WORLD NEWS | Big changes in health budgets – revive our antiquated Medicare fee-for-service system and boost bulk billing

Melbourne, 10 May (Talk) Four big changes to healthcare in Budget 2023-24: Prioritizing primary care, funding for stronger Medicare, cheaper access to common medicines and a bid to keep the digital health system Operation provides new funds. Recent weeks have foreshadowed many of these changes.

The big news of budget night was the tripling of bulk billing incentives, a key pillar of strengthening Medicare.

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The payment was introduced in 2004 to encourage GPs to bill pensioners, health card holders and children in bulk. It provides an additional amount, from around A$7 to over US$10, depending on GP location, on top of the normal Medicare rebate when services are bulk billed.

But volume charges have declined since then, from about 90% in early 2022 to about 80% a year later. Batch billing is unevenly distributed, with less than 50% of people in some low-income areas (batch billing deserts) batch billing for all their GP visits. This leads to uncertainty and people missing care.

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Tripling bulk billing incentives — billed as the largest investment in health insurance in 40 years — promises to halt and possibly reverse that decline.

However, it’s unclear whether it will increase bulk billing. Practice owners can simply pocket the increased incentive for patients already bulk-billed while the bulk billing rate remains the same. Alternatively, GPs could use increased revenue from existing bulk-billing patients to reduce their working hours, rather than bulk-billing more patients.

The most important change in the health budget was symbolic: the government spoke of primary care. Often, health budgets are concentrated in hospitals, and primary care is an afterthought, or worse: the target of budget cuts.

The 2023 Budget kicks off the primary care rebuilding process, modernizing the system to accommodate the transition to a larger population with multiple chronic conditions such as diabetes, heart disease and depression.

Ahead of the budget, Health Secretary Butler emphasized the centrality of primary care to the health system. Beyond rhetoric, this budget sets aside real money to create a new foundation for primary care.

The second change is to provide funding for long-discussed issues. Health Secretary Butler, when he appointed the Medicare Strengthening Task Force, of which I am a member, said that focusing on primary care was one of his first actions.

A working group report released late last year laid out an ambitious blueprint for change. The budget includes the first down payment and more than $1 billion in new funding throughout the year.

A major challenge for primary care policy is reliance on fee-for-service. The budget addresses this by modernizing the way the government pays for primary care in two key ways:

First, it introduces the concept of enrollment into Australian primary care.

A longstanding part of the international primary care system, and considered one of the key ‘cornerstones’ of good primary care, registration involves patients identifying their preferred GP as their primary source of care.

Patient registration, known as MyMedicare, means the clinic or GP is accountable to the patient between visits, thus creating a long-term relationship between patient and doctor.

The Strengthening Medicare Task Force also recommends more multidisciplinary or team-based primary care, including nurses, physical therapists and a range of other health care providers and administrative support. As the 21st century iteration of the Whitlam government’s community health programme, it’s a bit of a throwback to the future.

The Budget significantly increases the Workforce Incentive Scheme, which provides grants for practices that employ nurses, Aboriginal and Torres Strait Islander health workers and allied health professionals.

The program recognizes that caring for people with multiple chronic conditions requires a range of specialized skills. Importantly, many general practices already recognize this and are already offering team-based care.

Increased funding in this budget will reward past behaviors, make those practices more viable, and encourage the expansion of others.

The third budget change, announced in April, lowered prescription costs for drugs by expanding the number of prescriptions for many common drugs from a one-month supply to a two-month supply.

Despite the tears and posturing of the Pharmacy Guild – the lobby group for pharmacy owners – the expert Pharmaceutical Benefits Advisory Committee recommended the modest change five years ago.

It doubles the amount of medicine that can be filled under a single prescription, reducing patient co-pays and payments to pharmacists for fillings. It cut government spending by about $400 million a year and showed the government was ready to embrace strong stakeholders despite threats from guilds, huge political donations and local campaigns.

Finally, the budget tackles a ticking time bomb left by the previous administration: digital health.

The Strengthening Health Insurance Task Force identified contemporary digital health capabilities as essential to a modern health system. But it’s odd that the previous administration didn’t consistently fund digital health agencies and my health records. It was originally scheduled to expire on June 30, 2023.

Approximately $250 million has been allocated throughout the year to maintain operations and My Health Record.

While the current functionality and support for My Health Record leaves a lot to be desired, turning it off without replacing it is never an option.

Obvious omissions are related to mental health. While more budget time bombs have been funded – the schemes would otherwise end – and extra places in psychology courses are being funded, mental health reform is still underway.

The temporary expansion of the COVID-related Better Access program from a limit of 10 to a limit of 20 mental health visits has sparked predictable criticism, even though the program is clearly unfair. The government has recognized this gap, calling its mental health budget announcement “laying the groundwork”.

Overall, the health component of the 2023-2024 budget is well designed. It signals a new priority for primary care and provides a new basis for future funding reforms. (dialogue)

(This is an unedited and auto-generated story from a Syndicated News feed, the content body may not have been modified or edited by LatestLY staff)