingiari, which takes in the remainder of the territory, is the 14th most expensive, at $45.61.
Both Solomon and Lingiari are marginal seats, held by Labor at 3.1% and 5.5% respectively.
The marginal north-western Sydney seat of Greenway, which Labor MP Michelle Rowland holds by 2.8%, has the 20th highest average out-of-pocket cost for a GP visit, at $45.17, while in Queensland, the seat of Groom, which takes in Toowoomba, ranks 18th highest, with an average cost of $45.36.
Rising GP fees
Dr Karen Price, the RACGP president, wants the Coalition and Labor to commit to better funding GPs in line with the rising costs, and is keen for voters to understand the associated impact on health outcomes for Australians.
She said it was proven “time and time again” that investments in primary care lead to a greater saving for the government in hospital costs, by treating before conditions escalate.
Price acknowledged a government figure that about 89% of GP services were bulk-billed – but said this did not mean that 89% of patients were not paying for their doctor visits, rather, that a visit that included a consult and having something removed registers as two services.
“We think the number of Australians who don’t pay anything for their GP visits is between 67% and 70%.”
Price was alarmed at some of the higher average out-of-pocket costs in poorer areas. “If you’re in an area where there’s no other doctor and you’ve got a six-week wait for a bulk-billed appointment, they can charge more,” she said. “But the vulnerable people in those electorates are not going to access it.
“Most of the healthcare people need is related to their postcode and their socio-economic status. It’s often those who need the most care that are least able to pay for it.”
Rising cost of business
Price said higher out-of-pocket costs in regional areas came at a time when it was tough to attract GPs trained in cities to relocate for work. Even in cities, Price said, current Medicare funding levels were turning graduates away from general practice.
“We know that only 15% of medical graduates are looking to enter general practice, which is down from 50%. When you’ve got kids and Hecs debt after a long course, it can be more attractive to stay in a hospital job with leave and other entitlements, rather than become a GP.”
Price noted that the Australian Medical Association recommends GPs charge $86 for a standard consult, and that if they don’t charge this, “they’re basically discounting their work”.
Price said she had observed a recent spike in practices moving away from being entirely bulk-billed, and others being forced to close down, and believed this was in part because Medicare funding was outdated.
“Our healthcare has become more complex. We have an ageing population, and mental health and complex chronic conditions are more common. They require consultations but are not valued by Medicare in the same way. You’ll earn more if you see three patients in the time it takes for an extended appointment for one patient,” Price said.
Additionally, Price pointed to the increased cost of paying staff, acquiring and maintaining new computers and technologies used to treat patients, and the price of PPE that soared during the pandemic, as reasons why some GPs were forced to increase their out-of-pocket costs.
Dr Stephen Duckett, a Grattan Institute health economist and former secretary of what is now the Department of Health, echoed Price’s concerns that general practice was underfunded and graduates were turning away from the career, but said “the right answer may not be by increasing the rebate”.
“We want to reshape the way primary medical care works … so exploring funding that increases the incentive for continuity, to reward GPs for building a relationship with patients, which can allow them to be more proactive in their care with things such as phone checkups.
“You’ve got to invest more money in general practice. And we can’t ignore that if you’re leaving medical school today, the choice between being a GP and a cardiologist is five times as much money, so we have to start addressing that,” Duckett said.
What the political parties say
The opposition health spokesperson, Mark Butler, did not directly answer if Labor would increase the Medicare rebate, but said “Labor will always strengthen and protect Medicare, we’ll have more to say during the campaign”.
“Under Scott Morrison it’s never been harder or more expensive to see a GP.
“We know that when people can’t afford to see the GP they either end up in overwhelmed emergency departments or just put off getting the healthcare they need,” Butler said, also pointing out Labor’s urgent care clinic commitment.
Guardian Australia asked Greg Hunt, the outgoing health minister, if the Morrison government planned to increase the Medicare rebate.
A spokesperson did not answer directly, but referred Guardian Australia to the figure that 89% of GP services are bulk-billed, and said that “the Morrison government is committed to not just supporting GPs, but also supporting their patients”.
“In terms of funding, Medicare was $19bn under Labor and is $31bn this year growing to almost $36bn over the forward estimates,” the spokesperson said.
