The Rural Doctors Association of Australia says that necessary reform of health funding arrangements and a focus on big measures needed to boost access to rural health care are both missing from the latest federal budget.
‘The health funding announcements made by the federal government no doubt look very appealing to voters, and for some patients they will make healthcare more affordable – but there’s a lot that should have happened in this pre-election budget that hasn’t,’ said RDAA President, Dr R.T. Lewandowski.
‘There is no real reform of health funding to set up the system for a more sustainable future – and there is no targeted investment to improve access to healthcare for those living in the bush. While cost of living relief in the healthcare sector is welcomed, it is not sustainable in the long-term,’ he argues.
‘The expansion of the bulk billing incentive will mainly support general practices that have high throughput of patients through relatively short consultations, or services that already 100 per cent bulk billed, like many Aboriginal Medical Services (for which this funding boost is much-needed and welcomed).
‘But for many rural general practices, 100 per cent bulk billing will be virtually impossible. Patients at these practices generally need longer consultations due to more complex health needs, and minor procedures are often also provided in the practice. This is why for patients in rural and remote Australia, billing arrangements at their local practice will be unlikely to change significantly.’
Relieving pressure
Dr Lewandowski says the expansion of the tripled bulk billing incentive will relieve some financial pressure on practices that were already bulk billing an additional group of patients, and it may support some increased bulk billing for patients under financial pressure and potentially slow out of pocket expense growth for other patients.
‘However, not all rural practices will be able to provide bulk billing to all their patients, and the expansion of bulk billing will only apply to the consultation (not additional services like in-practice procedures or other diagnostics).
‘While rural doctors would love for it to be true, government messaging that “you will only need your Medicare card when you go to the GP” is unfortunately not going to be the case for many patients, particularly in the bush.’
GP training
Dr Lewandowski says that while the budget includes 400 more GP training places – 200 next year, and an extra 100 places each year for two years after that – only 7 per cent so far have been allocated specifically for rural or remote settings.
‘This is concerning, as RDAA has been asking for 200 extra Rural Generalist (RG) training positions to meet growing demand,’ he said.
‘As an example, around an extra 90 junior doctors applied this year and last year to the Australian College of Rural and Remote Medicine (ACRRM) to undertake RG training – that is, 90 additional applications over and above the annual training positions ACRRM is funded by the government to provide.
‘We need to be making hay while the sun shines. At least half of the additional 200 positions for next year should be allocated immediately to Rural Generalist training – as well as half of all new training positions in future years. It’s a no brainer.’
Welcome changes
‘On the positive side, we welcome the government’s decision to better support junior doctors who have to leave the hospital system to undertake GP training, by providing them with an incentive payment and helping ensure they are receiving entitlements that are more in line with those provided as a salaried hospital employee.
‘This will make it easier for more young doctors to choose to make the move across to GP training.
‘We also welcome the provision of additional Commonwealth supported medical school places, demand driven places for First Nations students to study medicine, and extra places for junior doctors to undertake rotations in general practice – helping them to experience the rewarding nature of a career in general practice.
‘But the positives are generally outweighed by the negatives or the “shoulder shruggers”.
‘For example, while we have seen an extra $658 million committed to open another 50 Urgent Care Centres, there has been no funding reform offered to better support rural doctors to provide after-hours care to their communities, nor reform to boost the number of GPs across the country providing after-hours services until 9pm.
‘We also need to simplify the arrangements – and remunerate rural doctors fairly – for 24/7 on-call rosters that integrate general practice and hospital after-hours care – because in rural settings, the same doctors generally work in both the general practice and hospital.’
RDAA is urging Labor and the Coalition to ensure rural and remote healthcare receives significant focus in the lead-up to the federal election.
‘We need to get rural health funding right, and we need to see intent from our future governments to deliver meaningful funding reform to boost access to healthcare for rural and remote Australians,’ said Dr Lewandowski.
