My name is Lily Madden and I'm a proud Arunda Bunjelung Calcottin woman from Gadighal Country. The Daily ozz acknowledges that this podcast is recorded on the lands of the Gadigal people and pays respect to all Aboriginal and Torres Strait Island and nations. We pay our respects to the first peoples of these countries, both past and present.
Good morning and welcome to the Daily os. It is Monday, the twentieth of November. I'm Billy fitz Simons.
I'm Emma Gillespie.
Earlier in the year we asked if you had been struggling with finding a bog billing GP, and overwhelmingly the answer was yes. I recently went to my GPU to get a mental health plan review. It cost me one hundred and sixty dollars up front.
Sorry, yeah, paid for two and a half minute our appointment.
It's just getting out of control now.
A new report from the Royal Australian College of General Practitioners the RACGP, has found that the number of GP clinics filling all patients has halved in the last year.
In today's Deep Dive, I'm going to speak to doctor Anita munyof the Victorian chair of the RACGP about what's led to this drop and what it means for you and the future of bog billing in Australia. But first today's headlines. The White House has denied a Washington Post exclusive that Israel and her mass are close to a
tentative US broken deal to pause conflict. According to National Security Council spokesperson Adrian Watson, they have not reached a deal yet, but we continue to work hard to get to a deal. The Washington Post article claimed to the pause could last for five days and free women and children hostages in exchange for a five day pause in fighting.
The New South Wales Rural Fire Service has remembered an enthusiastic and committed volunteer firefighter who died at the scene of a blaze in northern New South Wales. Captain Leo Franson was hit by a falling tree while fighting the Hudson Fire near Walgut last week. He was taken to
Lightning Ridge Healthy Facility, where he later died. The RFS said the loss would be felt deeply across the service and that it was providing support to France AND's wife and two children, as well as his fellow Fieries.
Australian mining billionaires Andrew Forrest and his ex wife Nicola have purchased the iconic Australian hat brand Acubra from the Kier family, who have owned the brand for five generations. Stephen Keer, chairman of the company, said, after we saw how the forests have invested in local manufacturing with Aaron Williams, we decided they were the right custodians for a Cubra. The amount the forest paid for the hat brand was not disclosed.
And the good news the government of Dominica is establishing the first sperm whale reserve in the world. Over fifty sperm whale families live in Dominica's waters, but the species is listed as vulnerable, with their global population under threat from whaling, pollution, fishing nets, oil spills and contaminants. It's hope the reserve, located in the Caribbean Islands bioregion, will help protect the endangered spec and support the biodiversity of the Caribbean.
Doctor Anita, thank you so much for joining us on the daily OS.
My pleasure to star.
Can you just explain for those who might not know what bulk billing actually is.
Okay, So all the people in Australia who paid tax pay a certain amount of tax to contribute to our Medicare scheme. So. Medicare is an insurance scheme that was set up in the mid eighties and it was designed to be the way the government gives a contribution to patients when they go to see a doctor to help them pay for the cost of getting healthcare. And so in the beginning when Medicare was set up, the amount that the Medicare scheme gave as a contribution basically covered
the whole cost of seeing someone like a GP. And as a result, the government asked the patients and the gps to come to an agreement whereby if the government gave the patients money directly to the doctor, the doctor agreed not to ask the patient for an additional contribution
on top, which is called a gap payment. And because at the time the government contribution was a good one, everyone was in agreement, and so the transfer of money from government directly to doctor without going through the patient
they termed bulk billing. So if I see a patient and that patient is bulk build What that means is the patient is signing a form that says to the government, don't give me the money, give it straight to my doctor, because that covers the entire cost of seeing the doctor on the day.
So if your bulk builled, it means that you don't have to pay any out of pocket cost, right correct. And so a new report has found that the number of GP clinics that are bulk billing all of their patients has halved in the last year. Can you explain why that percentage has halved in the last year.
So since about the two thousands, the amount that the federal government was willing to give patients to help them cover the cost of seeing a GP has not kept pace with how much it costs for GPS to give a person that service. And then over time they also froze how much they would increase the contribution to general
practice services. So put all those things together and we end up now where what the government is willing to give on the majority of general practice services is probably worth around about thirty or thirty five percent what the service is actually worth, according to the Australian Medical Association.
We pold our audience about this topic and more than four in five of them said that due to cost concerns, they have put off seeing a doctor for a non urgent medical issue. How big of an issue do you think that is?
So this is a catastrophe, And this is the exact situation we were pleading with governments over many, many years not to get to, because we know that, particularly for vulnerable populations, Australians in a first world country are sometimes making a decision in some weeks whether to go to the supermarket and purchase food or go and see their GP.
And I think that that is totally unacceptable. And I think all young people, all vulnerable people in particular, need the reassurance that they can get health care that they need, because if they don't get it early and they get it when they are sicker, it actually costs the health
system much more anyway. And so we're trying to argue that investing in primary care, where we keep people well and we stop illnesses from getting out of hand, is actually cheaper in the long run than allowing people to get very sick before they finally turn up to an emergency department desperate for help.
So the federal government recently introduced new bulk billing rules, and they tripled incentives for gps to bulk bill some patients. Has that helped it all?
It's too early for us to know, because the scheme started on the first of November. We're only two weeks in and we intend to try to gather data Before the first of November. There was an additional payment of six dollars to a GP who bulk billed someone from a vulnerable population, so a child, or a pensioner or
a healthcare card worker. And of course that incentive also did not keep up with the cost of running a practice, so the federal government made an agreement to triple that amount to try to get bulk billing rates to rise
again for vulnerable populations. Only we don't know what impacts that's having because the things that are affecting general practice in terms of how likely it is a practice can stay open from a financial point of view is much more complex than what the triple incentive is going to be able to solve. So it's very early days.
There's been a lot of media coverage around this. Can you shed some light on how gps are feeling at this time?
So general practitioners have been warning anyone who would listen for the last fifteen years that we were going to get to this point because there was not enough investment into general practice and primary care, and we knew that this was coming for a very long time, and our warnings have not been heeded. So now we're in this situation where it's difficult for general practices to stay open.
Some of them are closing. In fact, the only way a lot of them can stay open is by charging a gap to the patients because the Medicare contribution is not enough. So this is a situation that is heartbreaking for GPS because we knew it was coming and we
wanted to avoid this. And it's also heartbreaking to us because we need to recruit GPS into our profession, and a lot of medical students know that it is probably the toughest of the professions to enter in medicine, and that the government gives the least amount of money to our profession, so it's very hard to convince people to
join general practice when the environment is so harsh. So we need a lot more investment, but we also really need a change in attitude towards our profession across the whole country, including at government.
Do you think they're is a world in which bulk billing ever becomes more widely used.
Again, that really is going to be determined by how much the government is willing to invest in general practice services. I think bulk billing really is the future will be mainly for vulnerable populations. If I'm honest, I don't think that the Australian taxpayer can afford for every single person in the country, from millionaires through to people who are unemployed, to get every single medical service for free. We don't
have enough money for that. We are a small country, so we have to be clever about how we use our money. But I think that we should have all vulnerable populations getting medical services essentially for free. And we need to review Medicare. Medicare was created well over forty years ago. It's not really fit for purpose anymore. It needs to be overhauled.
In your eyes, what is the key solution to all of these issues?
So there isn't a key solution because this is what we term wicked problem, and wicked problems mean that they have such complexities that there's not one single solution and that's what makes this so very hard. But knowing that we are recording a podcast particularly for young people. I think an easy and quick win is to develop services that are particularly targeted at vulnerable populations where they know they can go and get health care they need without
fear of high payments. There's an opportunity to create Medicare contributions that are specific for young people and vulnerable people that are higher that say to the GP, we're going to cover that additional cost because it is a priority to us that these people get seen. So there are some options, but there are many different components to our health system, so we need to come up with more complex solutions within which those two simple ideas have just described could flourish.
Doctor Anita, thank you so much for your time. We really appreciate it my pleasure.
Thank you so much for joining us on the Daily Ods. If you learned something from today's episode, there's one thing you can do in five seconds and would mean so much. Share this podcast to your Instagram stories. It helps get the word out about the Daily Ods and it helps keep the conversation going. We'll be back again tomorrow, actually Sam and Zara will be back again tomorrow, but until then, have a great start to the week.