CHRIS O’KEEFE, HOST: Minister Butler is on the line. Minister, thanks for your time.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: G’day Chris.
O’KEEFE: Skin checks. We spoke to Dr McCroary, a GP in Campbelltown, who said he's charging about $160 for his skin check and patients are telling him they straight up can't afford it. That's not a good place to be.
BUTLER: There is, as you said in your introduction, there's been a huge increase in the gap fees being charged in general practice. For the first time in the history of Medicare the average gap fee to see a doctor for a standard consult is now more than the Medicare rebate itself. And we've got a real crisis in general practice. It's never been harder to get in to see a doctor. It's never been more expensive than it is now. We've been talking about this since before the election. There's no higher priority from us than to rebuild general practice and to strengthen Medicare. It's under enormous pressure, I think the most parlous state general practice has been in in the four decade or 40-year history of Medicare. We're very focused on it. I'm happy to talk about skin cancer more specifically, but I'm deeply worried about the state of general practice in general.
We demanded when we came into government much better data on bulk billing than, frankly, was being publicly released, and finally, we've got that over the last several weeks. And you're right, it’s seen big drops in bulk billing rates right across the country. Some of the worst drops are in the Central Coast and in the Hunter region in New South Wales, some of the worst in the country. Western Sydney still has probably the best bulk billing rates anywhere in Australia, but they're also in decline. And my colleagues who represent Western Sydney communities are telling me that practices are changing their bulk billing because frankly they're under such financial pressure, particularly because the Medicare rebate freeze was frozen for six years over the last decade.
O’KEEFE: Well have a listen to Dr Jamal Rifi. He's a GP in Belmore and we spoke to him a couple of weeks ago.
DR JAMAL RIFI: All my life I bulk billed for philosophical and ideological reasons. Right now, my practice is the only practice in Belmore. No one wants to come in to work in a medical centre that bulk bills only.
O’KEEFE: So Minister Butler, isn't it just time to pay the doctors more?
BUTLER: We've been working with the doctors in what I described as a Strengthening Medicare Taskforce, not just doctors, but also nurses, and obviously patient groups have an important perspective on this, allied health workers. We did work over the course of the period leading into Christmas. I chaired all of the meetings directly, we had six meetings for several hours each, we really dug into what GPs were telling us they needed to rebuild general practice and we've committed additional funds to that, which we promised at the last election.
I've said in the May Budget, which is now about six weeks away, we'll be releasing our response to that. There is no higher priority for us than to turn around the decline in general practice. It's not just us at a Commonwealth level who are saying that. When I talk to state Health Ministers and when my boss, the Prime Minister, talks to his Premier and Chief Minister colleagues, they're also deeply worried about this because, as they see general practice decline, what that's leading to is more people having to go to an emergency department. I mean, if you can't get a doctor when and where you need it out in the community, in your local community, you just end up at an emergency department. So that's already putting even more pressure on already stressed hospital emergency departments.
O’KEEFE: So you've raised the issues that we know that are apparent right now in general practice. What are the solutions? Is raising the Medicare rebate a solution?
BUTLER: That's obviously something on the table. The doctors' groups, unsurprisingly, have put that on the table. Given that, you know, over the last -
O’KEEFE: Is it something that you're amenable to?
BUTLER: I've said everything's on the table as far as we're concerned. I'm not in a position to pre-announce what we’ll do at Budget, but everything's on the table and you know, it's quite understandable, if your income is frozen for six years - which is what happened to doctors. - if your income is frozen for six years, while your costs are going up, that puts real pressure on your practice. And with the big spike in inflation right across the world that happened last year after the Russian invasion of Ukraine, many practices found it very difficult to keep doing the bulk billing they wanted to do. As your recording said a few minutes ago, many doctors went into general practice wanting to bulk bill. They see it as a very important part of their philosophy. So obviously, we've got to deal with the financial pressures. But one of the things I've been really clear about is it's not just the level of the rebate itself, the level of income, the big problem we have is that the current Medicare system just isn't delivering the sort of care that we need in 2023. When the Medicare system was designed 40 years ago, people generally went to the doctor because they were sick with an infectious disease, they needed some treatment, some medicines, they got better and they went away. That's not what patients tend to have today. They tend to have much more chronic disease that needs more intensive, ongoing management from their doctors -
O’KEEFE: And all that needs money, right?
BUTLER: All that needs a different type of money rather than for the fee for individual service, which you see in Medicare now. It needs a different type, and GPs are telling me this the AMA, the College of General Practice, the nurses' groups, they're all singing off the same song sheet. It's not just about whether there's enough money in the system, it's also about how the system is designed. So you're not just going to put more money into a system that was built around the 1980s. We need to change the system to reflect what patients need today.
O’KEEFE: But Minister, if there's more of us and our issues as we're living longer, our issues are becoming, as you say, more chronic.
O’KEEFE: Should Australians expect a rise in the Medicare levy in the Budget?
BUTLER: No, that's not on the table. That's not something we're considering.
O’KEEFE: How do we then pay for this?
BUTLER: Obviously, we've got a challenge to make sure that our Budget adds up. But obviously health care is a top priority - it should be for any government, it certainly is for a Labor Government that is very proud of one of our most important legacies, which is the Medicare system. So obviously your listeners will see the Budget when it's released in six weeks' time, we promised more money at the last election into the Medicare system. We were the only major party that promised additional investment, not just money into the Medicare system itself we've got a series of grants going out to the thousands of general practices who worked so hard over the last few years to keep us safe and frankly, deserve more than our thanks. They need some help upgrading their IT systems to take advantage of the opportunities of digital health, getting their practices into shape. So, we're rolling out a couple of hundred million dollars for that. We're building Urgent Care Clinics - 50 of them across the country, not only to deliver the sort of care that people need in the community for those non-life-threatening emergencies, like your kid falling off a skateboard and busting their arm. But that's important in and of itself - fully bulk billed, they'll be - but it also takes more pressure off the hospitals, because currently, if people can't get the care they need in the community when that sort of thing happens, again, they end up at the emergency department.
O’KEEFE: Just on skin cancer, there is no Medicare item for preventative skin checks. Why is that?
BUTLER: Obviously you can go to your GP and get a pretty standard skin check and obviously we encourage it. It is a really important issue as you know, Chris, I know how focused you are on it. This is our national cancer, that's not something we're proud of. But we have the highest rates of skin cancer and melanoma in the world, two in three Australians at some point in their life will be diagnosed with some form of skin cancer. All of us are interested in exploring all new ideas to prevent skin cancer, to identify them early, and all of the new treatments that are coming onto the table as well. There is obviously the ability to go to a GP and get a skin check - if you think something has changed about something in your skin, about one of the moles or one of the spots you've got on the skin - go and see your GP. Of course, there's a Medicare rebate to have that checked, or the GP might be able to take it off themselves, or if they think it's necessary, they might refer you on to a specialist which should also have an MBS rebate.
O’KEEFE: But Minister, some of our callers and listeners here, they just can't afford it. This is Sally. Have a listen.
SALLY, CALLER: My mother passed away from melanoma and her brother also. So, yeah, we have it in our family, and I think it's something that should be offered as a preventative. I go each year; I wait six months to see a skin specialist and it costs me $320 and that's for around 10 minutes of their time.
O’KEEFE: And I’ve got Mirella here from Croydon, too, Minister.
MIRELLA, CALLER: This is a subject very near to my heart because I've had my first surgery 23 years ago. I have to go to a dermatologist every six months. Surely if the government allowed skin checks to be done from the outset and paid for it, then we would have less people getting to the stage I'm at where you have to go and see a dermatologist which is far more expensive.
O'KEEFE: Minister, and we had one other lady call in yesterday who said that she had to say to her daughter: “Well, you're the one who needs the treatment right now, so I'm not going to go get my skin treated because I can only afford one of us to go to the doctors.” What do you say to these guys?
BUTLER: These are awful choices that families are facing. We've been talking over the last couple of months about the choices that families are making, about which medicine scripts they get filled because of the price of medicines, which is why we're focused on getting that down. And the gap fees that I talked about increasing for GPs have risen even faster for specialists, they have gone up by about 50 per cent in the last ten years because those specialists were also impacted by the freeze on the Medicare rebate. We've got to do something about the affordability of basic health care and there's nothing more important for Australians than being able to get good quality care for potential skin cancer, given how widespread it is. I'm also interested though in us looking at new technology, and I know you've been a bit interested in some of the new opportunities that mole mapping might involve. That was looked at a few years ago by the expert group that frankly determines what matters go on to the Medicare schedule - so what is able to be the subject of a Medicare rebate and what is not. They said at the time, about five or six years ago, that that mole mapping technology was not quite ready for their consideration. These sort of big screening programs do take a while to get to a point where they are satisfied that they're clinically effective and cost effective. But what they did want to happen was for more research to be conducted about mole mapping technology and there was a grant given to Monash Uni a few years ago which has been undertaking quite intensive research into this new technology, and that research will be available later this year. I'm sure as this technology develops and proves itself, those experts on the Medicare Services Advisory Committee will have a look at it again. This is what happened around bowel cancer screening, around cervical cancer screening, they've been looking for the last several years at potential population wide screening.
O’KEEFE: Can we get a timeline on some of this stuff, though? Because it's worthy. You know, you're the best part of 12 months into government, and it's not easy to get across all of this stuff in one go, but I think the Australian people are starting to feel, Minister, that you should offer us some timelines on solutions rather than just listing the problems.
BUTLER: I'm trying to do that as much as I can, Chris. We've been rolling out programs, as I said, there will be much more in the Budget. But it is really important as we reflect on our Medicare system, that it's not politicians or journalists who decide what procedures are supported by Medicare. It has always been experts who analyse the frankly myriad of applications they receive about new technologies and potential new treatments to assess whether or not they're clinically effective, to assess whether they are value for money. There's an endless list of potential ways in which we could spend the health dollar we have and it shouldn't be for politicians or journalists to decide on one technology or the other, we've got to be evidence based about this. Now this went to that expert committee, that expert committee understands as well as anyone, probably better, just how much of a challenge skin cancer and melanoma is to Australia. And it's getting worse, it's getting worse, it's not getting better in terms of prevalence. So, of course, they're focused on that but as they do in a lot of other areas, they are guarding taxpayer dollars, making sure we're spending our health dollar in the most effective way possible. They’ve said this needs more research and that research should be available over coming months. I don't know what it's going to say, it's not finished yet, we haven't got the report. But there's no one more interested or more excited about the idea of new groundbreaking technologies to detect skin cancer earlier than we are in government. I know your listeners are as well.
O’KEEFE: Minister, you’re a doer, I've seen you I've seen how you've operated in Parliament for a long time. You're a doer. Are you getting frustrated with the reports, the analyses, the expert panels, the this and the that, and not having a whole lot to show for it yet?
BUTLER: You've got to sort the wheat from the chaff in in this job. As I said, there is an endless number of ways in which you can spend health dollars. We're lucky enough to live in this turbocharged period of discovery where there's so many new treatments that are saving lives that 10, 15 years ago just weren't able to be saved. There’s an endless number of ways in which we could spend limited health dollars. You've got to be evidence-based about this, you can't just decide as a politician: no, I think we should spend our health dollar in this way. You've got to have the experts look at it, you know, stress test it, kick the tyres and advise governments of the day, whether they're Liberal or Labor, state or federal this is a clinically effective way to spend health dollars, it will save lives, it will improve live. So, I'm dead committed to that. I'm sure every Health Minister is, but yes, you're right, the health - just like so many other portfolio areas - is always at risk of having a lot of committees, lots of reviews and lots of taskforces.
We have come in at the end of the worst part of this pandemic with our health system in serious trouble, it is seriously stressed. And we’re no orphan. If you look at any health system of a developed country around the world, they're all deeply stressed after three years of a pandemic, you know, all of us have ageing populations, all of us have chronic disease rising as well. We've got the legacy of the pandemic with an utterly exhausted health workforce who worked so hard. This isn’t easy and it's not going to be turned around quickly in any country, but we are committed to particularly rebuilding general practice, that's the thing I'm probably most worried about, because if general practice falls over the whole system falls over.
O’KEEFE: Well, it's on its knees right now. Minister, we’ve run out of time but just before I let you, to tell the people of Australia can we at least expect some action come the May Budget? Will we be happy with what we see?
BUTLER: We are very committed to making sure this Budget starts to turnaround the crisis in general practice. I don't pretend we can fix everything in one Budget. A lot of this is deep, a lot of this is structural, you know, we've got a real problem with our pipeline of new GPs, but there will be a lot there to give people confidence that we're committed to turning this around.
O’KEEFE: I appreciate you coming on. Thanks so much.
BUTLER: Thanks Chris.