News Review
4 AUGUST 2023 ausdoc . com . au
‘ General practice is caught in a perfect storm ’
In this exclusive interview with Australian Doctor , Mark Butler answers questions on payroll tax , pharmacist prescribing and more .
Paul Smith
MARK Butler has been here before . Back in 2008 , he was a junior minister working under Nicola Roxon , the health minister who pushed for a fundamental shake-up of the health system : in short , to get it to think with one brain .
The language of the time will be familiar today .
Wraparound care for complex patients , block funding for chronic disease management and a move away from fee-for-service , along with a now-forgotten revolution in subacute care to stop hospitals crumbling under the pressure .
Many of the grand ambitions were punctured .
The global financial crisis struck , and the involvement of their chaotic and difficult boss , Kevin Rudd , did not help them much either .
Since then , the history of reform has grown simpler and darker .
Various health ministers have arrived , offering soothing words about the importance of general practice and then delivering stagnation .
Mr Butler knows this . He has been one of the few to use the word ‘ crisis ’ to describe what has happened .
But it is from this awareness of the bleak history that you sense his ambition as federal Minister for Health and Aged Care is to finish a little of what was left undone a decade ago .
The collapse of bulk-billing
During our interview , he talks , as you would expect him to , about the massive new investments the Federal Government has made to stem the collapse of bulk-billing and protect the Australian Labor Party ’ s most cherished political legacy : the social good of Australia ’ s universal health insurance system .
The question is whether the explicit focus on bulk-billing incentives for children and concession card holders is an acknowledgement that he has been forced to give up on the idea of mass bulk-billing for the rest .
“ Well , the short answer is no ,” is his response .
“ I do not necessarily have hard data for this , but feedback from the sector has indicated that bulk-billing concession card holders and kids had been a loss leader for practices .
“ And it was placing pressure on gap fees for non – concession card holders .
“ We hope that we are achieving a bit of a twin benefit from tripling the bulk-billing incentive .”
Does he accept that many GP practices cannot afford to bulk-bill non – concession card holders given the rebate levels ?
“ It is complex . You have got very high levels of bulk-billing in some of the more expensive parts of the country to run a practice and very low levels of bulk-billing in some of the less expensive parts — Tasmania , for example .
“ So , it is difficult to give a blanket answer to the question about what level of rebate , or what level of bulk-billing incentive , is the sweet spot for financial viability .
“ It is quite clear that , across the country , there are a large number of small markets rather than a single market .”
Is Professor Karen Price to blame ?
I ask if he blames Adjunct Clinical Professor Karen Price for what is happening , the Melbourne GP who , as RACGP president , finally did what had long been discussed privately in the college hierarchy by urging GPs to walk away from universal bulk-billing because of the damage it was doing to general practice and the quality of patient care . “ No , I don ’ t blame her ,” he says . “ I think general practice is experiencing a perfect storm of a number of different pressures .
“ Some of it is longstanding demographic change . But the financial pressure through the freeze on Medicare rebates over several years lies at the feet of government , not the feet of any particular stakeholder .”
So does he regret that Labor invented the Medicare freeze as a health policy , specifically the decision by the Gillard Government in 2013 to delay indexation for six months as a ‘ temporary ’ cost-saving measure ?
His response comes quick . He says his government ’ s policy was a technical fix .
“ The indexation was delayed for some months to realign it with usual financial year arrangements .
“ And then it was very clear in the 2013 budget , if you look at that year and then subsequent years in the forward estimates , that indexation was going to resume in line with that new indexation date .
“ It is not right to conflate that realignment of the indexation date with what was a deliberate decision — taken in the wake of the Parliament ’ s refusal to pass Peter Dutton ’ s GP tax — to freeze rebates for several years .
“ The two are very different things .”