Introduction by Croakey: Since the Federal election, Minister Mark Butler has given media interviews on health, disability and aged care policy, with topics including Urgent Care Clinics, the crisis in private healthcare, and the NDIS.
On specific health conditions, he’s discussed heart disease, COVID, bowel cancer and motor neurone disease. On public health matters, he has spoken about vaccination and tobacco-related issues, and also rejected calls for a sugar tax.
With the Minister’s agenda being so crowded – his responsibilities now extending from health and ageing to disability and the NDIS – what hope is there for prioritising big picture, structural health reforms over the types of single issues that often generate most media attention?
Peter Breadon, Health Program Director at the Grattan Institute, offers some suggestions below for how Minister Butler and colleagues could create a legacy built upon structural reforms, with a focus on financing, prevention and developing a pathway to universal primary dental care.
Peter Breadon writes:
Medicare was at the heart of Labor’s election campaign, and it helped deliver a majority. That political capital can be turned into major reform – but only if the government moves quickly.
Health reform is always hard. It is literally a life-and-death issue, and as Minister Mark Butler has joked, the sector is crowded with “sharp elbows and loud voices”.
Yet if ever there were a moment for bold change, this is it.
A healthcare-focused election victory comes as the health system faces rising costs, rising chronic illness, growing demand, and stubborn gaps in access to care.
Given the election result, Labor could be in charge for the next six years. Having pitched themselves as the party of Medicare, they should follow through by tackling those growing long-term pressures and setting the system on a better track.
They don’t have to start from scratch, because they already implemented initial reforms – including several as part of MyMedicare – and laid the groundwork for bigger reforms in general practice, public hospitals, and prevention.
Give GPs new options
In his first term, Minister Butler commissioned a slew of expert reviews, with general practice front and centre. Those reviews point the way to a more multidisciplinary model of general practice, where funding is based on patient need, not appointment speed.
Today, government funding for GPs is dominated by fee-for-service payments. Two reviews – on GP incentives and scope of practice – recommended increasing the share of other types of funding from less than 10 percent to 40 percent of the total.
Those payments would be flexible, allowing many clinics to hire bigger, broader primary care teams. And with bigger payments for clinics with sicker and poorer patients, it would make funding fairer.
Yet the election commitment to spend $8 billion increasing bulk-billing incentives pushes in the opposite direction by boosting existing fee-for-service payments. And the incentives now cover all patients, not just concession-card holders and children, removing one of the few mechanisms that tilted funding toward disadvantaged patients.
This term, the Government should do what the reviews call for. It’s time for a new way to fund general practice, moving away from the fee-for-service flywheel that rushes GPs and patients, blocks multidisciplinary care, and is blind to patient needs.
In line with good models overseas, GPs should be free to choose a payment approach where most of their funding is flexible, allowing them to expand their pool of patients and treat them with the help of a bigger team.
As decades of experience have shown us, tweaks and top-ups won’t achieve the transformation that the Minister and his reviews have called for.
A hospital deal that’s about more than money
Just before the election, the National Health Reform Agreement (NHRA) was rolled over for a year, postponing hard choices.
Public hospital spending has increased by more than five percent a year for the past five years, after adjusting for inflation.
Facing this rising tide of spending, the Federal Government has already pledged to lift its share in the next deal. It will increase its spending contribution to 42.5 percent by 2030, and 45 percent by 2035. It must ensure that this new spending buys reform.
The independent Mid-Term Review found the current NHRA is little more than a financing agreement with reform baubles tacked on.
The Treasurer says in its second term the Government will focus on productivity, and with ever rising costs, and pressing needs outside hospitals, that focus must extend to the NHRA.
A genuine reform deal should promote:
- Transparency – publish clear, comparable data on care, cost, quality, and unmet need
- Value – pay for best-practice care, not just the average cost
- Access – set minimum standards for timely GP and specialist care, and direct funds to underserved areas
- Workforce – revive national workforce planning and training, ideally via a new agency to replace the one scrapped a decade ago
- Demand reduction – set targets and allocate funds to shift care out of hospitals with home- and community-based models such as virtual wards and urgent-care centres.
Build a bullet-proof prevention system
An Australian Centre for Disease Control (CDC) was an election promise and is due to be established next year, with legislation expected in Parliament soon.
Australia spends less on prevention than most comparable nations. We double down on this dereliction with a stark lack of taxes or regulations, such as a tax on sugar-sweetened beverages, that promote healthy choices. It’s a terrible fit for a population getting older, heavier, and sicker.
To turn us from a prevention laggard to leader, the CDC must be independent, well-resourced, and empowered to recommend evidence-based policies. That is the best way to overcome the prevention blockers of short-termism, coordination challenges, and powerful vested interests.
The Federal Government should also strike a new national prevention agreement with the states, restricted to initiatives that the CDC endorses.
Another prevention priority is arresting our alarming slide in vaccination rates. Childhood immunisation rates have slipped for three years in a row, and adult uptake still varies sharply by geography, income, and cultural background.
The new National Immunisation Strategy must arrest the slide and reduce those gaps by promoting vaccination, setting ambitious targets, and funding focused programs in the communities with the lowest vacation.
Fill gaps in care
As mentioned above, targeted investment under the next NHRA can shrink ‘GP deserts’ and cut specialist wait times that stretch into years in many parts of Australia. But other access gaps need action too.
More than two million Australians each year delay or skip dentist visits because of cost and preventable oral-health problems are pushing record numbers of patients into hospital emergency departments.
It was an election issue this year, but the Government says it can’t afford to bring dental care into Medicare yet.
This term, the Government should design a phased path to universal primary dental care, so that at the next election, voters can decide if it’s worth the price tag.
From landslide to legacy?
Political fortunes can fade fast, but structural reforms can endure.
If the Government seizes this moment, future generations of Australians could remember 2025 as the year we started turning review recommendations into real reforms, and better health outcomes.
See Croakey’s archive of articles on oral health
