EMMA:

I haven't really not had a year where I haven't had a surgery since 2014.

KARA:

Emma is 41, and living with chronic health conditions means that she goes through a revolving door of specialists.

She goes from pain specialist, to clinical psychologist, It can seem never-ending.

EMMA:

There’s been other ones in the mix, rheumatologist's, or however you pronounce it.

I'm supposed to be seeing physios, exercise physiologists, but they’re just too out of reach

KARA:

For someone like Emma, she has to see some kind of doctor almost weekly, and getting to see them is becoming more expensive. For now, her GP is still bulk-billing. But that doesn’t cover everything.

EMMA:

Where I do go they have changed to a billing procedure, but with health care cards they still will bulk bill for now, I guess. This is the first time ever that I had that, all my other GP's have been “Yep. Not a problem.” It's the same thing every single time. And this one, he was a lot different. He’s “well I don't get paid by Medicare to do that so I’m gonna have to put it back on you.”

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KARA:

From Schwartz Media, I’m Kara Jensen-Mackinnon. This is 7am.

More and more people have to pay to see a doctor, GPs are leaving the profession, and the cost of seeing a specialist is rising at an alarming rate.

That’s why the government is promising the biggest overhaul to Medicare in its 40-year existence – the details of the plan could be released any day now.

Everything is on the table for consideration: increasing the Medicare rebate, giving pharmacists the power to prescribe drugs, and more.

But how do we make sure we get changes to Medicare right?

Today, associate editor of The Saturday Paper, Martin McKenzie-Murray, on why Medicare is being overhauled.

It’s Thursday, February 2.

KARA:

Marty, people who have visited the doctor recently, people like Emma, who we've just heard, are more likely to be paying more to see a GP – and that many practices have actually stopped bulk billing altogether. Just how big of an issue is this, right now?

MARTY:

Yeah what we've seen over recent years, an unfortunate decline in GPs bulk billing — that is, patients receiving full reimbursement for their care or their consultations— and so currently at the moment, only about 42% of GP’s are offering fully bulk billed services. That is, there are no additional fees or out-of-pocket costs for the patient. And close to 60% of Aussie patients are now paying a minimum of $40 out of their pocket. And elsewhere, we've seen extraordinary strain on hospitals via the pandemic. The concern from many medics that I've heard in the past week is that this might make people reluctant to go for those check-ups for that primary or preventative care, and that’s also what you hear when you speak to people like Emma.

EMMA:

I've now got zero super left. I've had all of them paid out.

I’ve taken out credit cards for surgeries. You name it.

Getting the help when you need it is not really there. Putting off surgeries or putting off… I’ve been putting off going to see a physio or pelvic physio now for probably three years because of affordability.

MARTY:

And unfortunately, as a result of these high costs and wait times, you've also got people just like Emma, who have had to resort to going to emergency departments when symptoms have become acute. And this is becoming a crisis.

KARA:

And over the years there has been a lot of blame, I suppose, thrown around for why Medicare is in the shape that it's in. So can you explain how we got to this situation?

MARTY:

Yeah, when Medicare was conceived in 1984, it was sort of revived or rebooted from Whitlam's Medibank scheme for universal health coverage, which was later abandoned by the Fraser Government.

Archival tape – Medicare Ad:

“Any day now, you will receive this envelope. It's vitally important that you read what is inside, because inside is your Medicare enrolment form.”

MARTY:

So in 1984, Hawke revived Medibank, now called Medicare. The median age for an Australian was 30 and our life expectancy was 75.

Archival tape – Bob Hawke:

“Every Australian, from newborn babe to Prime Minister, can share in the cheapest, simplest, and fairest health insurance scheme Australia's ever had.”

MARTY:

Today, the median age of an Australian is 38 and our life expectancy is almost ten years more. It's 84. So what this has meant is that we are living longer and we are also an ageing population.

We’re better at screening, we’re better at detection.

And we've seen quite significant increases in chronic disease. And more than that, we're seeing multimorbidity. So that is people with more than one chronic illness. That might be cancer, or diabetes, respiratory or cardiac disease, and mental issues are part of this as well.

EMMA:

Having I guess, endometriosis, fibromyalgia, a spine that's degenerating. I've already had a hysterectomy, so trying to access and get help, you just gotta make one appointment. But it’s still going through everything sort of again. If there's a couple of things that are already on my script, but I also want to ask a question about something else that's concerning or… There's no time, basically.

MARTY:

So those with chronic health conditions are at a much greater likelihood of developing anxiety or depression, for instance.

EMMA:

You get so anxious when it's multiple different issues, then you've got to explain to every single doctor what your health issues are. Unless I take the word of paperwork that I've got, it gets a lot. You get very anxious going to see doctors half the time now.

MARTY:

And so when you have this ageing population with a much higher rate of chronic illness, and patients with enduring and complex needs, the funding modelling of that needs to be more flexible to provide multidisciplinary care. That's, you know, a very consistent and strident criticism of fee for service is that it lets down those with complex and chronic health needs.

KARA:

Ok, so a lot of these issues can be traced back to a problem with what’s called this ‘fee for service’ model – and that’s really the basis of how Medicare works, isn’t it Marty? So is this why people are talking about Medicare needing a complete overhaul?

MARTY:

So the reform of Medicare is extraordinarily massive. And one part of this reform, in fact, a major part of it, will be reconsidering Australia's dependency — or reliance — upon fee for service, which is the payment model that underpins Medicare. Australia is now one of the few developed countries to rely so heavily upon fee for service.

But the fee for service model is whereby the Federal Government subsidises patients’ individual consultations.

This is the sort of significant part of the Medicare reform. That Medicare — and the fee for service model that underpins it — is now outmoded, because Australia has changed so significantly since Medicare was conceived.

The Federal Health Minister made this point, which is that it's in its worst shape that it's been in 40 years. It'll turn 40 next year.

The former federal health department secretary was scathing of the reluctance, or indifference, of the former government for meaningful policy reform. There was this profound antipathy, and that’s generally, but in the health area — and in medicare specifically — he said that we’ve been sleepwalking into crisis.

KARA:

We'll be back after this.

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Archival tape – Mark Butler:

“It's never been harder to see a general practitioner or a doctor out in the community than it is right now. We've heard that from Australians now for many months, and it's never been more expensive. Particularly after six years of a freeze on the Medicare rebate, gap fees have skyrocketed.”

KARA:

Marty, we've been talking about Medicare, which is under enormous strain, perhaps the most since it began. So much so that tomorrow the states will ask for major changes to the way we fund health care. The federal government is promising the biggest overhaul to the system in 40 years. So how is this going to play out?

MARTY:

Well, I think the federal health minister is right in that this may be — and it's theoretical at the moment — this may be the most significant reform to Medicare in its 40 years.

At the moment there’s a strengthening Medicare task force that he conceived last year.

Archival tape – Mark Butler:

“We had patient groups, doctors groups, obviously nursing groups, allied health, professional representation, and a series of experts, all of whom have been working hard over several years, frankly, to come up with the ideas…”

MARTY:

He’s yet to report, he’s promised that report is imminent it may be released in days.

Archival tape – Mark Butler:

“It will guide the decisions that our government needs to take in the May budget to finalise the investment to ensure that Australians get the world class health care they need, when and where they need it out in the community.”

MARTY:

What's been preempted is a blended funding model. For instance, retaining, say a 70% fee for service, 30% capitation, is one proposal.

A point of comparison is the British National Health Service, which uses a model whereby the government funds health providers for the number of patients that are assigned to them, regardless of whether or not those patients seek care.

We're yet to see the final report, so we don't know what will be suggested formally. But it's increasing access, ensuring that patients are not paying significant out-of-pocket fees, which might make them reluctant to go for those check-ups or any other consultations. And the general practitioners. who sit on that task force, are insistent that any funding model changes must retain the centrality of the GP. And there is some anxiety from the RACGP for instance, that by opening up patients to go see a pharmacist, for instance, a podiatrist, is that the GP's role as conductor in the patients experience of the health system is diluted, and that's something they're very anxious to retain. Certainly everyone is in agreement that cohesion within multidisciplinary care is vital. So I'm very curious to see what this report will suggest, and then what the budget will offer later in the year.

KARA:

You mentioned the British National Health service there but I think most of us, most Australians, when we look around the rest of the world and how places like the United States and Britain with their NHS and how they do their health care, they're pretty grim examples. And given that we're about to see what has been called “the biggest changes to our system since it was invented”, just how high the stakes to get this right.

MARTY:

It's very significant. It may come to define. The federal health minister.

It was put to me by a health expert at the Grattan Institute, a think tank here in Melbourne, Peter Breadon, who's not sitting on the taskforce but released a very large report last year on Medicare reform. The silver lining or the benefit of a crisis is that people enthusiastically agree that something needs to change. And he said the unanimity about that, and the sense of urgency is pleasing.

But as is stressed to me, by many members of the taskforce, there is no perfect model.

KARA:

So then, this may be an overhaul, but are we going to see the kind of change that will help someone like Emma – somebody with complex health needs – because everyone seems to agree our system should be better for them, but will the government actually be able to deliver a system that works for people like Emma?

MARTY:

I think what's insisted upon, what there's passionate consensus about is that for those who are suffering, and in increasing numbers, those suffering complex chronic conditions, that the full scope of the medical health system be available to them. There are concerns that at the moment nurses, for instance, are being used inefficiently. So the hope is that there will be much greater access, much less stress upon a very strained hospital system, and that a tinkering or a reform of the funding model might better allow patients to see several specialists while having continuity of care provided by the GP. That's the hope.

KARA:

Marty, thank you so much for your time.

MARTY:

Thank you.

EMMA:

Definitely a lot more that needs to be done with the whole Medicare, and doctors, and understanding of… everything, I guess.

You make plans, you cancel your plans, or you go “I really want to do that, but I know I'm not going to be able to afford it.”

Trying to be healthy, and happy, and live the best life you can. It's.. you can’t. Today I'm just on the couch because I'm in too much pain to move or...

Yeah there just needs to be a lot of understanding I guess.

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KARA:

Also in the news today…

A protest will take place in Sydney to coincide with the funeral of George Pell.

The rally, organised by members of the LGBT+ community as well as survivors of child sexual abuse, was challenged by NSW police, who said they had safety concerns about the expected 3,000 protestors marching near St Mary’s cathedral.

But the protest will now take place, after an agreement was reached on the route the march will take.

And…

It’s been revealed that Clive Palmer’s company mineralogy was the biggest single donor last financial year.

The company donated $116 million dollars to Clive Palmer’s own United Australia Party.

I’m Kara Jensen-Mackinnon, this is 7am, see you tomorrow.

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