Payroll tax on GPs, increasing costs for GP visits, and a complicated Medicare scheme—is our health system failing our communities and the most vulnerable?
Are the increasing healthcare costs becoming a deterrent for people in our district to visit a GP/doctor and seek treatment when our public hospitals are already overcrowded?
Who should be held accountable for the burden of the extra healthcare costs people in country towns are facing?
The Royal Australian College of GPs and the Australian Medical Association have warned the payroll tax would force clinics to pass on the cost to patients, end bulk billing, or shut down completely.
In this edition of Hard Talk, The [Naracoorte] News digs deep into the much talked about GP payroll tax, the increasing cost of seeing a GP in country towns like Naracoorte, and a review of our Medicare system.
We asked the SA Health Minister Chris Picton, Federal Health Minister Mark Butler, SA Shadow Regional Health Services Minister Penny Pratt, and Federal Opposition Leader Peter Dutton, what needs to be done to reduce the burden of increasing healthcare costs on people in country towns, where access to various health services is already limited?
The [Naracoorte] News asked:
- The cost of seeing a GP in country towns like Naracoorte has significantly increased compared with two years ago. Why?
- Do you think our country towns are facing a healthcare affordability crisis?
- Is the increasing cost a deterrent for people to visit a GP/doctor and seek treatment?
- Do you think the payroll tax costing patients around $10 or so extra per visit to a GP is detrimental to patient care when our public hospitals are already overcrowded? Should it be removed?
- Should we hold the government accountable for the burden of extra healthcare costs country people are facing?
- Are the new bulk billing changes under Medicare helping those trying to access a GP?
- Do you think our Medicare system needs a rebuild?
- What are your plans of making GPs more accessible and affordable for our people?
The responses
Federal government should invest more in primary care: State minister for health, Chris Picton
Mr Picton says primary care and the provision of GPs are the responsibility of the federal government.
He said the state government continued to encourage the federal government to invest more in primary care services.
“From next year we will be introducing a Single Employer Model for GP training in regional South Australia following approval from the federal government,” the minister revealed.
He said in future this would help SA attract and train GPs in regional areas such as the Limestone Coast. Mr Picton denied the imposition of the new payroll tax, saying these were long-standing laws.
“In fact, the Treasurer, Stephen Mullighan, has introduced legislation to help give a payroll tax cut for bulk billed GP services, of which the most recent figures show 76 per cent of services are.”
This, he said, was more generous than many other states.
“The State Government is making a generational investment in SA’s health system, with our primary responsibility being for hospital services.
“In the Limestone Coast, construction has started on a $24million upgrade of Mount Gambier Hospital, which will include an expanded emergency department, two new inpatient drug and alcohol withdrawal beds, and a doubling of the number of mental health beds.
“We are also investing $9million into upgrades at Naracoorte Hospital—delivering much-needed new clinical and patient spaces—and to investigate regional service delivery across the entire Limestone Coast Local Health Network,” he claimed.
Mr Picton said the operating of the Limestone Coast Local Health Network had increased by $31.4 million—or 19.1 per cent—in 2023-24 compared to the final year of the former Liberal Government in 2021-22.
Decade of cuts and neglects: Federal Minister for Health, Mark Butler
Mr Butler told this newspaper [Naracoorte News] that after a decade of cuts and neglect to Medicare by the Liberals, it had never been harder to see a GP.
He blamed Federal Opposition Leader Peter Dutton for causing the pressure on general practice.
“The pressure on general practice began when Peter Dutton was Health Minister, and he tried to do away with bulk billing by introducing a fee on every single visit to the GP and then started a six-year freeze on Medicare rebates,” Mr Butler claimed.
That’s why, he said, the Albanese government made the largest investment in bulk billing in Medicare history a year ago.
“One year of data shows our investment to strengthen Medicare has revived bulk billing and created an additional 103,000 bulk billed visits to the GP every week, on average, or 5.4 million additional visits since November last year,” he said.
“Nationally, more than 77 per cent of all GP visits were bulk billed in October 2024, an increase of 1.7 per cent on the same time last year, before the bulk billing investment took effect.”
Mr Butler said of the 5.4 million extra bulk billed GP visits created in the last year, 2.2 million were outside the major cities, in regional, rural, and remote communities.
“Ninety per cent of GP visits with children under 16 were bulk billed in the past year.
“In South Australia, there have been 460,000 extra bulk-billed GP visits since our government tripled the bulk billing incentive, an increase of 3.8 per cent to 74.5 per cent.”
Strengthening Medicare
Mr Butler said it would take time to strengthen Medicare after it was cut by the Liberals, but through the government’s investments in bulk billing, they are starting to see the green shoots of recovery.
Our country patients are frustrated: State Shadow minister for regional health services, Penny Pratt
Ms Pratt claimed that in the last two years, since the Malinauskas government came to power, country patients have been increasingly frustrated by not being able to access their own GPs due to pressures on the health system.
She told The [Naracoorte] News that the current Labor Government had failed to develop a workforce plan, which had led to midwife shortages, increasing numbers of GPs leaving the system due to retirements, and no government incentives to recruit GPs to country towns.
“Since July 1, the government (state) has ignored the pleas from the AMA (Australian Medical Association) and the RACGP (Royal Australian College of General Practitioners) not to introduce a GP Payroll Tax at a time when our GPs continue to be the most efficient part of a system in crisis,” Ms Pratt said.
She said she was deeply concerned about the many costs that country families are having to face.
“Cost of living crisis, cost of doing business crisis, no relief from interest rates, farmers facing the worst drought in 100 years, limitations to mental health services in the regions, and we are paying the highest power bills in the nation,” Ms Pratt said.
“Where is the Labor government, and what is it doing to actually address this catalogue of hardships?
Ms Pratt agreed that the increasing healthcare cost was a deterrent for people to visit a GP/doctor and seek treatment.
“The recent Auditor General report shows what we already know is happening,” she said.
“There has been a steady increase in presentations to the emergency departments of our country hospitals. Rising costs, longer waiting times, and the introduction of the Labor government’s GP payroll tax are making primary health unaffordable for many.”
She said the Liberal Opposition had committed to scrapping the tax on local GP’s if elected in 2026.
“If it was good enough for the Queensland Labor government to make that commitment last month, then Premier Malinauskas should follow suit,” Ms Pratt said.
“The Australian Medical Association, led by Dr John Williams, has repeatedly called for this government to stop collecting a tax that is now unfortunately being passed on to patients.”
More money, worse outcomes
Ms Pratt claimed SA Premier Peter Malinauskas had allowed his minister to blow this year’s health budget by nearly $1billion.
“How are we better off for that money being spent?” she said.
Referring to the recent Auditor General’s report, Ms Pratt said Mr Malinauskas and Mr Picton “must be held accountable for spending more money but getting worse outcomes.”
She said under the new bulk billing, patients in the Upper South East were “actually losing services”.
“The government will have to account for its own efforts in having years to address this national issue,” she said.
“We have seen a national taskforce established, and there has been a lot of lobbying, but can patients say that health is more affordable or accessible? Patients in the Upper South East are actually losing services.”
Can Medicare be fixed
Ms Pratt claimed that country doctors have told her the Medicare system cannot be fixed.
“This is the challenge facing the federal Labor government, and even minister Butler says there is a long way to go,” she said.
When asked of her plans as the Shadow Regional Health Services Minister, Ms Pratt said she would continue to call for the state-enforced GP payroll tax to be scrapped, take bookkeeping pressures off local doctors, and restore confidence in country health services and treatment options to reduce the number of people travelling to the overcrowded city system.
“Imagine if the Limestone Coast could offer radiation therapy treatment to hundreds of cancer patients instead of sending them across the border to access the Victorian health system?” she said.
“There are many ways taxpayer money could be spent to get better outcomes for country patients.” No response was received from Mr Dutton when this edition went to press.
Background:
While the federal government is responsible for setting Medicare fees and rebates, most GPs operate their practices as private businesses and are free to determine whether they bulk bill some or all of their patients or charge a co-payment.
The government provides a bulk billing incentive for Medicare services to patients with a Commonwealth Concession Card and children under 16 years of age. This supports GPs to bulk bill their patients.
This article appeared in the Naracoorte News.
