Introduction by Croakey: The universality of Medicare is under threat, according to a health consumer leader, who has warned against a tendency to see this “Australian institution” as a safety net.
Dr Elizabeth Deveny, CEO of the Consumers Health Forum of Australia, has called for reforms to ensure Medicare better reflects the needs of today’s consumers, and has highlighted the importance of the consumer health movement in contributing to reforms.
“Australia needs a healthy, robust and unapologetic consumer health movement who are determined to work alongside practitioners and bureaucrats to deliver full equality to consumers in the healthcare system,” Deveny told Deakin University’s conference, ‘Medicare: a 40-year health check‘.
Below is Deveny’s full speech, titled ‘Consumers’ experience with Medicare’.
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Elizabeth Deveny writes:
To begin I would like to acknowledge the Traditional Owners of the lands on which we are meeting, the Wurundjeri Woi-wurrung and Bunurong/Boon Wurrung peoples of the Kulin and pay respects to their elders past and present. I also extend that acknowledgement to any Aboriginal and Torres Strait Islander people here with us today.
The Consumers Health Forum of Australia is very proud to have consumers who identify as Aboriginal and Torres Strait Islander as part of our consumer network. Their engagement and contribution to health policy and system design are a crucial and essential part of how consumer health operates in Australia.
In the time I have today, I will be covering a few themes starting with what we know to be consumers general sentiments towards Medicare, then drill into some data from our Consumer Sentiment Survey, we’ll hear directly from some consumers about what they think about Medicare and finally share our thinking about where we think Medicare needs to be strengthened into the future.
Just before I start that, for those who don’t know, CHF is the national peak body representing the interests of Australian healthcare consumers.
CHF believes that healthcare in Australia must be accessible, affordable and safe. CHF member organisations comprise of the state-based consumer health groups and disease specific consumer groups.
Consumer engagement
We started in the AIDS crisis of the 1980’s when HIV/AIDS consumer groups came together to fight for the lives of their members and communities with a collective voice.
This collective action then grew into a wider health consumer movement for Australia and through funding in the 1986/87 federal budget, CHF was born, so in many regards Medicare is our slightly older sibling.
During the last 40 years, what we have seen in Australia is the maturation of the consumer health movement.
Just like Medicare, our movement doesn’t look like it did 40 years’ ago and the needs of consumers has also changed, as has their involvement in each part of the healthcare system.
We now see consumers actively engaging with health bureaucracies to ensure that the health system is meeting their needs and where it doesn’t, they look to hold the people responsible accountable and create better ways of providing healthcare to remedy the problem.
This is not going to go away and the next generation of health consumers and the one after that will continue to have their voices heard as we fight for full equality in the healthcare system.
But if health consumer organisations aren’t properly funded, supported and included in decision making, then it will stifle any progress.
Australia needs a healthy, robust and unapologetic consumer health movement who are determined to work alongside practitioners and bureaucrats to deliver full equality to consumers in the healthcare system.
Universality under threat
In terms of what consumers think about Medicare, I think the first question to answer is what do we mean by Medicare?
For a lot of consumers, they assume Medicare means they can access their GP for free through bulk billing, but as we all know, Medicare is more than general practice.
Sometimes the fact that Medicare helps people access the hospital system and pathology is overlooked.
We would like to see more consumers become aware of what Medicare provides them and this should be done through better health civics campaigns and programs.
Consumers like that Medicare provides a universal public system which means you can access the care you need, when you need it and you don’t have to financially ruin yourself to access care, unlike other countries like the United States.
The universality of Medicare is under threat. CHF is concerned by some of the commentary that has emerged in the sector over the last few years which is viewing Medicare as a safety net and not as a universal access scheme.
Those that believe in universal healthcare should take note of this and not let our current system be eroded.
We know, because consumers tell us, that they love their little green card and that they can use it across the country, not just in their local area tied to certain practitioners.
This is an important and I think often overlooked point which some of us take for granted. In the UK for instance under the NHS, your funding is fixed to a particular GP in your area. Imagine the outcry if we tried to now implement that in Australia.
Public scepticism
You’ll see in my presentation I raise the issue of trust. I recently came back from the OECD’s Health Minister’s Meeting and two of the key issues, which were raised for all countries, were declining trust in governments and a mixed reception to artificial intelligence (AI).
In terms of lack of trust in government, I guess what we have seen in Australia is a public more sceptical of politicians and institutions.
In terms of AI, there are mixed feelings, some love it and see it as the future and there are other people in our community who again are sceptical of it and the digitisation of the healthcare system.
So how does a more sceptical, less trusting public, some of whom are not exactly embracing the digitisation of healthcare, how does all of that fit with the future of Medicare? I’m not saying I have the answer, but it is something policy makers, governments and healthcare professionals need to have in the back of their minds as they plan Medicare’s future.
We get the general sense that consumers know that Medicare is a rebate system and that they will have to pay a contribution to their healthcare but they won’t have to pay the whole amount.
This seems to be generally accepted and we have a certain level of comfort that Australians know that if they get really sick or in an emergency situation that they will get the care they need in hospital and that cost isn’t the determining factor.
But again, with the cost of living we are seeing sentiments changing, as outlined in the latest ABS patient experience survey.
Medicare is an Australian institution and is for everyone, unlike the Medicaid system in the US, which is just for people who can’t afford private health cover.
Medicare is seen as a right, not a nice to have. This fits in more broadly with the global consumer movement belief that health is a human right.
Here in 2024, it is important to remember that many Australian adults have now grown up with Medicare and have not known any other system.
Because of this and the positive sentiments Australians have shown to Medicare and the principles of universal healthcare, we do wonder if it leads to less young people feeling that they need to take out private health insurance.
The private health insurance figures show us that the older age demographics use it more than those under 40 and that isn’t that unexpected on the surface given that’s how health and ageing work, but we do wonder if another reason fewer younger Australians are taking it out is because they feel they don’t need to because they have their little green card.
Consumer sentiment
CHF works in partnership to conduct the Consumer Sentiment Survey, which asks a range of questions about how consumers feel about Australia’s healthcare system and what their interactions with it have been over the last 12 months.
For today I am going to be looking at what consumers told us in the 2018 and 2021 survey. We have a new survey coming out later this year.
In 2018 we had 1,024 complete the survey. Of those 97 percent reported having a Medicare card.
In 2021 we had a much larger sample size with 5,100 consumers taking part, 95 percent of them reported that they had a Medicare card.
When respondents were asked if they would be prepared to contribute more than the current two percent Medicare levy on their taxable income if it meant they paid more tax overall, in 2018, 34 percent of participants said yes, 37 percent said no and 29 percent didn’t know. In 2021, these percentages were 40 percent for yes, 38 percent no and 23 percent didn’t know.
In terms of satisfaction with health services received, the surveys told us a few things including;
- 84 percent of consumers in 2021 were satisfied with the healthcare received in the past 12 months, up from 67 percent in 2018.
- satisfaction with public hospitals increased from 69 percent in 2018, to 82 percent in 2021.
- satisfaction with GP services used in the past 12 months increased from 80.6 percent in 2018 to 89 percent in 2021.
- 52 percent of respondents stated that the health system works pretty well and only minor changes are needed to make it better, up from 45 percent in 2018.
Consumer voices
In preparation for this presentation, we asked a few consumers to tell us what they think about Medicare and what they would like the future of it to be.
Justan:
Justan lives with Crohn’s disease, which he has had since he was a child. He says in his video that he really likes Medicare because it looked after him when he was sick in the 90’s and has helped him thrive into the adult he is today. Justan mentions in his video that he doesn’t feel that invisible diseases like Crohn’s get as much support through Medicare as someone who has an illness or disability which shows up physically. Justan wants the future of Medicare to be one where people living with invisible illnesses are seen by the system
Leonie:
Leonie’s video is about Medicare and oral health. Leonie starts by saying that Medicare covers the whole body except for the mouth. Leonie says that when she meets with people in a health consumer context, one of the things they rarely have is access to dental treatment. Leonie goes on to say that people can get access to see a GP, they can go to hospital, they can get subsidised drugs, allied and mental health support, but they can’t access dental. Leonie would like to see oral care added to Medicare, especially for senior Australians as a priority.
Strengthening Medicare
In terms of areas where Medicare could be strengthened, CHF have advocated on the Strengthening Medicare Taskforce that the fee-for-service model doesn’t work for people with chronic conditions.
Medicare must keep up with the changing needs of Australians, particularly given Australians are living longer than we were 40 years’ ago and more Australians live with a or multiple chronic conditions then we did in 1984.
We want to see Medicare support greater levels of healthcare integration of GPs and hospital and GPs with aged care and disability.
With the benefit of hindsight, CHF also believes that Medicare should have originally included the mouth.
Dental care in Australia is not where it should be for a country like ours and we have great ways to go, largely through investment, to ensure that people’s oral health continually improves.
So to finish, consumers tell us that they are generally very supportive of Medicare and the principles of universal healthcare.
Many Australians have grown up with Medicare and don’t know any other system.
The Australia of 1984 is not the Australia of 2024, and as society and the health needs of Australians have changed, so too must Medicare change to better reflect the needs of today’s consumers.
Consumers have told us in the survey that there is appetite in the community for people to pay more into the Medicare system through taxation, but this needs to be explained and justified.
And finally, we need to improve the Medicare system to better support people living with a chronic condition or multiple chronic conditions.
See Croakey’s archive of articles on consumer health matters and the Strengthening Medicare Taskforce.
