Articles

23rd Apr 2025

Health and the Election: Band-aids When Surgery is Needed

Pearls and Irritations
By: Dr Tim Woodruff

Health policies are out and there is little difference between the two major parties. The policies definitely help patients afford to see GPs and get medication. More GPs and more nurses will be trained. The Labor Government has signed off a hospital funding agreement with the States. It has opened more urgent care clinics. It has increased wages for aged care workers. It has funded women’s health issues better. It is paying GP registrars better (but not as well as hospital registrars). It has promised extra funding for mental health but it’s not in the budget so when will it happen? However, all these all these changes are band-aids or catch-ups. Most should have been done long ago. Read more

19th Nov 2024

Health and Human Security: a sense of control over one’s life

Pearls and Irritations
By: Dr Tim Woodruff

It is time to think more broadly about security than the narrow military concept about which there is endless debate. Security for individuals and communities does not depend on a nuclear powered and nuclear armed submarine. We are humans and human security is about many things including health, and it is health which our organisation, the Doctors Reform Society, has focused on for the last 50 years. Read more

15th Nov 2024

Putting the mouth back into Medicare

Pearls and Irritations
By: Dr Tim Woodruff

How would it be to walk into a general practice with a toothache and be triaged to see the oral health therapist, who assesses and then develops an oral health care plan? They are then qualified to provide dental treatment but may also involve a GP or dentist across the corridor for further assessment. It is time to dream this could become a reality if Labor is prepared to embrace the mouth, gently.

It could be started immediately by listing oral health therapists as part of the primary care team (general practice and others), in the Government’s recently proposed most radical restructure of primary care funding since the introduction of Medicare. Such therapists could focus on oral disease prevention and health promotion. Dentists could be added later.

Currently the radical restructure ignores the mouth. This restructure was initiated by a taskforce chaired by Mark Butler, Health Minister. Further detail on the restructure was addressed by a committee chaired by the First Assistant Secretary for Primary Care. With such senior people driving the restructure one could reasonably expect that suggested changes or a variation of them will be implemented over time.

The Federal Government’s main funding for general practice is through fee for service i.e. you receive a service, and the Government provides a set rebate, the value of which depends on the service. The provider can charge a copayment of whatever value. If no copayment is charged it is called bulk billing. There are other Government payments to general practice for a variety of things which are not related to an individual service. These other payments currently make up less than 10% of Government funding for general practice.

Central to new changes is a move to increase the percentage of general practice funding through non fee for service payments from the current less than 10% to 40%, and adjust them for socio-economic status, rurality, and complexity. Funding will now aim to enable general practices to employ a variety of other health care providers in the practice to promote a comprehensive primary health care team, consisting of GPs, Allied health, nurses, Nurse Practitioners, Midwives, and social support services. Oral health therapists and Dentists are primary care providers. Put them in the list and finally, the mouth is into Medicare.

Importantly, it is suggested that the changes be introduced gradually, with an aim of reaching the 40% target by 2032. This is partly because the changes are quite complicated and cover much more than the above. In addition, the resistance of the medical profession needs to be carefully managed. Lastly, spending extra money on health, education, and welfare is not a priority of this Labor Government unless it has an immediate political impact.

There are a variety of proposals to get the mouth into Medicare. The Greens propose having a rebate system like Medicare to address the issue. There are three problems. Firstly, there is the cost. Labor leadership does not have a ‘crash or crash through’ Whitlamesque visionary who can see the political, economic, and social benefits of equitable access. Minister Butler’s comments reflect that reality. The second is that it would mean adopting a fee-for-service rebate system. That doesn’t work well with doctors’ visits because copayments decided by doctors mean patients can’t afford to go. The same would almost certainly happen with dentists. The Child Dental Benefits Schedule (a limited fee for service scheme introduced in 2014) relies on dentists to participate. Sixty percent don’t, most likely reflecting the fact that eligible patients would not be able to afford the copayments these dentists would charge. A recent review of that scheme concluded there is only a 40% take up of the scheme. The third problem is that it would lead to a federally subsidised dental profession which would then resist any change away from fee for service medicine. That change is precisely what the restructure is intending. It is resisted by doctors’ organisations because it affects their income and autonomy. We don’t need dentists as another adversary to patient centred care. Resistance from dentists was part of the reason Whitlam ignored the mouth in 1974. Doctors’ resistance was enough of a problem then.

Butler said on Q&A recently,

“It’s in our platform that we would one day move to incorporate dental care into Medicare, which conceptually makes sense……We don’t have the ability to [incorporate dental care into Medicare] right now”.

We do. Doing it slowly and carefully is so much better than ignoring it for another 50 years

The mouth has been largely forgotten by Federal Governments since dental care was left out of Whitlam’s Medibank and Hawke’s Medicare for financial and political reasons. The opportunity now exists to start putting the mouth back into the body to address the huge inequities in access to dental care across the country.

Read more

12th Apr 2024

Aged Care Funding: On the Road to Entrenched Inequity

Pearls and Irritations
By: Dr Tim Woodruff

UK Health Minister Aneurin Bevan introduced the National Health Service (NHS) pointing out that “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.

Advancing age brings with it infirmity and a much higher likelihood of ill health. People do not choose to become old and infirm.  

Whilst conservatives despise the sentiments expressed by Bevan, particularly the concept of sharing by the community, liberals do agree, but with very variable degrees of commitment. Read more

26th Jul 2023

Prescription Co-payments: Time to Stop the Silent Killer

Pearls and Irritations
By: Dr Tim Woodruff

Prescription co-payments are imposed by the Federal Government for subsidised drugs. Australians pay $1.6 billion a year in co-payments. Why do we continue to have financial barriers to accessing these drugs?

Co-payments are $7.30 or $30 per prescription for Pensioners and Health Care Card Holders or the remainder respectively. Scotland, Wales, and Northern Ireland abolished prescription co-payments in 2011. New Zealand has just abolished co-payments in July 2023. Read more

21st Jan 2023

Medicare Needs Reconstructive Surgery Now, not Band-aids

The Medical Republic
By: Dr Tim Woodruff

Structural problems won’t be fixed by doubling rebates. Voluntary patient enrolment can improve access if funding varies with SES.

Our health services are struggling. For patients, even the wealthy, it can be difficult to access timely care. For all patients there is no ‘system’. They see a collection of poorly connected, differently funded services which they are expected to negotiate. Read more

3rd Dec 2022

Rorts and Revamping Medicare

By: Dr Tim Woodruff

Rorts and Revamping Medicare

This series of three articles looks at the above topic under the headings:

  1. The Vision: Where could we be?
  2. The Reality: Where are we now?
  3. Implementation: How do we proceed with the needed changes?

Read more

9th Oct 2020

Opportunity Lost: Covid-19 and the Budget

“The many problems in our society exposed by the Covid-19 pandemic and the response to it have been largely ignored by the Federal Government’s budget”, said Dr Tim Woodruff, President, Doctors Reform Society. “Residential Aged Care has been ignored. Aging in the home has been trickle fed. 1.6 million unemployed have been left in poverty on Job Seeker, waiting for the job creation which will be slow and painful. Poverty kills. And the middle aged unemployed have been left on the scrapheap, despite being much more likely to have dependant families, and sadly perhaps because women make up a much larger percentage of this group”. Read more