Radio interview with Minister Butler on ABC Perth WA Mornings - 2 February 2024

Read the transcript from Minister Butler's interview with Nadia Mitsopoulos, which covered Medicare Urgent Care Clinics, the 40th anniversary of Medicare and bulk billing.

The Hon Mark Butler MP
Minister for Health and Aged Care

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NADIA MITSOPOULOS, HOST: Minister, good morning and thank you for joining me.
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: My pleasure. Nadia. Good to talk to you again.
MITSOPOULOS: Are you disappointed to hear those clinics aren't having the impact on EDs that you hoped they would?
BUTLER: The first thing I'd say is that they're still pretty new. We committed at the last election to set 50 of them up over the course of 2023, and by the end of last year, we'd set 58 of them up. I think the last one to open was actually Broome right at the end of December. So they’re still scaling up, but as you say, 1400 to 1500 people in Western Australia are attending an Urgent Care Clinic every week.
About a third of them are kids under the age of 15, so when your kid falls off the skateboard and breaks their wrist or sprains their wrist you need urgent care, you can't necessarily wait the seven or ten days that it might take to get into your usual GP, you need urgent care but you don't need to necessarily go to a hospital. So we're finding hundreds of Western Australians are going to these clinics already, about somewhere between 50 and 60% of those people attending these clinics tell us, or tell the operators of the clinics, that if the clinic wasn't available, they'd otherwise go to a hospital ED.
We’ve got some data from Queensland for example, that shows that their less urgent presentations, so not the heart attacks and the car accidents, obviously, but your kid falling off the skateboard and spraining their wrist, those presentations are coming down in some of the hospital districts where there is now an Urgent Care Clinic. But to the other perspective, so the patient's perspective, not necessarily the emergency physicians perspective, what we're getting overwhelmingly is stories from the mums and dads who are taking their kids there, or the adults who are going there, saying it is such a better experience than going to the hospital ED. Instead of waiting hours and hours in an ED with your kid who needs urgent attention, they're being seen relatively quickly. One of the operators that runs 20 of these clinics says that the average waiting time is about 35 minutes instead of hours and hours. It's obviously fully bulk billed, they're operating seven days a week. I've had stories of kids who were seen on Christmas Day in some of these Urgent Care Clinics very quickly, instead of having to spend your Christmas Day waiting for hours in a hospital emergency department.
MITSOPOULOS: Minister, you were very clear though, when you announced the first one in Morley that the clinic will ease pressure on the Royal Perth Hospital, not might, but will. So when do you think that will happen where you'll actually start to see a marked impact?
BUTLER: We will have to get some data from the hospital systems. Queensland was the first one to start providing that. So the Logan Hospital, which is south of Brisbane, it found that their category four and category five presentations - so those are the less urgent presentations, not heart attacks, not strokes, but the less urgent presentations, had come down by about 10% after the opening of that clinic. In Ipswich, which is west of Brisbane, the hospital there reported a reduction in those less urgent presentations of 20 to 25%. Now that is not necessarily going to clear a whole lot of the inpatient beds where people are put into a bed as your earlier guest said, but it is going to clear the rooms, it is going to take pressure off triage nurses, it is going to take pressure off the staff within the ED who might have to have the kid come in and have their wrist seen to and potentially plastered.
But I don't pretend this is going to change things overnight. This is a relatively new model of care for Australia. It's one that operates in most other countries we compare ourselves to - New Zealand across the ditch, for example, has had this operating for many, many years and you look at their emergency department data, it is way lower than Australia, not just a little bit, but way lower than Australia. So again, we've got to be patient, we've already seen in just a matter of months 150,000 Australians go to these Urgent Care Clinics seven days a week, many of them are going on the weekend when they otherwise wouldn't be able to get in to see their usual GP. As I said, about a third of those presentations are kids, it's fully bulk billed, free of charge, and I think it's a model that is proving itself well worth the investment from taxpayers.
Now we only have 58 of them across the country, that's also important to say. Because this is a new model, we want to scale it up, evaluate it to make sure that it's working, it's delivering value for that taxpayer investment, and then potentially increase the number of Urgent Care Clinics over time so that you will see other hospital catchment areas get the benefit of it as well. But can I say it's not just about hospitals, although that is an important thing, it's also about patients and parents feeling that there's an option for them in their community that they can go to any day of the week fully free of charge, fully bulk billed, other than just going to their hospital.
MITSOPOULOS: Isn't the real issue though here, and you heard Dr Peter Allely say that, you know, in the ED he works at, there's 28 beds and he says any given day 25 of those beds are taken up by people waiting for in-ward beds, so bed block is the issue, but more beds is the way to ease that pressure, which is, I appreciate a state responsibility, not a federal responsibility. So could this be seen as a band aid solution? Because it's not fixing the root of the problem here.
BUTLER: To add another metaphor, Nadia, to the band aid solution, there's no silver bullet for the pressures on our hospitals right now. Hospitals are under unprecedented pressure, not just across Australia, but right across the world. Any measure across the world shows that hospital systems are really feeling the brunt of the four years of the pandemic, so many people didn't get the care they needed during that pandemic time, they didn't get their cancer screens, they didn't see the doctor as often as they should have for their chronic disease management, so on and so forth. Every hospital system across the world is dealing with unprecedented pressure and we're having to work together to manage that. It's not just a state government responsibility or the Commonwealth, we're working together.
Now, trying to reduce the number of people coming in the front door of the hospitals is something that's worthwhile, Urgent Care Clinics will help that, but they are no silver bullet. Trying to work between the hospital systems and aged care facilities to try and reduce the number of people - aged care residents being admitted to the hospital is also something that I know the WA Government and the Commonwealth are working closely on. And also trying to see a flow through the hospital so that when patients are clinically ready to be discharged, particularly older patients or patients on the NDIS - the National Disability Insurance Scheme - there's an option for them to go out of the hospital rather than be stuck in there sometimes not just for weeks but for months.
So there's a series of things that we're working, not just with the WA Government on, but with all of the state governments. And you saw that reflected in the National Cabinet meeting of the Premiers and the Prime Minister in December, when they agreed to ten years of hospital funding that will see the Commonwealth contribution to hospital systems increase over time.
MITSOPOULOS: It has been three months since you tripled the bulk billing incentive in regards to Medicare, what difference has that made?
BUTLER: We've only got two months of data, so that's November and December. The new incentives took effect on the 1st of November and the first really pleasing thing that I think we've seen is we've stopped the slide. When we came to government, bulk billing for visits to your local GP, frankly, were in freefall. WA was one of the worst states in terms of bulk billing, Tasmania, as well some other areas of New South Wales were all seeing a really steep decline in bulk billing numbers.
So the first thing that happened, I think really pleasingly since we announced this in our May Budget, is that we stopped the slide. But in the first two months where the additional money was actually hitting general practices, we've also seen an increase. In just those two months across the country there were 360,000 additional free visits to the doctor, where all people had to do was produce their Medicare card, not their credit card. Now that's a great start.
MITSOPOULOS: But does that mean more people were visiting their doctor who already bulk bills, or did more doctors start bulk billing again?
BUTLER: We’re confident that there was more bulk billing, so in WA for example, there was about a 2.4% increase in the percentage - so the share of GP visits that were bulk billed. This varies across the country, in regional communities it was even higher because the incentive we pay to the GPs to bulk bill their patients in regional communities is higher than we pay in the cities, although they're very big in the cities as well.
So in some parts of country WA, so in the electorate of O'Connor, there was a 4% increase in bulk billing rates as well. So I obviously want to see more than that. But our first job, as I said, was to stop the slide. Doctors were telling us that if we didn't invest more money into Medicare, there was a real danger that the slide would continue, it might even accelerate, and a few years down the track bulk billing would be increasingly a thing of the past. And we just were determined not to let that happen.
MITSOPOULOS: Finally, Medicare turned 40 years old this week, and I was talking to Professor Stephen Duckett from the University of Melbourne, who was talking about some changes that need to be made to Medicare to see it fit for purpose, if you like, for the next 40 years. And I know he's not the first person to say this, but he believes it needs to cover dental care. A lot of listeners have also said the same sort of thing - expensive, but a lot of people believe necessary. Is that something you would ever consider?
BUTLER: That’s something that's been on the list of things for governments to consider for a long time as I'm sure Stephen Duckett said, Whitlam decided with Medibank not to include dental. The same decision was taken largely for practical reasons by the Hawke Government when they introduced Medicare 40 years ago yesterday, on the 1st of February 1984. There's currently a Senate inquiry underway into oral health care, dental care, and I'm sure that we'll get some good information out of that Senate inquiry.
But right now, the focus of the government is on strengthening the Medicare that we have. Because when we came to government, after ten years of cuts and neglect to Medicare and then four years of a pandemic, general practice in particular, but Medicare broadly was, I think, in the most parlous condition it’s been in its 40 year history. So our focus right now is strengthening what we’ve got with the Medicare system, but I’m very aware that there will be strong advocacy into the future for better arrangements in relation to dental care.
MITSOPOULOS: All right, I’ll leave it there, appreciate your time.
BUTLER: Thanks Nadia.


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