Minister for Health and Aged Care – press conference – 1 February 2024

Read the transcript of Minister for Health and Aged Care Mark Butler's press conference in Carrum Downs on 1 February 2024 about Medicare 40th anniversary, bulk billing, Dunkley by-election, and GP payroll tax.

The Hon Mark Butler MP
Minister for Health and Aged Care

Media event date:
Date published:
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General public

LABOR CANDIDATE FOR DUNKLEY, JODIE BELYEA: Good morning. I'm Jodie Belyea. I'm the Labor candidate for the Dunkley by-election on the 2nd of March. I'm here today at the Ballarto Medical Clinic with the Minister for Health, Mark Butler. We are here talking to staff about the health system and Medicare, understanding what the needs and issues are for medical clinics. 

Today is a really special day: it is the anniversary of Medicare. Happy 40th Birthday, Medicare. If I am elected on March 2nd, I will continue to advocate for Medicare and the health system. 

Everyone deserves the medical support they need, not the medical support they can afford. So I will be advocating to ensure that medicine and healthcare is affordable. I'm very aware that I will be supporting the $1 billion upgrade of the Frankston Hospital and also promoting the Urgent Care Clinic in Frankston, ensuring that more families in our community have access to affordable healthcare. 

I'm really grateful to the staff for hosting us here today. And I would now like to introduce the Minister for Health, Mark Butler.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thanks so much for hosting me here today 40th anniversary of the most important social program that we have in Australia, and that is Medicare. I also want to thank the doctors and staff here at the Ballarto Medical Centre hosting us but also having a great conversation. 

We had a talk with the enrolled nurse here whose been helping with vaccinations, checking the babies that are being born in this fast growing area. She saw some baby twins this morning. So that's been a great conversation to have. 

We were reminded by staff here at the medical centre of a conversation that Peta Murphy and I and the staff had, 2 years ago, about the need to be able to recruit more doctors to this fast-growing area. And they made the case really strongly for Frankston and surrounds to become a Priority Area for GP recruitment. It would mean that this area was able to recruit overseas trained doctors – something that wasn't possible under the former Morrison government. And I'm really delighted to say that not only did we deliver on that commitment that Peta Murphy made to her electorate, but since delivering on that commitment, an additional 19 GPs have been recruited and are practicing in this area, which is making it easier to get in to see a GP, when and where you need it.
Medicare changed Australia. It was really hard fought at the time. People that were around at the time will remember doctors’ groups strongly opposed the introduction of Medibank under Whitlam and then Medicare under Hawke. The Liberal Party strenuously opposed it for decades and promised, if they got the chance, to abolish it. But we were able to deliver it as a Labor Party and it changed Australia for the better.
It's often not remembered, but before Medicare was introduced 40 years ago, 1 in 7 Australians had no coverage for health bills. Unpaid health and hospital bills were the leading cause of personal bankruptcies in Australia. And all that changed in one fell swoop with the introduction of Medicare. After Medicare was introduced, the list of bankruptcy reasons no longer needed to include unpaid health and hospital bills. It simply disappeared as a cause for personal bankruptcies. And it has also, as a system, delivered some of the best health care on the planet. When you are considering health care systems in developed countries, OECD countries, Australia in a recent report, rated as the number one healthcare system for health outcomes - the outcomes actually delivered to patients. And it also ranked as the number one health care system as a matter of equity. And that's exactly what Bob Hawke, his Health Minister Neal Blewitt and all of those who drove the universal health insurance system in this country had in mind. And I'm really pleased that 40 years on we see that still delivering for Australians.
But we know that 40 years on, the system is under pressure. That's why strengthening Medicare was a centrepiece commitment that we took to the last election, that Peta Murphy took to the people of Dunkley. And in last year's Budget we delivered on that commitment, with more than $6 billion in new spending, overwhelmingly focused on general practice, because we know general practice is the backbone of a well functioning health care system.
I was delighted today to give early reports on the impact of our bulk billing changes. This triples the incentive for doctors to bulk bill concession cardholders, pensioners, and children under the age of 16. That accounts for about 60% of all GP consultations. Tripling that incentive means that at a practice like this, the income for a bulk billed standard consult increased by about a third, and in regional Australia, even more. The increase in general practice income for a standard bulk billed consult increased by about a half. That's a really big increase to general practice income and it's a big investment in the confidence of general practice to continue bulk billing.
The first thing we had to do was to stop the slide. When we came to government, bulk billing for general practice consults was in freefall. After 10 years of cuts and neglect which was started by Peter Dutton as Health Minister. The first thing we had to do was stop the slide. And I'm really pleased over the last several months, since we made that commitment in the Budget, we have managed to arrest that decline. 

But in the last 2 months since that money started to hit general practices, we've also seen an increase in bulk billing. In November and December alone, just 2 months, there were 360,000 additional free visits to the doctor when people didn't have to pay a gap fee. Pleasingly, the biggest increases in bulk billing are in some of the areas that I was most worried about, particularly regional communities and states like Tasmania, that have had some of the lowest rates of bulk billing. 

In this area in Dunkley, bulk billing is now up to more than 80% for GP consults. It is a great credit to the GPs in this area that are committed to making sure that those who can't afford to pay to see the doctor are bulk billed, and they received the income that we committed in the last Budget to do that. So thank you very much to the doctors and the staff for hosting us again today. All the best to Jodie for your continuing advocacy for the sort of services that Labor has committed to delivering, and a central to that is our commitment to strengthening Medicare.
JOURNALIST: A survey said only 24% of clinics were offering bulk billing. How do today’s figures measure up?
BUTLER: There are different ways to measure this and the report you refer to essentially rings around the general practices and asks whether they bulk bill every single patient that walks through their door – no matter whether they're a healthcare cardholder or a millionaire – whether they bulk bill them for every single service. The way in which we have been measuring bulk billing since we came to office is to ask: how many visits to the doctor in Australia are bulk billed? That's I think what Australians want to know: how many visits to the doctor are bulk billed? 

What I said earlier was that that figure was in freefall when we came to government and we had to arrest it. It was about 76% before we introduced the new bulk billing incentives. That's increased to about 78% across the country since the 1st of November. So almost 4 in 5 visits to the doctor are bulk billed. Here in Frankston, in the electorate of Dunkley, it's more than 4 in 5, but we want to see that continue to increase.
JOURNALIST: It’s only a 2% rise though?
BUTLER: It’s 360,000 additional visits where patients didn't have to put their hand into their pocket. All they needed to produce is their Medicare card, not their credit card. Now I really want to stress that the first job we had to do, the first objective of these investments, was to stop the slide. The bulk billing rate was in freefall after 10 years of cuts and neglects. That was the first job. The second job is to start getting that increase happening. And I'm particularly pleased that it's substantial in some communities, where bulk billing had been lower. In regional Victoria, for example, it's almost 5%. In Bendigo it's 8%. In Tasmania, it was almost 6%. So of course, we want to see more increases in the future. But we managed, in one short year, to stop the slide and to start to see a turnaround. Within 2 months 360,000 additional free visits to the doctor.
JOURNALIST: So you don’t have a figure on where you want to see it go to?
BUTLER: There's very different numbers across the country. In parts of Western Sydney you see bulk billing rates of more than 98%. Whereas in Tasmania it’s been in the 60s. I want to see Tasmania increase. I want to see regional communities increase. Well more than half of those additional free visits that I talked about, well more than half of them, are outside of our major cities where some of the access to general practice is the most difficult. So we want to see general practitioners continue to take advantage of the multibillion dollar investment we made in the last Budget – a big injection of money, but also an injection of confidence into general practice.
JOURNALIST: There’s also a pretty big spread from the Productivity Commission today about across health services across the country. Here in Victoria it’s the lowest rate of available public hospital beds and ambulance response times are getting worse. It is like that across the country. What’s the federal government doing to help that situation?
BUTLER: You’re right to say it’s an issue across the country. More than that, it's an issue across the world. On any report you read right now, healthcare systems across the world are dealing, not just with some of the demographic changes that we're all having to manage, with older populations and more chronic disease. But importantly, healthcare systems across the world are still grappling with the legacy of COVID. So many people didn't get the care that they should have been getting during the years where healthcare systems understandably were focused on the pandemic. A whole lot of people didn't get to the doctor to get the care for their chronic disease. A whole lot of people didn't get the cancer screening. So there is a legacy still in healthcare systems, including here in Australia, that we are all grappling with.
In December, the National Cabinet – the Prime Minister and the Premiers and Chief Ministers – all agreed new funding arrangements for our hospitals that will not just endure for the next 5 years, but will take us into the middle part of the 2030s .That will lift the Commonwealth contribution to hospital systems to take some of that funding pressure off state governments. But we also know that really to relieve that pressure on hospitals, you need to build the primary care systems out in the community. Medicare Urgent Care Clinics, like the one at Frankston, are designed not just to give people the care they need, close to home. But it's also designed to take the pressure off emergency departments. We know that about 60% of people going to those Urgent Care Clinics say that if that wasn't available to them, they otherwise would have gone to the local hospital emergency department. So taking that pressure is a strong job of the Commonwealth as well.
JOURNALIST: Do you want to see state governments performance improve though?
BUTLER: Of course we do, and of course they do, and patients do, too. You know, these are really serious challenges that healthcare systems across the country and indeed across the world are grappling with. And our job is as a series of governments – state, territory, and Commonwealth - is to work together, to come together. And that's what the National Cabinet did in December, recognised we all have a way in which we can contribute to the task of getting better healthcare to Australians, when and where they need it.
JOURNALIST: Can you clarify the percentage today, is it services bulk billed or number of GPs bulk billing?
BUTLER: This is a focus on the number of GP consults that are bulk billed. That very unapologetically was the focus of our investment in the May Budget. When I came to government, as the Health Minister, I said very openly that the priority for our Government was to rebuild general practice. 10 years of cuts and neglect to Medicare, particularly that 6-year-long freeze to the Medicare rebate had really squeezed general practice. Bulk billing was in freefall. And general practice being the backbone of our healthcare system, deserved to be the priority of the government in Canberra. It was neglected by the former the Morrison government, it is a priority for the Albanese Government. So yes, those incentives apply particularly to GP consults. I think when you ask Australians what's a key measure of a well performing healthcare system? It's: how quickly can I get in to see my GP, do I have to pay to see my GP? So that's what we measured. That's what we published today.
JOURNALIST: Just on GPs, in Victoria there’s a payroll tax and the RACGP has been quite against it. What’s your view on state governments increasing that charge? It’s another burden on GPs, should they really be doing that in a cost of living crisis?
BUTLER: This is an issue in a number of states, as a result of some judicial decisions about tax arrangements in New South Wales that flowed on to some other states, as well. The first thing I'll say is payroll tax is ultimately a matter for state governments. But I've said on a number of occasions publicly that I don't want to see the very substantial investment that the Albanese Government made into general practice last year in our Budget – more than $6 billion in new spending – I don't want to see that end up in state treasury through changes to payroll tax rates. Because I want to see that stay in general practice, so that it is easier and cheaper to see a general practitioner. 

You know, I've urged on a number of occasions, state governments to sit down with doctors’ groups and find a sensible way through this. You know, we're not responsible ultimately for payroll tax arrangements, but we are responsible for a vibrant general practice system. So again, I encourage all state governments, this is not a Victorian issue, this is an issue across a number of state jurisdictions, I encourage them to be constructive about this and to sit down with doctors’ groups to find a better way forward.
JOURNALIST: In November and December how much was spent on the increase to the bulk billing incentive?
BUTLER: We don't have those figures, in terms of sort of separating out the spending for the bulk billing incentive being tripled. We said in the May Budget, we projected that to be a $3.5 billion dollar investment over the course of the 4 years. You know, we want to see that spent. That will only be spent if general practitioners take up the invitation and bulk bill those concessions cardholders, those pensioners, those children that their mums and dads bring into their general practice.
JOURNALIST: You spoke about a modest celebration for the 40th Medicare anniversary - what’s the total cost?
BUTLER: We’ll publish that in due course, look, it’s really modest. What I said when I announced this is that the Medicare cards that are issued as a matter of course, will now have a 40-year anniversary reference to them. That's no extra cost, that's just taking some changes to the layout of those cards. We're also putting in place an interactive website, we want communities and schools to learn about the history of this most important social program that we have, what it's delivered to this country. I think that's what a good civics education approach does. We're also launching an exhibition at Parliament House, so that all of those school groups that are visiting Parliament House, are learning about their democracy, learning about what it delivers to their families and their communities can learn about this important social program. And we want to be able to send that out to the community, as well.
JOURNALIST: Can you clarify the percentage figures released today?
BUTLER: It is GP consults. So you know there are there are particular items on the Medicare Benefits Schedule, when you go to see a doctor, depending on how long you are there, you will be billed certain items and there'll be an incentive to bulk bill. So it is GP visits, GP consults that attract these bulk billing incentives and that's what we're measuring with the figures. Now I want to say that before we came to government there was very little transparency about the actual rate of bulk billing in the community. And I’ve made many complaints about that, as have doctors’ groups, in the lead in to the election. I promised that we would be more transparent, I worked very hard with our Department, to make sure that we were measuring what mattered and we were publishing those as measurements. And we've been doing that. So that we didn't try to inflate the figures with some of the temporary COVID measures, as Morrison government did. We were transparent about the fact that we had a real problem on our hands. And we were determined to fix that problem with that investment we made in the May Budget.
JOURNALIST: Jodie, this morning you were at an event alongside your federal Liberal candidate. How do you feel it’s going, do you feel it’s going to be a battle down to the wire?
BELYEA: It's going to be very competitive and I'm up for that. And I'm certainly giving my all, getting out and about door knocking, on train stations, meeting with locals to understand what matters most to them. And certainly doing my very best to lean into the legacy of Peta Murphy in the Dunkley community and be a strong local voice for Dunkley.
JOURNALIST: Historically Dunkley was held by Bruce Billson. He had that name recognition through his work. Do you feel like you have enough to contend against him?
BELYEA: Look, I've been in the Dunkley community for the last 11 years as a worker across not-for-profits. I have run my own organisation that supports women across the community. People know that I'm out there, committed to doing good things for the community, not just women, but also young people. I used to run a youth service in Frankston. So I'm very aware and connected to all parts of the community. So I'm in there giving it my best shot.


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