Systemic reform necessary for bulk billing

Transcript: AMA Queensland President, Dr Nick Yim, 4BC Radio, Mornings with Bill McDonald, Monday 24 February 2025

Subject: bulk billing funding announcement

BILL MCDONALD: The Albanese government and the Coalition have both pledged to throw $8.5 billion into Medicare to boost the rates of bulk billing. Now, that's great news on the surface, but is it just papering over a massive crack in the system? Dr Nick Yim is the President of the Australian Medical Association Queensland, we'll ask him that question now. Good morning, Nick.

DR NICK YIM: Good morning, Bill.

BILL MCDONALD: Nice to talk with you again. What do you think of this $8.5 billion? Is it going to kerb the decline in bulk billing?

DR NICK YIM: Good question. So firstly, it's really pleasing that the Australian Government and the opposition has recognised the critical need to invest in Medicare and general practice. The good thing is, there is a significant investment into workforce and training. So, over $200 million has been put aside for GP training and funding, say, medical students. So those are the good things. I think with regards to the bulk billing and Medicare, we really need to dig into the details on this. At this stage, it really looks like the government has only promised an increase in the bulk billing incentive, but the underlying issue is actually that initial Medicare rebate. Every time the patient sees their GP, they get that rebate amount, and that hasn't changed for decades or kept up with inflation. This is the big issue. So obviously we need to see a lift in Medicare rebate and no one has really mentioned about that component.

BILL MCDONALD: Okay, so with more bulk billing is there the risk of wait times getting longer and consultations getting shorter.

DR NICK YIM: This is one of the key components. We know that the Queensland population, we're unfortunately getting older. We have more complex health conditions. So, heart disease, diabetes cancers, mental health and that takes time. We would like to see investment for complex health issues and also investment into those longer consultations. This is where nuance is really important.

BILL MCDONALD: What would you like to see the – you said it's not been matched with sort of cost of living and CPI - where would you like to see it, where does it need to sit?

DR NICK YIM: The first element here is, we need a big uplift in that Medicare rebate. So for example, we know that for many listeners, you might see out of pocket expenses upwards of $50, for example, for a consultation. So, in those metropolitan areas, with this current initiative, that bulk billing incentive doesn't even come close to what some of the out-of-pocket expenses are seeing in the metropolitan regions.

The reasons why general practice needs to charge out-of-pocket expenses is because everything's gone up over the past decade. So, your staff wages, electricity, mortgages, rents, etc., but that initial Medicare rebate has not really changed. That's something that we need to change, because if we don't change that, three or four years down the track, ten years down the track, we're going to have exactly the same problem we have now.

BILL MCDONALD: Okay, so what do you make of Nick Coatsworth’s, the former Deputy Chief Medical Officer’s, summation of it – that this is trying to give CPR to a system that is already dead and can't be revived.

DR NICK YIM: Those are some interesting words there. But there's elements of truth to that. I think general practice itself, we are under pressure. So to give you an idea, we have 6 per cent of the healthcare funding, and obviously they see 86 per cent of the consultations. So we know that preventative care is really important. If we can get people seeing their general practitioners, keeping them well and having that preventative health in check, they don't need to use the hospital system, they don't risk getting those chronic diseases that need more expensive care. So, investment at the early stages is really important.

BILL MCDONALD: As part of what you've already outlined, is that why going to the GP has gotten so expensive? Or is it a bit more of a mix as well of a case of supply and demand?

DR NICK YIM: I think there's many facets to this. To circle back around, in 2022 there was that tripling of the bulk billing incentive. For some areas around Queensland, that stabled the storm to a certain extent, but it hasn't really made much of a dent in those metropolitan regions. It’s something where we do need to tweak it, we need to look into it, and focus on investment into the primary care sector.

BILL MCDONALD: Would you like to see a broader, and I was saying this earlier, whether there's a bigger picture, a bigger, bolder view from the coalition, the alternative government. Would you like to see the whole Medicare system reformed so that it was more holistic and takes pressure off GPs and improvements to mental health coverage as well, and even adding dental to the scheme?

DR NICK YIM: I think you're spot on. I think the reality is, Medicare reform needs to occur. I think we do need to focus on investment in complex diseases, complex health care, and also those longer consultations so we can see patients for that duration time that's needed.

BILL MCDONALD: How much does it contribute to the public health system, the hospitals, the free health services that are being overrun, overworked, overstretched when people aren't going to their GPs?

DR NICK YIM: I think we are seeing it. This is further accentuated by the fact that we do have a workforce crisis across the whole state. The whole system is under pressure, and I think this is the challenge that we face in Australia, that we have one element that is federally funded, one element that's state funded. So we need to ensure and remind ourselves that healthcare, it's a whole system. We need to ensure that we look at the community, general practice and also into the private specialists, private hospitals and also public hospitals. The whole system needs to work together.

BILL MCDONALD: So overall, your view on this, the fact that both of them have just said ‘yep, here's the deal, $8.5 billion’.

DR NICK YIM: I think it's a bit mixed. There are definitely positives, including that there's recognition that we need big investments into the healthcare sector. But I think we do need to tweak around the edges to see how we can ensure a lot of that funding is getting back to the patients as well.

BILL MCDONALD: All right. Appreciate your time. Thanks very much, Nick.

DR NICK YIM: Perfect. Thanks, Bill.

Contact: AMA Queensland Media, +61 419 735 641, media@amaq.com.au