AMA recommends updates to Medicare, notes healthcare system is outdated

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Australia’s public healthcare system is out-of-date and no longer meeting the needs of today’s patients, according to the country’s peak medical body.

The Australian Medical Association (AMA) is calling for reform to the Medicare system and says the lack of investment in the GP workforce has left the system struggling to keep up with community needs, leading to logjams in hospitals.

The association has proposed a series of changes, including restructuring GP consultations, addressing workforce challenges, and increasing funding and resourcing.

Is the Medicare system out of date?

Medicare is Australia’s universal healthcare system and was introduced in 1984.

AMA president Dr Danielle McMullen told SBS News that when Medicare was first introduced, patients typically had fewer health issues and only needed a few minutes for an appointment with their GP.

McMullen said many patients now have more complex needs, and short consultation times mean patients are not getting the care they need.

“Medicare was revolutionary when it was introduced in the 1980s, but with our ageing population and growing chronic disease rates, GP consultation items have become out-of-date,” Dr McMullen said.

“Now, of course, we’re in a time where people have more chronic diseases, more mental illness, and even the treatment of simple health conditions is more complicated than it was back in the eighties.

“And yet we’ve got the same old structure of Medicare.”

Dr Danielle McMullen speaking in a press conference.

AMA President Dr Danielle McMullen says Australia’s Medicare system is at a “tipping point”. Source: AAP / LUKAS COCH/AAPIMAGE

Peter Breadon, director of the health program at the Grattan Institute, said poor Australians and people living in rural and remote communities are disproportionately impacted.

He said these people have less choice of where they can go and less access to bulk billing services.

“People who live in GP deserts, these communities in many rural parts of Australia where there’s just much less care and those people are sicker, they’re much more likely to go to hospital for a condition that could have been prevented with good primary care,” he said.

“It’s really perverse that we have the least care in those areas that need it most.”

Sharon Friel, professor of health equity at the Australian National University, said patients being unable to access adequate care through GPs could lead to more serious illnesses and increase pressure on hospitals.

“We’ll see more people going into the hospital presenting with conditions that really should not be in the hospital; they should not be in the emergency department,” she said.

“The GP or the wide primary healthcare system is so important for equitable access, timely treatment, and reducing the financial cost to the system.”

Medicare was introduced in Australia in 1984. Source: AAP / /AAPIMAGE

Friel said longer appointments and more time with their GP would enable more holistic care and empathy.

“The empathy that is enabled in a longer consultation is really important for people’s sense of wellbeing,” she said.

“And being heard, being listened to, having a sense of involvement in your health decision making processes is really useful, really important for your outcomes, for your health outcomes, both physical and mental health outcomes.”

How can Medicare be improved?

The AMA’s Modernise Medicare campaign is proposing increased funding and resourcing and a new seven-tier standard consultation item structure designed to support patients to have longer appointments.

The campaign is also calling on the government to tackle workforce challenges and encourage a more multi-disciplinary approach to general practice health care.

Additionally, the AMA is calling for an extra 500 training rotations in general practice for early career doctors as well as an additional 500 GP training places as part of efforts to address the AMA’s predicted shortfall of 10,600 GPs by 2031– 32.

McMullen said Medicare is at a “tipping point”, and should be made a priority.

“We’re reaching a point of no return where after years of a Medicare freeze and then inadequate indexation, those Medicare rebates just don’t meet the cost of providing care,” she said.

“And unless the government acts now, the gap will be so wide that no government will be able to catch up.”

Dr Michael Wright, the president of the Royal Australian College of General Practitioners, said he agreed longer consultations are required to meet the needs of Australia’s ageing population, many of whom have multiple chronic health conditions.

Wright said there should be a focus on GP training and increasing rebates and access to bulk billing.

“Increasing the rebate will make it easier for GPS to bulk bill these longer consultations and it will also decrease the out-of-pocket costs for people who don’t have access to bulk billing,” he said.

“By supporting patients with higher rebates, we’ll make it easier for them to spend more time with their GP when they need to. All Australians deserve affordable access to a GP who knows them.”

A spokesperson for Health Minister Mark Butler said the Albanese government’s investment had led to more bulk billing, Medicare Urgent Care Clinics, and more doctors joining the healthcare system in the last two years than any time in the past decade.

The spokesperson said the government’s investment had created an additional $5.8 million bulk-billed visits since November 2023

“Although we’re not out of the woods yet and there is a lot of work still to do, we are seeing things turn around in those areas that we need.

“We’ve got more doctors, we’ve got more bulk billing, and we’ve got Medicare Urgent Care Clinics that have already seen more than a million patients, all fully bulk billed.”