The Albanese government is expected to begin overhauling Medicare in the May budget, with a new funding model slated to be detailed under a $750 million election commitment.
With Treasurer Jim Chalmers’ second budget just weeks away, a plan to increase scripts from 30-day doses to 60-day doses for routine medicines, in a bid to lower costs for millions of Australians, was announced this week.
It’s the first of a tranche of budget measures Health Minister Mark Butler will outline in May, amid a pledge to boost funding for Medicare.
Mr Butler will use the budget to respond to a landmark report in March that called for widespread change to Medicare funding to handle a rise in chronic diseases and inadequate access to quality health care.
It comes after Prime Minister Anthony Albanese said fixing Medicare was his government’s “top priority” earlier this year, with a $250 million-a-year boost pledged at the election to fund changes.
However, experts warn the funding increase won’t be enough to tackle escalating crises across Australia’s healthcare system, with a fall in bulk-billing rates and long GP wait times emerging as key challenges.
Grattan Institute health program director Stephen Duckett said the boost is merely a “down payment” on fixing Medicare.
The funding may “set up the infrastructure for future changes” but won’t address the underlying problems with Medicare’s fee-for-service model, he told TND.
Patient registration
Aside from cheaper access to medicines, it’s unclear what reforms will be funded in the budget in response to the Medicare report.
Key recommendations include a patient registration scheme that would direct payments to practices that sign up people for ongoing care, and a new blended funding model that includes lump sum taxpayer payments.
Each of these changes would cost the budget, Dr Duckett said, with the patient registration scheme being a relatively “basic” move that would improve the system at the margins.
Angela Jackson, a health economist and lead at Impact Economics, agreed the registration scheme would be an easy win, but warned marginal reforms wouldn’t deliver needed relief for many Australians.
“When you’re talking about both the size and the way in which solutions could be implemented, it’s not clear yet what that pathway is for setting up the funding effectively,” Dr Jackson said.
“Patient registration has been spoken about for some time, and it’s part of the solution.”
Medicare equity a ‘critical issue’
Dr Jackson said major questions about the state of healthcare funding remain, including whether taxpayers are getting “value for money with our healthcare spending” and inequitable access.
Dr Jackson said the combination of public funding in Medicare with a largely private network of doctor’s practices has delivered a system that over services richer areas, where GPs can charge higher excess fees.
That has left poorer areas with fewer bulk-billing clinics, she said.
“A critical issue at the moment is that people, particularly those in low socioeconomic areas, really struggle to find GPs,” Dr Jackson said.
“Reforms need to ensure healthcare services are being provided in areas they’re needed.”
Inadequate access to healthcare services nationwide, and particularly in regional areas, was a key focus of the Medicare report, while Productivity Commission data shows GP wait times have blown out.
But Dr Jackson said even minor reforms aimed at tackling these issues, including longer script lengths and a push to allow pharmacies to write some routine prescriptions, have been opposed by industry lobbyists.
In a sign that even small changes are difficult, the Pharmacy Guild has vigorously opposed the government’s plan to extend some scripts to 60 days to reduce administration barriers for GPs and lower patient costs.
Meanwhile, doctors’ groups have opposed calls to allow pharmacies to begin writing scripts, which is also aimed at reducing GP workloads.
“These are evidence-based reforms,” Dr Jackson said. “If we can’t even do this basic stuff, then how do we move forward on calls for wholesale reform? There will be winners and losers at each point.”
Dr Jackson said the government could implement a permanent expert body tasked with making evidence-based recommendations for health reform, which could help ease disagreements between health groups.
Such a body already exists in the UK, called the National Institute for Health and Care Excellence.
