The Australian Medical Association says ongoing debate over specialist fees is missing the main drivers of rising healthcare costs, as new data highlights a widening gap between Medicare rebates and the cost of care.
The AMA on Thursday released its latest Gaps Poster, showing the extent to which Medicare rebates have fallen behind healthcare costs, as inflation affects both patients and medical practices across Australia.
AMA President Danielle McMullen said the system had been weakened by years of limited indexation.
“We have had decades of under-indexation, and half a decade of a Medicare freeze, leaving the rebate woefully out of reach of covering the cost of care,” Dr McMullen said.
She said recent increases in bulk billing incentives had improved access in some cases but were limited in scope.
“While recent government injections into Medicare bulk billing incentives are positive and have improved access to care, these relate to a tiny fraction of the more than 5,000 MBS items.
“These are ‘bolt-on’ incentives, not Medicare reform. And they don’t do anything if you need to see a specialist for a consultation, a privately billing GP, or need surgery.”
The AMA said the underlying rebate, which applies across all medical services, has not kept pace with rising costs, contributing to higher out-of-pocket expenses for patients seeking specialist care, surgery and general practice services.
The Australian Medical Association says years of limited indexation have weakened Medicare, with rebates no longer covering the cost of care. “We have had decades of under-indexation, and half a decade of a Medicare freeze, leaving the rebate woefully out of reach of covering the cost of care”
Dr McMullen said criticism directed at doctors was misplaced.
“The continuing attacks on doctors are neither helpful or focused on the kinds of significant reforms that would make a difference.”
The Gaps Poster includes a QR-linked resource outlining policy gaps and proposed reforms, aimed at helping patients understand why out-of-pocket costs persist and guiding government action.
“To help people understand why gaps exist in their care, and to guide governments on how to address them, our Gaps poster includes a QR link to our resource which outlines the policy gaps that currently lead to patient gaps. It outlines the clear steps governments could take right now to help patients and practitioners.”
The AMA is calling for broader reform of Medicare, including higher GP rebates through a new seven-tier structure to better reflect complex and chronic care needs.
It has also proposed changes to specialist care funding, including increased rebates, adjustments to private health insurance no-gap policies, improved indexation, and greater transparency around insurer payments.
“We must also see real investment in public hospital outpatient clinics so that patients have access to both public and private options for care.”
Dr McMullen said the timing for reform was critical, citing recent remarks from the health minister about delays in overhauling the system.
“Now, when cost of living is really biting is the time to act. Without action the gaps will only continue to grow, further impacting patients.”
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