2023-03-01
Australia is struggling to deliver Medicare’s original vision of universal health care, especially in rural areas. Privatised health care continues to grow, provided through private health care companies. The Greens policies go a long way to addressing these challenges, including making dental and mental health care free under Medicare.
By Juanita Doorey, member of Fremantle-Tangney Greens and the Unions Working Group
There’s been a lot of discussion about Medicare lately and the need for comprehensive reform of the scheme. Introduced 40 years ago as a universal health insurance scheme, Medicare was designed to reimburse GPs for medical services and procedures, ensure access to public hospital services and provide access to the Pharmaceutical Benefits Scheme through the Medicare card. Financed through the taxation system (a Medicare Levy), the introduction of Medicare was visionary and courageous public policy, aimed at providing universal access to health care.
Four decades on however, this universal health insurance scheme is playing out very differently. Finding a GP who bulk bills is more and more difficult and at the GP surgery I go to, the out-of-pocket cost for a standard consultation is now $49. While I’m lucky I don’t usually have to wait too long for an appointment, in the 2021-2022 financial year, nearly 40% of Australians with an urgent medical issue had to wait more than 24 hours to see a GP. I wonder how many headed straight onto a hospital emergency department instead?
Many rural communities struggle to even have a local GP and in late January 2023, the Shire of Quairading, 160 kilometres east of Perth, offered a $1 million package to attract a GP to their community of 1000 people. The good news is they’ve had lots of applicants! The WA Country Health Service and Aboriginal Community Controlled Health organisations provide health services in regional WA, however, access to specialist services is difficult ‒ people either have to wait months to see a visiting specialist or travel to Perth to see a specialist or for diagnostic and hospital services. Shortages of midwives and obstetricians in parts of regional Australia also mean that women have to travel much longer distances for obstetric care and to give birth. It’s little surprise that people living in rural communities have poorer health outcomes, including delayed diagnosis and treatment of cancer and for chronic health conditions.
The Covid pandemic really stretched WA’s public hospitals to the limit and saw elective surgery wait times and ambulance ramping blow out even more. Nurses and other hospital staff continue to be on the front line of Covid, however, they’ve had to battle hard during the past 12 months for reasonable pay increases and better working conditions.
Perhaps the biggest change since Medicare’s introduction 40 years ago has been the rapid growth of private health care and private health insurance. According to APRA figures, as of June 2022 45.2% of Australians (11.67 million) had private hospital cover while 55.2% (14.26 million) had private extras cover. For many people that I know, taking out this insurance is a last resort ‒ when faced with the prospect of sitting on public hospital wait lists for months or even years. However, paying premiums just isn’t an option for many, especially in the current cost of living crisis.
How does Australia compare?
New Zealand, the Nordic countries (Denmark, Finland, Sweden) and Britain (England, Wales, Scotland, Northern Ireland) also have universal health care, funded through a mix of taxation and government funding. However, rates of private health insurance in these countries are generally much lower than here: around 11% in the UK; estimates of 6.5-10% in Sweden and around 10% in Finland. New Zealand has a higher percentage, with 34% of the population having some form of private health cover.
Hailing from New Zealand, I was really interested to find out that the co-payment for subsidised medicines there is capped at $5 per prescription. Compare this to Australia, where people can pay up to $30 for most PBS medicines or $7.30 with a concession card. While $30 sounds (and is) a lot, this is actually a $12.50 reduction in the cap on co-payments from January 2023 ‒ from $42.50 to $30 per PBS medicine.
It really seems that Australia’s ‘hybrid’ public/private health system is now deeply entrenched, with increasing commercialisation and corporatisation of health care. Government policy also encourages private health insurance through reduced tax levies. But while those accessing private health care may have quicker access to a specialist or health care provider of their choice, many are also paying big out-of-pocket costs for specialist care and hospital treatment.
2023 Strengthening Medicare review
Released in early 2023, the Taskforce made a number of key recommendations including:
- More investment to support multidisciplinary teams in general practice, with coordination of patient care via a GP/general practice ‒ this would include nurse practitioners, midwives, pharmacists and allied health professionals working with GPs to support patient care in new funding models (yet to be specified);
- Funding for longer GP consultations ‒ recognising that patients with chronic and complex care needs often require more than a 15- minute standard consultation;
- Improving access to GPs and primary health care outside of standard business hours, also intended to take pressure off hospitals;
- Investing in Aboriginal Community Controlled Health Organisations to commission primary care services, and looking at new funding models to sustain rural and remote practices.
Labor committed to this Medicare review during the 2022 Federal election campaign. However, the extent to which the Albanese government responds to these recommendations will be seen in this year’s federal budget and the Strengthening Medicare Fund.
Greens’ advocacy around Medicare and free healthcare for all
During the 2022 Federal election campaign, the Greens advocated for dental and mental health care to be part of Medicare. When doorknocking before the election, so many people I spoke with agreed these policies made good sense. The Covid pandemic exposed the lack of affordable mental health services and for many, dental care is a huge and unaffordable expense. During the 2010 power-sharing Parliament, the Greens got Medicare for 3.4 million children and getting dental into Medicare for everyone is unfinished business!
The other policies in the Greens’ comprehensive health plan related to:
- Putting money into hospitals instead of private health insurance;
- Safer drug use;
- First Nations’ health;
- Women’s health;
- Tackling future pandemics;
- Prioritising prevention; and,
- Ensuring high quality aged care.
To say that prevention is better than cure has never been more applicable. Around 50% of Australians have a chronic health condition and there are many contributing factors. The nature of our built environment, income level, access to public transport, working hours and conditions and access to nutritious and affordable food are just some. The Greens are calling for a National Preventative Health Commission to be established to drive research and interventions. And the effect of climate change on peoples’ health is another priority area for The Greens.
Since last year’s Federal election, Senator Jordan Steele-John has launched a big campaign which aims to have Attention Deficit Hyperactivity Disorder (ADHD) diagnosis for children and adults covered under Medicare and for the National Disability Insurance Agency (NDIA) to recognise ADHD as a primary diagnosis. More than 10,000 people took part in a survey conducted through Jordan’s office – the survey aimed to learn about peoples’ experiences in the healthcare system, about barriers and gaps and how to improve access to ADHD diagnosis and support. This campaign would have been welcome news for a friend who fairly recently waited more than 12 months to see a psychiatrist for an ADHD assessment and paid lots for it!
Another big issue is that people in prison don’t have access to Medicare. The rationale for this is that health care in prisons is the jurisdiction of states and territories; however, there is lots of evidence that this health care isn’t adequate, especially for people with complex and chronic health conditions. It means in effect that prisoners are denied access to the PBS. This situation just isn’t fair or equitable and is another area of concern for The Greens.
Quality health care that is accessible and free for all is fundamental to our sense of security and wellbeing – at an individual and community level. However, it seems that we’re really moving away from the aims of Australia’s universal health insurance scheme set up 40 years ago and rapidly moving towards greater commercialisation and corporatisation of health care. More than ever, The Greens have a really important role to play in advocating for free and accessible public health care and for major government investment in Medicare.
[Opinions expressed are those of the author and not official policy of Greens WA]