Minister for Health and Aged Care – interview on ABC AM – 1 November 2023

Read the transcript of Minister Butler's interview with Sabra Lane about the largest investment in bulk billing in the 40-year history of Medicare and the health workforce.

The Hon Mark Butler MP
Minister for Health and Aged Care

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SABRA LANE, HOST: From today, the Federal Government is tripling the bulk billing incentive for GPs when they treat children under 16, pensioners and other Commonwealth concession card holders. The measure was a major part of the Federal Government's May budget. Bulk billing is when a doctor bills Medicare directly for their patient's medical service, leaving those patients with no out-of-pocket costs. The incentive is an extra payment doctors receive on top of the Medicare rebate every time they bulk bill an eligible patient instead of charging them those out-of-pocket fees. The Federal Health Minister is Mark Butler. Minister, will the tripling of the bulk billing incentive make it easier for these targeted groups to see a doctor?

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: We're very confident it will. This is what doctors’ groups had called for a long period of time. When we delivered it in our May budget, they called it a “game changer”. Already we're hearing practices changing their shift from bulk billing, which really they've been forced to after a decade of cuts and neglect and the latest global cost of living shock, but they've said that they'll be returning to bulk billing or many of them who are considering a change would stick with bulk billing for those more than 11 million Australians. That's about 60 per cent or more of the throughput of the average general practice So it's a huge boost in confidence and funding to a sector that I think is probably in its most parlous state it's been in the 40-year history of Medicare.

LANE: The Australian Institute of Health and Welfare earlier this year reported a big drop in GP services, saying it could be related to a sharp rise in out-of-pocket costs. Is the tripling of the incentive the only measure you've got planned to help families with these costs?

BUTLER: No, this is part of $6 billion almost in new initiatives taking effect from today. As well as the tripling of the bulk billing incentive we're delivering the biggest increase this year across the board to Medicare rebates since Paul Keating was prime minister more than 30 years ago. A bigger increase just this year than the former government managed in seven entire years. We're doing a range of things to boost the viability of general practice to make it easier for patients to see a doctor, particularly free of charge, and also to introduce a range of reforms that we negotiated with the sector that reflect the fact that the patient profile is not what it was in the 1980s when the Medicare system was first designed. So a mix of reform, delivering better quality care to patients with an injection of funding that's long overdue to this sector.


LANE: Tasmania is like many parts of regional Australia and many outer fringe city suburbs. Doctors can't be found or their practices have shut, making quality care hard to find. The Government currently has a scope of practice review underway. What change do you hope this will bring to deliver healthcare to people who can't easily get it right now?


BUTLER: You're right to say that right across Australia we've got a real problem with the supply of our workforce. This is a global issue that was really aggravated by the pandemic. A shortage of supply of workers, but an increase in demand for healthcare. We're getting older, there's more chronic disease, there's legacies of COVID. So, at a time of constrained supply and increasing demand, I've said many times it doesn't make sense not to have every single one of our health workers operating to what they describe as the top of their scope of practice, which is utilising all of their skills, all of their training and all of their experience. That's what I want to see for our nurses, nurse practitioners, pharmacists, allied health workers and general practitioners as well. There's been this glass ceiling, particularly on nurses that has not allowed them to utilise all of their skills and training that I want to see removed. I want to see their potential unleashed and that's what this review is all about.

LANE: That scope of practice review has already received nearly 700 public submissions. An interim report is due next month and all the state and territory governments are on board. How confident are you that the various health professions will agree on how health is delivered that it actually needs to change in favour of patients and not protecting the professional turf of various groups?


BUTLER: You're right to say that in the past or, you know, suggest that in the past this has been an area where there's been lots of turf wars, lots of sharp elbows. But when we went through the strengthening Medicare process over the course of last year, I detected a real sense of goodwill between the different professions. Obviously, the devil will be in the detail. We want to work sensibly with all of the professions to make sure we get this right, but there really is a recognition that we need to utilise everyone's skills to the fullest if we're going to deal with this problem of not enough supply to meet the demand for good quality healthcare in the system.


LANE: We heard on AM yesterday that practitioner nurses could deliver a lot of services in towns where doctors just don't practice anymore, but they're not properly compensated for that. Would you like to see that change?


BUTLER: Well, again, in the Budget in May, we announced that we'd increase the Medicare rebates for nurse practitioners by a full 30 per cent next year. We've also committed to removing the requirements for them to work essentially under the supervision of a general practitioner, what they call collaborative arrangements. This will allow nurse practitioners to work more independently. These are very highly qualified nurses. In addition to doing their registered nurse qualifications, they then go on to do master's qualifications. I was shocked when we came back to government to discover there was only 2,000 nurse practitioners in Australia, which was the same number there was when we left government ten years ago. So there just hasn't been the investment in this really important workforce that has so much potential, particularly in regions, but also in a number of sectors like mental health, palliative care, aged care and primary care here in the cities as well. We want to invest in growing that workforce but also reward them better for the work they do with that 30 per cent increase to the rebate and allow them to operate more independently from general practitioners or doctors than they currently can.


LANE: Might it be possible for nurse practitioners to connect with specialist doctors with a patient without the need for additional referrals which are sometimes just form filling exercises just to have things done face to face?


BUTLER: I think that's exactly the sort of thing that the scope of practice review will be looking at. Certainly that's one of the issues that's commonly raised with me by the College of Nurse Practitioners. That is the ability of practitioners to do their own referrals for tests, for diagnostic tests or pathology referrals to specialists. That's something that Mark Cormack, a very highly qualified person in this area, is going to be working through with the professions over the coming months.    


LANE: Minister, thanks for talking to AM this morning.

BUTLER: Thanks, Sabra.


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