The Australian Medical Association has launched a campaign aimed at explaining why many patients face out-of-pocket healthcare costs, arguing that Medicare funding has not kept pace with the way medical care is delivered.
The campaign, titled The Medicare Gap, focuses on the funding arrangements for general practice, specialist consultations and surgery. The AMA says the public debate has often centred on doctors’ fees, while the underlying funding structure has received less attention.
AMA President Dr Danielle McMullen said the campaign was designed to help patients understand what she described as a fragmented Medicare funding system.
She said general practice rebates had not kept pace with the growing complexity of patient care and called for a new seven-tier Medicare rebate structure that would better reflect the time required for longer consultations.
Dr McMullen said the AMA was also seeking broader Medicare reform, including support for practices to provide after-hours care and continuity of care through patients’ regular general practice.
The campaign places particular emphasis on specialist consultations, where the AMA argues Medicare funding has fallen well behind other parts of the healthcare system.
According to the AMA, Medicare funds about 89 per cent of general practice costs, while Medicare and Medicare-supported private health insurance together cover about 80 per cent of private hospital funding. For specialist consultations outside hospitals, the association says Medicare covers about 53 per cent of costs.
Dr McMullen said specialist consultation funding had received little policy attention over many years and argued that rebate freezes and the lack of reform had contributed to higher gaps for patients.
The campaign also examines out-of-pocket costs for people with private health insurance, pointing to differences between insurers’ rebates for the same medical service.
The AMA says patients can face very different costs depending on their insurer and policy, even where policies carry the same government classification such as gold, silver or bronze.
Dr McMullen said the association’s Uncovering the Gaps in Private Health resource shows that relatively small differences in fees can produce large changes in patients’ out-of-pocket expenses and insurer payments. She said doctors often need multiple fee schedules for the same service because insurers use different rebate arrangements.
The campaign comes as healthcare affordability remains a major issue across Australia, with patients reporting increasing pressure from consultation fees, specialist costs and insurance-related expenses.
Successive federal governments have introduced a range of Medicare and primary care funding measures, including recent increases to bulk billing incentives. The AMA argues that broader reform of Medicare rebates is still needed to address the funding gap affecting patients across general practice and specialist care.
Dr McMullen said the association wanted governments to focus on strengthening Medicare rebates rather than adding further layers of funding complexity.
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