MATTHEW PANTELIS, HOST: I'm pleased to invite and welcome into the studio here this morning, the Federal Health and Aged Care minister, Mark Butler.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Good morning, Matthew.
PANTELIS: Thank you for coming in. Lots to have a chat about, Let’s start with aged care, legislation currently before the parliament, which will result in self-funded retirees particularly paying more for their aged care moving forward. Is that going to hit people who are potentially vulnerable and some who might be close to borderline in being a self-funded retiree, paying more for aged care in the future could tip them into, well, the poverty side of the balance sheet, couldn't it?
BUTLER: No, we've been very careful in our design of the new co-contribution arrangements for aged care. Our challenge, really, Matthew, was that we had a Royal Commission delivered to the previous government about the state of aged care, and many of your listeners will remember all of the pretty shocking stories about the state of the sector. It became worse during COVID in many parts of the sector. And so there were dozens and dozens of recommendations from those royal commissioners about how to build a system that was decent today and dignified today, but also one that was sustainable for the future, because we know we've got a very big increase in demand coming our way. The baby boomer generation in particular is about to hit the aged care sector. So, the oldest baby boomers born in sort of ‘45, ‘46, ‘47, like my dad, they're now hitting the average age of home care packages. So, the big increase in demand for home care packages. And in about five years, they'll hit the average age of entry into nursing homes or aged care facilities. And we don't have enough. We really are in a bit of strife because there's been effectively a capital strike by aged care operators. The system has not been giving them the returns that they need to build new facilities and build new beds. So, banks haven't been willing to lend to them. There's been a whole range of different challenges. How do we build a system that works for people? How do we build a system that keeps people living in their own homes for as long as possible, which is what everyone wants, but also one that has enough beds in aged care facilities to deal with the demand that is coming down the way. And so the problem with the Royal Commission report was that it didn't give a clear recommendation about how to finance the show sustainably. There were two Royal Commissioners, and they both had different ideas, unfortunately. So, we had to come up with our own idea. We made it very clear we were not going to put in a new tax, and that was also a position Peter Dutton made clear from the Opposition. And we said we were not going to change the treatment of the family home. People want to have security over their family homes. We made that commitment as well and what we've done instead, after a lot of work, the Aged Care Minister Anika Wells has led with the sector, with consumer groups, representatives of older Australians, has come up with a system of contributions that we think is fair and sustainable and will deliver a much better aged care system. So, it's not just that people might pay a little bit more where they've got the capacity to pay in the future. We're going to deliver a much better system, hundreds of thousands of more packages. They're going to be better packages. So shorter wait times and a whole range of other benefits for people to keep them at home as much as possible as well.
PANTELIS: It is a de facto tax, though, isn't it? You're asking people to pay. Either way, it's a tax. You're certainly charging them for it in the future, self-funded retirees. How long before the levels increase?
BUTLER: We think this is sustainable. We've designed it very carefully. We've projected over ten years that this means that the aged care system, and we still will continue the aged care budget that the amount taxpayers are kicking into the aged care system will continue to grow quite sharply over the coming ten years. We get that growth rate down a little bit, but the important thing is that taxpayers are still funding the vast bulk of aged care, and when we do ask people to contribute to that cost where they have the capacity to pay.
PANTELIS: That means they're paying twice, doesn't it? They've paid through their taxes and then they're paying again?
BUTLER: Just to give you a bit of a sense, Matthew, currently, taxpayers pay about 76 per cent of the total cost of residential care. That'll come down to 73 per cent. So, it's a bit of a reduction in the taxpayer. A bit of an increase in the amount people pay for their own aged care but it is not a massive change: 76 to 73. In the Home Care system, so people getting support in their own home, currently taxpayers pay for about 95 per cent of that cost. Now we'll get that down to 89 per cent, but still, pretty much $9 in every $10 is being paid by taxpayers. We know that the number of people out there in the workforce paying taxes is shrinking as a proportion of the population. That's no surprise. We've known that was coming for a long time as the population ages. We are just going to have to adjust these things carefully to make sure we're able to finance a decent, dignified aged care system in the long term.
PANTELIS: The aged care system and people living in their own homes. I read an email. I think it was last Friday from memory, Tommy, who emailed in talking about the fact that their aged care provider charged them $150 for a service they'd cancelled. That was the cancellation fee. And Bill Shorten as NDIS minister has spoken of the rip offs in the NDIS over a long period, but to cancel a podiatrist, I think it was appointment $150 charge. That's just ripping off the taxpayer?
BUTLER: That's right and those things should not be happening where they're happening. Complaints should be made to our Complaints Commission, which has been, you know, long established. I was the Aged Care Minister 12 or 15 years ago and the Complaints Commission was in place then. I mean, the difference really with the NDIS Matthew, is that that's a relatively new system. It's still sort of building its compliance systems. There are thousands and thousands of unregistered providers in the NDIS. Bill Shorten has only said in recent days that they should get registered, so that we can have confidence that they comply with standards and so on. That's long been the case in aged care. Providers are registered. They have clear accountable standards and when they do the wrong thing, there is a well-established complaint system to deal with them. And so, when there are cases like that do inevitably arise in the system as big as this people should be hauled in.
PANTELIS: Yeah, absolutely. Because it's all of us that are paying that cost. I mean, no one minds a reasonable cancellation fee, I don't know, $20, $30 - $150, you’ve got to shake your head at that. Bulk billing, we need more doctors. We need more GP training places. We need more of them out in the community offering the services. Medicare rates, should they rise? What needs to happen here to make the GP system work more effectively for all Australians?
BUTLER: Look, this of all of the pressures in the health system that your listeners will be very familiar with, they were there before COVID, but they were aggravated by COVID. You know, COVID really did hit the health system hard. It hit all of us hard but hit the health system hard. Of all of the pressures in the health system, the thing that has worried me most over the last several years is general practice. It was run down terribly over the past ten years. The Medicare rebate, which is the main income source for GPs, it was frozen for the best part of a decade. So you freeze the income of GPs while their costs are continuing to go up. Well, you know what happens. They start charging gap fees. And so, when we came to government, bulk billing was in freefall. You know, and for us as a Labor Party that created Medicare, bulk billing is the beating heart of Medicare. We've put a lot of money into not just Medicare, but particularly into general practice. We've increased the Medicare rebate over the last two years in our two budgets by more than the last government did in nine years.
PANTELIS: Well, that hasn't stopped doctors increasing that bulk billing and the gap rate though?
BUTLER: I'll come to that. The two biggest increases in the Medicare rebate in 30 years, the first and the second biggest. In addition to that, we tripled the bulk billing incentive. This is the extra payment GPs get if they bulk bill someone coming through their doors. That had been the claim or the ask, if you like, from the College of GPs. They said this is what's needed to turn around bulk billing. And we did it last year, the biggest ever investment in bulk billing. Now it only took effect in November, so it hasn't even been going for a year. But already we've seen well over 4 million additional free visits to the doctor that would not otherwise have been bulk billed. That's a lot of additional free visits in less than 12 months. And here in South Australia, just in the last four months, there have been about 260,000 additional bulk billed visits to the doctor. Now, that is making a real difference. It doesn't mean it's not still tough to get a doctor appointment. And it doesn’t mean it's not still tough in some areas to get bulk billing, but what was a situation that was falling off a cliff has turned around. We're seeing bulk billing rates go up in every state and every territory, and one of the highest increases in bulk billing rates in the last ten months or so has been here in South Australia.
PANTELIS: I reckon if I asked people now, how much have you paid at your last doctor's visit, I'd get calls of $40, $60, even up to $100. We had a person telling us $100 recently?
BUTLER: I hear them around the country and we're doing what we can to turn that around. I was really worried that bulk billing was going to start to disappear. Here in South Australia, for GP visits, the bulk billing rate is now over 75 per cent again. So, 3 in 4 visits are bulk billed but, 1 in 4 people are paying a gap fee. We want to see that bulk billing rate continue to go up. And one of the other points you made, Matthew, which is really worrying to me, is we're just not getting enough junior doctors choosing general practice as their preferred career. I mean, 30, 40 years ago, about 1 in 2 medical graduates would go into general practice and the other half would go into surgery and psychiatry and all the rest. That's down from 1 in 2 to about 1 in 7.
PANTELIS: What do we do to reverse that?
BUTLER: We have to make general practice more attractive. And that has been part of my very clear commitment to reviving general practice. I mean, the vast bulk of our investments into strengthening Medicare have quite deliberately and unapologetically been into general practice because that was my first priority.
PANTELIS: So, funding places in university, do we need to do that?
BUTLER: I'll come back to that. But this year, the number of medical graduates choosing general practice is 20 per cent higher than it was last year. Now that's a good sign. It's green shoots of recovery. It's not glasses down this is all fixed by any stretch of the imagination. We've got a long way to go. But again, like with bulk billing, we're starting to see things heading in the right direction again.
Chris Picton, the terrific South Australian Health Minister here, a number of his colleagues have made the case to us that we need more medical school places. So, we need more medical graduates into the system. We are considering that, it was also a recommendation from the Universities Accord that the Education Minister, Jason Clare, received a little while ago. But I also want to make sure that if we are having more medical school places and medical graduates, that they're going into the areas we most need, like general practice is top of the list, psychiatry is an area of shortage as well. Anaesthetics is an area that state governments say they're a little short on as well. We need to get a better sense as governments about where these highly prized junior doctors are going.
PANTELIS: You mentioned Chris Picton. Now the state government’s promised to end ramping. You can look at that from afar, from above, if you like, as the federal minister and say, well, that's your problem. But it is aged care that is one of the big factors people in hospitals who should be in the nursing homes. So, it's going to take years, isn't it? Once your bill passes and aged care providers ramp up services, we're still talking years before hospitals are cleared of the people in hospital beds who should be in an aged care bed.
BUTLER: That's right, I am the federal Health Minister, but I'm also a proud South Australian as you know, Matthew. I watch this closely, I talk to health ministers across the country who are experiencing exactly the same pressures that the state government here is experiencing. We've got the ageing population I talked about. A lot of people didn't get the care that they should have got during COVID because people were locked down. There were density restrictions on things as simple as but important as cancer screening and all the rest. So hospitals are under very real pressure. Leave aside the sort of winter flood of respiratory illnesses that everyone's experiencing right now.
We are doing all that we can at a Commonwealth level. I'll just talk about a few of them. The first thing is that the Commonwealth, frankly, has not been providing enough financial support to state governments to run their public hospitals. So, in December last year, at a meeting of the premiers and the Prime Minister, our government committed at least $13 billion additional into the hospital system. And the biggest winner of all of the states from that would be South Australia, because for some curious reason that I don't think anyone understands, South Australia has got less funding from the Commonwealth than, say, the big states of New South Wales and Victoria. Our commitment to lift all boats up to a much higher level, but at an equitable level across borders, would be a very big win for South Australia. So we need to do that.
PANTELIS: You're a South Australian minister, though. Why aren't you lobbying for more for the state?
BUTLER: I am. We've made that commitment. We're in negotiations with state governments to finalise that hospital funding deal. But it's money we've already put on the table. The second thing is that bulk billing question. We hear stories all across the country. If people can't get in to see a GP or if they're on low and fixed incomes and can't get in to see a bulk billed GP, too often they feel their only option is to go to the EDs. So, increasing bulk billing rates is important. We've also set up this network of Medicare Urgent Care Clinics. This is something I promised at the last election. We set up 58 last year, including five here in South Australia, and we're doing more to get up to 87. They are seeing people who have minor emergencies. They need to be seen urgently, but they don't need to go to a fully equipped hospital. The classic is they're very busy on Saturday afternoons. They operate seven days a week. They're fully bulk billed. There's one in the north, there's one in Marion, there's one in the South.
PANTELIS: They’re good. We got good reports from people they ring in. Tell us good stories.
BUTLER: Yeah, their kid gets a broken arm. You can't wait seven or eight days to get into a GP, but equally, you don't necessarily have to wait eight, ten hours at the local ED. That is taking pressure off emergency departments off the front door, if you like, at the hospital. But you're right to say that there are too many older patients in hospitals right across the country who are effectively languishing in hospital beds when they don't need to be there. They've been clinically assessed as able to be discharged, but there's nowhere to go. That's why building more aged care facilities is really important.
PANTELIS: But again that's what 2 or 3 years away?
BUTLER: We've already had providers announce that they've had plans, they've got development approval from the local council. They just haven't been able to get the finance. But since our announcement of the deal last week, which Anne Ruston, a local Senator, was involved in negotiating with the government. Already providers have said we're ready to go.
PANTELIS: And realistically then, that means ramping will continue for that long?
BUTLER: We've got to find some interim ways to help get older patients out of hospitals. We can't just wait for new facilities to be built over the next 2 or 3 years. Chris Picton and I announced a couple of months ago some funding that we'd committed to all state governments to help older patients get out of hospitals to effectively create new bespoke services outside of hospitals, particularly for people who were going to struggle to be properly cared for, even in a well-staffed aged care facility. They might have very high-level dementia, they might have quite complicated medical needs that don't need a fully equipped hospital, but do need more medical attention than you see in a standard aged care facility. We're rolling out that $56 million commitment as soon as we can here in South Australia. I've done the same thing in other states.
PANTELIS: David's called in from Elizabeth. Dave, good morning.
DAVID (CALLER): Good morning guys. I just want to let you know I had a Benson radiology appointment the other day. They wanted me to pay $655 for a CT scan. You get back $400 from Medicare, so it's $255 gap and 100 meters up the road at Radiology SA it’s completely free. Is this price gouging?
BUTLER: Thanks for calling in David. I'm not sure what it was particularly for and what the MBS item is, there are hundreds of them and they're at different prices. The private operators like the one you mentioned will try to make money that they can, which is why it's so important to have different operators, who might be bulk billing as well. I've talked a lot in the interview that I've just had with Matthew about bulk billing for general practice GP visits are critically important, but I know that people are paying out of pockets to see non-GP specialists. They're paying, not so much for pathology that tends to be very high levels of bulk billing for blood tests and things, but increasingly for radiology for imaging. That’s something that we do have to focus on. Thanks for your call in. Those sorts of cases are really important for me to have my head around as we think about how to get those costs down as well.
PANTELIS: They vary to the radiology. I paid $200 a year or so ago for a knee scan, an MRI, and you think, well, why? is it that much? And $600 for Dave? That's just extraordinary.
BUTLER: We made some decisions in the Budget this year to try and expand options in imaging. We hadn't indexed some of the not particularly MRIs, but particularly the nuclear medicine like PET scans and things like that for more than 25 years, that was starting to flow into, out-of-pocket costs as well. We've tried to expand the number of MRIs. We're going to do that over the next couple of years that have Medicare entitlements, because too often people should be getting MRIs, but there's not one available that's Medicare-licenced: that attracts Medicare rebates. So, people end up getting a lower quality CT scan instead. It's not just about the out of pockets in imaging It's also making sure that people are getting the best technology just while we're talking imaging.
PANTELIS: And just finally and perhaps quickly, I'm not sure how across you are as the federal minister on the proton machine that was going to go into the Bragg Centre, some issues with that in terms of the supply and not being able to meet the contract. The state government looking elsewhere, are we any closer to getting that?
BUTLER: The state government here is leading on this, but the Commonwealth does have skin in the game in the sense that we provided quite a substantial grant for the machine itself. Ultimately, when it was first decided by the former governments several years ago, it would have been the first in the Southern Hemisphere. So a very significant addition to our ability to fight cancer, particularly for children. Children often have to go to the US to get the sort of treatment they'd be able to get. This is very, very high-level technology. We paid for the machine at the Commonwealth level and also we developed the Medicare rebates that would be attracted as well. We're obviously involved in these discussions about how to land this capability here in Australia. But South Australia is leading on the details of that.
PANTELIS: So are we any closer to getting it?
BUTLER: I'm not in a position to say that right now. I'm sure the South Australian Government will keep your listeners informed as and when details emerge.
PANTELIS: Mark Butler, thank you for your time this morning.
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