Interview with Stephen Cenatiempo, 2CC
17 November 2023
Topics: Bulk billing, primary care crisis
STEPHEN CENATIEMPO: Despite being at record highs under the Coalition, bulk billing rates have dropped every single month since this government came to power, and this is after what they call a tripling of the bulk billing incentive. But it's not as quite as easy as it is sounds. Senator Anne Ruston is the Shadow Minister of Health and Aged Care and joins us on the line. Anne, good morning.
SENATOR ANNE RUSTON: Hi, Stephen. How are you?
CENATIEMPO: Very, very well. I mean, this is extraordinary given that the Government has talked up a big game with the tripling of the bulk billing incentive. And of course, that doesn't apply to everyone and it doesn't seem to be kicking in.
SENATOR RUSTON: Well, certainly. You know, even after they made the announcement that they were intending to triple the bulk billing rate, obviously the sector had no confidence in it at all because nothing changed. All we've seen is a continuing decline in the number of practices that are bulk billing, because the reality is that clearly most practices don't see that that increase is sufficient for them to be able to bulk bill. The cost of running a practice at the moment is exceeding the amount of money that they're getting, and a lot of it has to do with the cost-of-living crisis. You know, they're paying more for their energy bills just like everybody else is. They're struggling to get staff and having to pay staff, particularly those that are having to get from agency a lot more than they previously were. So the cost-of-living crisis is hitting everyone - Small businesses, and most of our general practices are small business.
CENATIEMPO: Well, here in the ACT, we're talking about increasing cost of visits anywhere up to $20 or $25 across the nation. It's sitting around that $10 to $15 mark. But the other thing that's exacerbating this is the State Government's insisting on applying this payroll tax to GPs. Does the Federal Government play a role here in maybe getting the states together and saying, hey guys, this might not be a good idea at this time?
SENATOR RUSTON: Well, they should be. They absolutely should be. Because you've got a situation here where, you know, you're paying Peter to rob Paul. So, the Federal Government puts up this $3.5 billion - Albeit, it's not necessarily going to do what the Government says it's going to do. In fact, we are all sure it's not going to do what the Government says it's going to do - And on the other hand, you've got the states and territories, particularly New South Wales and Victoria, who are saying, okay, we're now going to - we've changed our taxation interpretation and now we're going to slug general practice with payroll tax. So, basically you've completely negated any benefit whatsoever from the Federal Government's initiative, and the Federal government just wipes their hands of it and says, no, no, that's a state government problem. Well, actually, no, Federal Government, it is your problem because your initiatives aren't going to work if every time you do one, the state governments just steal the money by another means.
CENATIEMPO: So, is it time to rethink the concept of a maybe a means tested co-payment? I know that it became a real sticking point prior to the, well not the last election, but the one before that. But I mean, clearly we shouldn't be bulk billing everybody, but those that need it have to have that safety net and a co-payment would have solved a lot of that problem.
SENATOR RUSTON: Well, I think the reality on the ground right now, Stephen, is that because so few people are being bulk billed, and we're seeing that rate drop every day, people are getting higher and higher out-of-pocket expenses. I mean, we saw from the Royal College of General Practice's Health of the Nation report that was released a couple of days ago that just in the last 12 months, the cost of seeing a GP has increased on average by $11. That's $11 straight out of the pocket of every person that visits a GP. So, we know that because the bulk billing rate is plummeting, Australians are paying more and more and more every time they go to see the doctor. And we're talking in some instances, you know, 40, $50. And, you know, when you've got a family and you're being hit by the cost of living in other areas - mortgages, energy, at the petrol bowser, or at the supermarket - those sorts of costs to go and see a doctor are actually stopping people going to the doctor. So it's a real crisis and the Government is not addressing the real issue that's before us and that is a workforce shortage. We simply do not have enough general practitioners, we don't have enough nurses, we don't have enough nurse practitioners to meet the demands of the Australian - the health needs of Australians, and they're just ignoring it.
CENATIEMPO: And it's certainly a false economy, because it ends up biting you at the back end when people clog up the hospital system as well. Anne, I really appreciate your time this morning.
SENATOR RUSTON: My pleasure. Thanks for having me, Stephen.