More bulk billing is fine. But what the health system really needs this election is genuine reform
- Written by: Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne
Worrying signs are emerging about aspects of Australia’s health system, which will require the attention of whoever wins the May election.
Despite big money pledged for Medicare and the Pharmaceutical Benefits Scheme (PBS), only limited attention has been paid by the major parties to key reform priorities.
Any fresh reform agenda will be starting from a position of relative strength. Australia has a good health system that consistently ranks well compared[1] with other wealthy nations, including on life expectancy, which is on the high side.
Medicare remains the right infrastructure for funding primary care. But it is now more than 40 years old and needs to be updated and improved.
Policy action is necessary on five fronts:
- financial barriers to care
- managing chronic conditions
- mental health and dental care
- public hospitals
- workforce
Priced out of care
Despite Medicare’s promise of universality, around one in ten people defer[2] seeing a doctor because of the cost.
And despite the provision of subsidised drugs via the PBS, people also report missing out on filling prescriptions.
Labor has announced big-ticket measures to improve bulk-billing[4] rates and cap[5] PBS prices at A$25 a prescription. Given cost-of-living pressures are central to the election, it’s unsurprising the Coalition has pledged to match both policies.
But, critically, neither party has announced anything to improve access to other medical specialists[6]. The gap continues to grow between what specialists charge and what Medicare will cover. This means some patients are delaying or avoiding necessary care altogether.
Complex chronic conditions
The health system has not adapted to the rising prevalence of chronic disease in the Australian community. In 2023–24, 18% of the population saw three or more[7] health professionals. But for 28% of those people, no single provider coordinated their care.
Medicare was designed in a different age and needs to be refurbished to respond to this new reality of more patients who are suffering multiple health conditions.
The Strengthening Medicare Task Force[8] and the GP Incentives Review[9] have proposed new systems to fund general practices to facilitate multidisciplinary care.
Work needs to continue in this direction, regardless of who forms the next government.
Forgotten care
Dental and mental health are largely the forgotten sectors of health care. The number of people delaying access to oral health services because of affordability issues is more than twice[10] the 10% who are missing out in other areas of the health system.
Seeing a dentist is very much dependant on income. More than a quarter of Australians living in the most disadvantaged areas defer getting their teeth fixed because of the cost involved. Uncapped access to dental care, as proposed by the Greens[11], is not the answer. What is needed is a more sophisticated route towards universal access[12].
By contrast, the pattern for mental health care is different, with people in both poor and rich areas facing access problems.
The Coalition has promised to restore the maximum number of Medicare-subsidised fee-for-service mental health sessions[13] to 20, despite it being regarded as an inequitable[14] policy.
More fee-for-service mental health care is not the right approach. By contrast, Labor is making a $1 billion commitment[15] to expanding services which are free to the consumer. This includes Medicare Mental Health Services and headspace clinics, which generally employ salaried professionals.
Both parties should support another initiative already underway: the universal[16] program for people with low-to-moderate mental health needs, which doesn’t require either a referral or a co-payment. Labor announced the plan in the last budget, scheduled to start in January 2026.
Inadequate hospital funding
The Commonwealth share of public hospital funding has been trending down[17] for the last few years, reversing the growth in its share over much of the last decade.
Some states have fared worse than others, which means some hospitals have become squeezed and waiting times have blown out.
In late 2023, National Cabinet reached a new funding deal[19] which would lift the Commonwealth share to 45% by 2035–36.
But subsequent negotiations have become bogged down in a quagmire of claims and counter-claims. The Albanese government has responded with an interim one-year funding down payment. But both major parties need to address this issue and commit to implementing the full 45% in the agreed time frame.
No doctor in the house
In 2014, the Abbott government abolished Health Workforce Australia[20], the national agency responsible for health workforce planning. Ten years later, it’s no surprise we are in the middle of a critical shortage[21] of doctors and nurses.
The Albanese government has implemented changes to speed up the recruitment of internationally trained[22] health professionals. It is also offering incentives to encourage more clinicians to work in rural and remote Australia.
But these are just more of the same, similar to the plethora of policies which have left us in the mess we are in. Ensuring we have the right workforce mix to address rural health needs requires a fresh approach. That includes revised funding models – as proposed in the GP incentives review – and allowing all health professionals to work to their full scope of practice[23].
Reform hard slog
Although health often ranks in the top three issues people say are important to them in elections, cost of living is the main focus of media and political commentary.
The promise to increase bulk billing will help lower primary care costs.
But genuine health care reform does not attract much media attention, which means it doesn’t get the profile necessary to prompt the right political promises.
The hard slog of change takes years, and involves much more than a few carrots thrown to voters in an election. It takes careful negotiation with stakeholders and getting the infrastructure right.
Given the initiatives listed above, Health Minister Mark Butler has done well on reform this term. Unfortunately, voters don’t see that, and appear not to value systematic and coherent reform strategies.
It is hoped that whoever is health minister after the election will continue on the reform path to a more sustainable and affordable health system.
This is the eighth article in our special series, Australia’s Policy Challenges. You can read the other articles here[24].
References
- ^ compared (www.commonwealthfund.org)
- ^ defer (www.abs.gov.au)
- ^ Robyn Mackenzie/Shutterstock (www.shutterstock.com)
- ^ bulk-billing (www.health.gov.au)
- ^ cap (www.abc.net.au)
- ^ specialists (findanexpert.unimelb.edu.au)
- ^ three or more (www.abs.gov.au)
- ^ Strengthening Medicare Task Force (www.health.gov.au)
- ^ GP Incentives Review (www.health.gov.au)
- ^ more than twice (www.abs.gov.au)
- ^ Greens (greens.org.au)
- ^ universal access (theconversation.com)
- ^ mental health sessions (www.news.com.au)
- ^ inequitable (www.mja.com.au)
- ^ $1 billion commitment (theconversation.com)
- ^ universal (consultations.health.gov.au)
- ^ down (www.health.gov.au)
- ^ Rose Marinelli/Shutterstock (www.shutterstock.com)
- ^ funding deal (www.pm.gov.au)
- ^ Health Workforce Australia (www.google.com)
- ^ critical shortage (nceph.anu.edu.au)
- ^ internationally trained (www.abc.net.au)
- ^ full scope of practice (www.health.gov.au)
- ^ here (theconversation.com)
Authors: Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice and Primary Care, The University of Melbourne
