The Budget 2023: Here is what it really means for us as a rural health practice.

As I am sure you have all heard, this week the budget was released, and healthcare was one of the key areas of focus. After minimal attention on Medicare for far too many years, it has been really exciting to see long overdue and highly necessary changes start to occur.

You have probably heard me talking about the need for Medicare reform a lot lately. In case you have wondered why this is something I have been so vocal on, here is a snapshot for you. In a recent article for the Daily Telegraph, Sue Dunlevy quoted that “more than 60 practices around the country have shut their doors in the last 3 years, many practices have stopped bulk billing as Medicare rebates fail to keep pace with inflation, only 14% of medical graduates now want to become a GP, and 4 in 10 patients wait 3 weeks for an appointment”. We have a big problem, and something really needs to change!

This week we started to finally see some of this change. Now it is not exactly a silver bullet, we have some way to go, but it is nice to see that we are taking a step in the right direction. Here are some of the proposed changes, and what it will mean for us as a rural practice:

The bulk billing incentive has been tripled for certain people.

For most patients, when you see your GP, you are charged a gap payment, and you receive a rebate from Medicare. When the GP does not charge you a gap payment and you do not pay for your consultation, the GP bills Medicare, and this is what we call a bulk billed session. Unfortunately, as the Medicare rebates have not drastically changed for many years, they have not kept up with the cost of running a practice, and so bulk billing is no longer a viable option.

This week, the Government increased the bulk billing incentive. This is an additional payment that the GP receives for their consultation, each time they bulk bill a patient. The Government have not substantially changed the actual Medicare rebate or bulk bill payment, only the small incentive that is added in addition when the GP bulk bills. Inclusive of the bulk billing incentive, the payment to a GP when they bulk bill, is still less than the private fee charged by most GP practices, and therefore still unlikely to lead to many general practices being financially viable if they choose to bulk bill.

Further to this, the incentive has only been tripled for older patients, children, and concession card holders. This means that for the majority of people aged between 18 and 65 years, no significant change has occurred to rebates.

While the changes proposed this week are exciting, unfortunately this does still mean that many practices will still have to charge most patients privately for their consultations.

There will be additional funding for multi-disciplinary healthcare.

Another exciting announcement this week, was that General Practices will receive additional funding to employ multi-disciplinary teams. This means that much like what occurs at our practice, the practice you attend may also have other healthcare providers available to support you, such as Psychologists, Dietitians and Physiotherapists. Obviously we are big believers in the benefits of multi-disciplinary care at MHC (our whole practice model is built on it!) so we were very excited to hear the Governments emphasis on this one, and we can’t wait to hear more details about exactly how this will look.

There will be funding to train more Psychologists.

At the end of 2022, the Government halved the number of Medicare sessions available for people to see Psychologists to 10 again (rather than 20). This was really disappointing news, especially following what can only be described as a couple of exceptionally stressful years for Australians. It was disappointing to hear that the Government did not make any changes to this in the budget this week, and have deferred this review until later in the year. On a pleasing note, however, they have pledged further funding to support more training positions for Psychologists, so we are also really excited to hear more details in the coming weeks about how this will work and how it may benefit our region.

There will be additional funding to allow GPs to reduce the burden on emergency departments.

Also included in the budget, was funding to assist GPs with reducing the demand on emergency departments. GPs will receive additional funding to support patients who frequently visit the emergency department. This move recognises the important role GPs play in reducing the pressure on our hospital system. It also recognises the benefits of proactive healthcare, and the essential role GPs play in this. Not to mention, it is far cheaper for the Government if they fund proactive healthcare via our GPs, rather than reactive healthcare via the emergency department!

What it doesn’t include.

There has not been a substantial change to the overall Medicare rebate. This means that the funding for the majority of patients, still does not match inflation or the rising costs of running a medical practice. For the majority of patients, you will unfortunately still have to pay privately to access your GP.

There was no mention of the wider issue facing General Practice, the declining number of doctors on the General Practice pathway. Fewer and fewer medical graduates are choosing General Practice. Many of these doctors voice that at least part of the reason for this, is that they know they will make more money on other pathways, due to the current problems with the Medicare rebate system. Until we can adequately address the workforce shortage concerns, we will continue to have problems with General Practice access, and considerable demand on our public hospital system. Most people in our community would be aware that accessing a GP locally is challenging. It should be noted that this is now an Australia wide concern, not purely something impacting our region. Drastic changes are required to turn this problem around.

As mentioned, the session numbers available to access a Psychologist have not changed. Our current healthcare system does not recognise the true needs of mental health care in our country or our region.

Summary

While more is certainly required, the announcements this week are certainly a step in the right direction. I hope this is the start of more attention and action for General Practice and Medicare reform. For now, it probably means that unfortunately you will still have to pay a gap fee for your GP, similar to what you have been doing. Let’s all pledge to continue to be advocates in the hope we will see further steps towards affordable and accessible healthcare for our region and Australia at large.