While doctors have called for higher Medicare rebates to meet the rising cost of providing care, a new report from the thinktank the Grattan Institute argues that GPs have “steady profit margins” and that more drastic measures are needed to preserve Medicare.
General practices need to be overhauled to employ a team of health workers including physiotherapists and nurses to better manage rising rates of chronic and complex disease, the report led by Grattan health and aged care program director, Peter Breadon, said.
According to the report, a broken funding and care model is “actively discouraging team care and rewarding speed, not need”.
A growing number of general practices are turning away from being exclusively bulk billing to becoming mixed or private billing practices, with the Grattan report describing how this has affected poorer Australians the most, who are also more likely to have multiple chronic diseases.
As a result, the federal government has convened a “Strengthening Medicare taskforce’” to advise on how to spend $250m a year to keep healthcare accessible and affordable. More GPs and higher Medicare rebates have been put forward by doctors as candidates for the funding, with GPs saying rising costs mean they can not afford to exclusively bulk bill patients.
But the Grattan report says, “Australia has many GPs, with more on the way.”
“And general practices have survived the four-year Medicare Benefits Schedule [MBS] freeze battered but intact, with higher take-home pay and steady profit margins,” Beardon and his colleagues wrote.
“More of the same – more GPs, and more funding under the same model – will not be enough to relieve the pressure on general practices. It will not address the structural mismatch between Australia’s outdated primary care system and the care Australians need.”
Australia must address regulatory and funding barriers, so that nurse practitioners and physician assistants can bill a broader range of consults and treatments for their patients to Medicare. Medicare item numbers and rebates available to nurse practitioners are limited, and doctor approval is needed for a patient to receive a Medicare rebate for a nurse practitioner consultation.
The report said funding must be “more flexible, with less micromanagement through complex MBS rules”. “Link funding with need, supporting longer consultations for people with complex care and social needs,” it recommends.
The Royal Australian College of General Practitioners president, Dr Nicole Higgins, said while she supports multidisciplinary teams, these must be GP-led. However Higgins said there are shortages of other healthcare workers such as nurses and pharmacists, and so simply calling for larger teams is not enough without addressing the broader staff crisis across the health system.
Higgins is concerned that the Strengthening Medicare taskforce review is considering measures that may lead to the “fragmentation of care,” and that pilot trials occurring in some states to allow pharmacists to prescribe a limited range of medications are an example of the erosion of GP-led care.
“I do have deep, deep concerns about the review,” she said.
“It’s really important that while we look at the Medicare system, and the MBS, we make sure that GPs remain at the centre of multidisciplinary care. General practice is the solution to the healthcare crisis and fee-for-service should remain central to that model, and any flexible models proposed should be an add-on. GPs provide the vast bulk of primary care and we need to make sure it’s adequately funded.
“Really, $250m a year is just $10 per Australian. So we also need an urgent injection of further funding into general practice.”
