Minister for Health and Aged Care – transcript – RN Breakfast – 12 May 2023

Read the transcript of Minister Butler's interview with Patricia Karvelas about Medicare, bulk billing and Better Access. 

The Hon Mark Butler MP
Minister for Health and Aged Care

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PATRICIA KARVELAS, HOST: Mark Butler is the Health Minister and joins me in the studio just where I want him. Welcome to the program.  


KARVELAS: Minister, plenty of GPs are saying they still can't afford to bulk bill, under the new rate, so how many people realistically will be able to see a GP for free? 

BUTLER: You can always find some who will make a business decision not to bulk bill, and I hope that their patients shop around and find a practice that will bulk bill because this, as the College of GPs has said is going to be a 'game changer'. The Council that represents the big corporate owners of general practice, which your listeners will increasingly be familiar with, said pretty much the same as well. This is a huge increase to the fee that a GP will get for bulk billing children, pensioners, self-funded retirees and low-income families. This is less than half the population, but it accounts for more than 60% of the throughput of a general practice. It is a huge financial injection and it's a real game changer for all those millions of mums and dads who want confidence that when their kid gets sick, they'll be able to access a bulk billed doctor. Now, maybe not every doctor will take this up. If they don't, they don't get the money obviously, and hopefully a practice down the road will take it up. And if a patient, if a mum, dad and a pensioner want a bulk-billed session they know that there is a general practice that has been properly rewarded for that service.  

KARVELAS: There's been a more than 6-year freeze on Medicare rebates, you've increased bulk billing rates for people on concession cards and children under 16. But for everyone else the rate is still stuck in that freeze, will that ever change? 

BUTLER: The freeze was lifted a couple of years ago. It was a freeze that was initiated by Peter Dutton when he was Health Minister some time ago, but this year, in addition to the huge injection in bulk billing incentives, we’re putting in place the biggest overall increase to the Medicare rebate since Paul Keating was Prime Minister more than 30 years ago.  

The increase next year in Medicare rebates, aside from the bulk billing changes, the increase next year will be the equivalent of the increase over 7 long years of the former government. This is a big injection, as I say, the biggest since the early 1990s. 

KARVELAS: When will you unfreeze the Medicare rebates for the rest of the country? I understand you've made it quite targeted, people on concession cards, as you say, and for families who have children under 16, but there are many others, I mean, you describe them as the working, poor people who, you know, aren’t on very high incomes who can't get bulk billing, and they still can't get bulk billing under this plan? 

BUTLER: Rebates aren’t frozen. Every rebate on the MBS is going to increase next year. The biggest increase in Medicare rebates across the board, every single service, every single type for every single Australian will increase by more than it ever has since Paul Keating was Prime Minister 30 years ago. There is no freeze on the rebates, they all go up by more than they have for 30 years. In addition, of which obviously there's the big injection into bulk billing. In addition to which, again, there's more than $2 billion in reform measures there. So, you know much more money for general practices to employ nurses, to employ allied health workers, the sort of multidisciplinary teams that patients need nowadays. A big injection – almost a billion dollars into digital health. This is a sector of the economy that is further behind than any other I can think of in using the opportunities of the digital economy. We've got to do better than that. So, in addition to the bulk billing, a very big investment in general practice, in particular.  

From the time I was in Opposition I have been very clear with people, my priority in strengthening Medicare is to rebuild general practice. I hope tens of thousands of general practitioners out there know they've got a government in Canberra now that recognises how critical their work is, how valuable their work is as the backbone of our broader healthcare system.  

KARVELAS: Do you accept, though, that in cities, in fact, the Melbourne Age ran a story about how in the city of Melbourne you won't see a big increase in doctors taking up this bulk billing, that it does actually advantage regional areas, but in the cities, there might continue to be issues 

BUTLER: The fee a city doctor will get for a bulk billed visit, so, a standard bread-and-butter bulk billed visit of 10 or 15 minutes duration, the fee in the city will increase by more than a third. Yes, it will increase by more in regional areas, it will increase by about a half, where bulk billing is under even more pressure than it is in the cities. But city doctors will see an increase of more than a third, in addition to the biggest increase overall in the rebate in 30 years, that is a huge financial injection into general practice. Now, I don't pretend that every general practitioner will take it up, but when you talk to the representatives of general practice as a whole, or the council's that represent the big corporate owners, they're all saying: this is a 'game changer' and those are their words: it is a game changer in bulk billing.  

As you said in your intro, we've seen a decline in bulk billing for years now, and really worryingly that is starting to creep into a decline in bulk billing for pensioners and for children, which is really the beating heart of the Medicare system we established 40 years ago. This will change things. I have no doubt about that.  

KARVELAS: Do you have any modelling on what impact it will have on hospitals as well, there has obviously been pressure on hospitals as a result of not being able to access doctors who are bulk billing. Has the department looked at all of that? 

BUTLER: We've got long experience that shows that when bulk billing GP clinics change their practice, the hospital in the area tends to see more presentations at emergency departments. That's why I think what's really been interesting is the last few months, National Cabinet meetings, you've seen Premiers and Chief Ministers start to talk about general practice. Usually they want to talk to us about hospital funding. They recognise now that the real challenges in general practice are showing up at their emergency departments. That's why you've seen some really positive responses from Premiers to our announcements on Tuesday night, and that's in addition to the announcements we made on Tuesday night about our Urgent Care Centres which are rolling out over the course of this year.  

We've funded 8 additional centres working very closely with state governments because they know that those bulk billed services for non-life-threatening emergencies where you need urgent care, like at the time your kid falls off a skateboard and busts their arm. At the moment they’re rolling into the hospitals as well, and really placing additional pressure on an already very strained system. 

KARVELAS: Just on another issue in your portfolio. On January 1 this year the number of subsidised psychology sessions got cut in half from 20 to 10. We've talked about it previously. Last night Peter Dutton announced that he wants to increase it back to 20, now, obviously, he can't do that, he's in opposition. But it does put some pressure on you, given he's now got a distinctive different policy on this that says 20 sessions is the right number. Will you revisit this decision? 

BUTLER: He could have done it, because it was their Budget last year in March, before the election, that saw the sessions end in December last year. So, he could have advocated within government for the 10 sessions to continue when he was a member of the former government, but apparently either he didn't, or if he did, he wasn't successful.  

This is a lazy policy. This is a policy that will make waitlists longer for psychological therapy. That was the finding of the independent evaluation that I published in December. It made waitlists worse, and it cut tens and tens of thousands of people out of getting any psychological support whatsoever. It also showed – this evaluation – that the additional 10 sessions, which had only been in place for a couple of years, they were a COVID measure to respond to lockdowns. It showed that those additional 10 sessions were not going to the people who needed it most. They were not going to people with more complex needs.

We're dealing with it, we’re working with the sector to deal with those two issues. How do you make this system, which is a system I strongly support, but how do you make it more equitable. It's clearly not getting to lower income communities in the outer suburbs, certainly not into the regions, so how do you make it more equitable, and how do you find a model that provides better support for people with more complex needs? That's the work we're doing. We've set aside money in the Budget to finalise that work over the course of the rest of this year and we also had money in the budget to expand the psychology workforce, which is a real, real driver of the waitlist problem we have now, we just don't have enough psychologists. We've got substantial money in the Budget to train hundreds and hundreds more psychologists as well but this is a lazy policy. It's a serious problem we have in this area and needs a serious response, not a lazy headline. 

KARVELAS: You also delayed a decision on how to serve people with these complex mental health conditions until later this year. How can you rip out support, right, and you've given your reasons for why you did it, but then hold up the replacement, because that's the key part, you can't take the one away without giving...

BUTLER: I didn't rip out support, that was a decision made by the former government...

KARVELAS: Ok. Either way you continued...

BUTLER: You need to respond to that, the second point I made was those 10 sessions were not going to people with more complex needs and that's what the evaluation found. So, it’s cutting a whole lot of people out of the system altogether, and not serving the people with complex needs the evaluation said were a missing part of the system. Now, we have Head to Health clinics that we're rolling out, we've funded, they're being opened, really, as we speak. They're targeted at people with more complex needs, but I know we want to build this system into something that is able to identify, triage people who need more than 10 sessions and find a way to deliver those additional services to them. But this is not simple. This is not a system that is designed for that, it's not a system designed to identify and triage people with different levels of need. Everyone in the sector recognises that, and they recognise also that the hard work needs to happen. We've got money set aside in the Budget, we are committed to doing it over the course of the rest of this year. 

KARVELAS: There is a sense of urgency around all of this, though, isn't there, I mean there are a lot of issues that have emerged in the community, not just because of COVID, but certainly exacerbated by COVID. Do you accept that there is strong community need on mental health, particularly some of these more complex issues? 

BUTLER: Absolutely. I absolutely accept that, and I think over the last 10 years, particularly in COVID, the cohort, the group, in the number in the community who do have that more complex need, not acute, not the sort of need that has traditionally been serviced by acute services in hospitals and the like. But what – and I don’t love this term – but what people have increasingly described as the missing middle is a real challenge. But one of the one of the bottlenecks we have in developing these systems is not particularly money its workforce, like so much in the healthcare sector, we just don't have enough workers, which is why training more psychologists – that was a real focus of this Budget, now that won't happen overnight, it takes a while to train them. But while we are building these new systems we also have to pay attention of the workforce shortages that really developed very seriously over the last several years and, frankly, Peter Dutton as a member of the government didn't do anything about.  

KARVELAS: I want to move to another issue that didn't get as much attention but I think is worth asking you as the Health Minister. There's not much in the Budget either for contraception or abortion access, which was quietly abandoned as a Budget priority. Abortion is legal and decriminalised across the country, but many women struggled to access it. Why isn't that something that the government has focused on? 

BUTLER: We have a Senate Inquiry underway right now into reproductive health services including termination, and this is getting a lot of attention, lots of great submissions, hearing a lot of really good evidence. As you know, Patricia, sometimes in this building those inquiries, whether they are in the House of Reps or in the Senate, do really good policy development work. I’ve very much supported the establishment of that committee. I'm looking forward to its recommendations. But it's still underway and so we'll have a look at those recommendations when the inquiry is delivered. We are deeply committed as a matter of principle to equitable access to reproductive health and termination services. I think this inquiry is really going to flesh out what we can do as a Commonwealth, either ourselves or in partnership with state government, to actually deliver a lot of these services, what we can do best, and I'm looking forward to that inquiry.  

KARVELAS: In 2019, the Labor Opposition then took to the election publicly funded abortions in public hospitals. That didn't go to the last election, so it wasn't one of your promises. But do you think the principle there is something that a Labor Government should deliver?

BUTLER: Well, as I said, our position is there's got to be equitable access. You know, that’s the very core...

KARVELAS: That’s the issue isn’t it, it’s prohibitive right now?  

BUTLER: ...a very core principle, and in so many parts of the country the only services available are public services. I think the way in which we put that principle into practice is going to be fleshed out through this inquiry. As I said, I'm looking forward to its recommendations, and I have very little doubt that it is going to require some conversations with state governments because the public hospital system and so many other public health services are delivered by state governments, even if to a very significant extent they are funded by us. 

KARVELAS: Just before I let you go, on a broader political question, the Opposition Leader delivered his Budget in Reply last night. I'm about to speak to the Deputy Leader of the Liberal Party Sussan Ley, and really at the centre of his argument is that middle Australia has been abandoned by the Labor Government and you've focused, obviously, on some vulnerable people but middle Australia is doing it tough. Do you do you accept the charge that you've abandoned a middle Australia by focusing on these vulnerable groups? 

BUTLER: A Labor Government is always going to focus on vulnerable Australians and we make no apology for that. We've done that since our party's establishment. But the idea that this Budget and our Budget in October was not focused on working families, on middle Australia if you want to use that term, is complete rubbish. The substantial injection into general practice impacts everyone, supports everyone - 

KARVELAS: But it is focused on concession card holders? 

BUTLER: No, as I've said, there's billions of dollars in additional funding to Medicare, to rebuild and strengthen Medicare. But the idea that millions of mums and dads who want bulk billed services for their children are not middle Australia is ridiculous. Cheaper childcare, cheaper medicines, all of these things are focused on the needs of working families who are doing it so tough out there in the economic environment. I think what was missing from last night in Peter Dutton's reply was a sense that this is a party that has listened and learnt from their devastating election loss last year. He was a senior, central member of a government that was comprehensively rejected. But there was nothing from last night to show that they've changed, the same old policies they tried to run at the last election. 

KARVELAS: Thanks so much for your time. 

BUTLER: Thanks Patricia. 

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