Minister for Health and Aged Care – transcript – ABC Afternoon Briefing – 10 May 2023

Read the transcript of Minister Butler's interview with Greg Jennett about strengthening Medicare and bulk billing.

The Hon Mark Butler MP
Minister for Health and Aged Care

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GREG JENNETT, HOST: The biggest single element of new spending that hadn't been foreshadowed before Budget night has come through a package focused on Medicare. Doctors will be paid more to bulk bill younger and low-income patients, or those on concession cards. Health Minister Mark Butler is responsible and he's with us in the studio now. 

Welcome back, Mark. Triple the bulk billing incentive paid to doctors, in many cases it’s $6, goes to around $20. You expect that 11 million people will be eligible to now be bulk billed because of this incentive. Do you have a number for those that you actually expect to be? 

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: You’re right, Greg. This is the most vulnerable, the most in need group of patients – children, so 16 and under, pensioners, concession cardholders, a bit less than half the population but account for more than 60% of activity in GP practices. And, really disturbingly, we are actually seeing bulk billing rates start to drop for that cohort as well. We've seen a drop for many years for general patients. There's been a particularly sharp drop in recent years which is the product, really, of a Medicare rebate freeze in place under the last government but we've got to secure bulk billing for children, for pensioners and for concession cardholders. And our initiative last night to triple the bulk bulling incentive will be as the College of GPs has said: 'a game-changer' in that sense. 

JENNETT: I suppose the question is, what is the take-up rate expected to be within the eligibility pool – which is very large, almost 12 million – did you do any modelling in coming up with the $3.5 billion cost over 5 years – it looks like you might have – on the number of people, the number of doctors who will respond? 

BUTLER: I think just go to the College of GP’s response and that will give you a sense of really how important they think this is. The College had been calling for tripling of the bulk billing incentive for some time, it was raised in the Strengthening Medicare Taskforce that I chaired directly last year. And as I say, it's a very big increase to the total amount GPs will now receive for a standard bulk billed GP visit. An increase of more than a third in the cities, and by about half, really. So, it is going to really shift the dial. 

JENNETT: And can you say, or have you set some overall national benchmark target in order to measure the success of this for bulk billing of all forms of consultation nationally? 

BUTLER: There's never been any national target for bulk billing. Obviously, the incentive scheme that was actually put in place by the Howard Government some time ago, frankly, isn’t attractive enough yet right now anymore. It has always targeted children, always targeted pensioners and concession cardholders, seniors' health cardholders as the population most in need of access for bulk billing visits. And this will be, as the College said, a game-changer for all those parents who want confidence that when their kids get sick, they can access a bulk billed visit and for pensioners who really need the same level of access to bulk billing. Now...

JENNETT: Even if there’s not a national target that you’re working towards, the rebates rise by higher amounts in regional areas. Were those variable rates set in accordance with current or currently low bulk billing rates, or were they just mapped according to an old formula? 

BUTLER: The differences between different parts of the country – there’s 7 categories of the country, the major cities obviously being the biggest category, out to very remote parts of the country, Thursday Island and the Torres Strait. I talked about Longreach today in Question Time in far west Queensland, the most remote. And there has always been a formula that differentiates between those 7, and we followed that formula again last night. 

JENNETT: There will be a lot of Australians who aren’t eligible. How will delivering this cost-of-living relief to a targeted group of patients help families, particularly with children? 

BUTLER: As I said, it is a targeted group, but it's a large target and it’s a group that accounts for more than 60% of activity in most general practices. In some parts of the country, like my electorate, for example, which is relatively older than the national average, it's much more than 60% of GP activities. So, this big injection of funds into general practice, if they choose to take up bulk billing of those patients, is going to be a big financial injection to their practice, generally. And I know what we've seen, because we've heard this from general practices, is effectively because they wanted to keep bulk billing children, keep bulk billing pensioners, there's been an element of cross subsidisation in the gap fees that general patients have been paying to allow doctors to continue to offer those bulk billing services, in spite of the fact they've effectively been making a loss because the rebate has been too low. 

JENNETT: But there’s nothing in this mechanism that requires them to continue that cross subsidisation given that their in a stronger position because of it.  

BUTLER: We don't run doctors’ surgeries, never have, haven't since the 1940s because of the provision put in the Constitution back then. But I know doctors want to do the best thing by their patients. They been really squeezed over the last decade. I mean, 6 years of the Medicare rebate freeze has put general practice, I think, in the most parlous state it’s been in, in the 40-year history of Medicare. Which is why there was such a focus on it last night. We went to the last election promising to make it easier and cheaper to see a doctor. There’s more than $6 billion in new investments in strengthening Medicare last night. As well as a $1.5 billion boost to indexation, which will mean that next year there is the biggest increase across the board, beyond these bulk billing incentives, the biggest increase across the board to Medicare rebates since Paul Keating was Prime Minister. 

JENNETT: A quick final one in your portfolio on aged care, there was a temporary reduction in the number of residential aged care places, saves more than $2 billion over three years. What’s the reason? 

BUTLER: A really big difference between our government and the former government is when the former government changed funding to aged care, they took it out of the system entirely. What we are doing now is recognising there is a whole lot of unused residential care places. Now, people aren't going into residential care in the same numbers as they were 5 years ago for a range of reasons, partly COVID, frankly, but also because people want to stay at home longer, and they want to access home care. So, we decided to make a very rational, sensible decision to reallocate those funds into other areas of the health and aged care system. We’re not cutting the Budget – which is what Scott Morrison did – and returning it to other areas. We are reinvesting it in new areas of aged care like 9,500 new home care packages which will come into the system on 1 July. 

JENNETT: Sure. Thanks for clearing that up. Mark Butler, always good to talk. Thanks for joining us today. 

BUTLER: Thanks Greg.  

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