Clara Tuck Meng Soo | How will federal budget's health measures help?

She likes to take Caden to their regular GP who knows all this and will be able to prescribe Caden the right antibiotic. Mia is a single mum and with the cost of living going up the way it has this year, she has to watch every dollar. With all the talk in the news about pressures on general practice, she is worried that their regular GP will start charging Caden for their regular visits. She already pays a gap fee for her own consultations. If their regular GP starts charging to see Caden, she may have to find a GP who will bulk bill Caden but she worries that this GP won't know much about Caden's history.

Andy has schizophrenia. He is on regular medications for this. He hasn't had a bad flare-up of his schizophrenia which has required him to go into hospital, but he still suffers badly from anxiety. He has a GP whom he really trusts and goes to see her regularly. He also gets arthritis, chronic constipation and strange aches and pains in different parts of his body. Fortunately, his GP is able to reassure him about the benign nature of many of these aches and pains without sending him to have lots of investigations.

The last time he went to the walk-in clinic with a strange pain in his chest, they insisted on referring him to the Emergency Department and he spent 24 hours in there. He found the whole experience very frightening and doesn't want to have to go through it again unnecessarily. His GP used to bulk bill him but has now told him that their clinic will have to charge him a gap fee and he is unsure if he can afford to see her as much as he used to.

This week, Treasurer Jim Chalmers announced the budget and among the measures he announced, the one that could have the most impact on Mia and Andy is the tripling of the bulk-billing incentive. The bulk-billing incentive is a payment GPs get if they bulk bill patients with concession cards or children under 16 years. The amount of the incentive varies depending on which part of Australia we are in.

So, in ACT, the tripling of the bulk-billing incentive means GPs who bulk bill someone in an eligible group will now receive $20.65 instead of $6.60 in addition to the Medicare rebate for that service.

I think how this will affect bulk-billing patterns in Canberra will probably depend on what the clinic is already charging. For practices that currently bulk bill an eligible patient group, they will probably continue to bulk bill for now and see how the increased bulk-billing incentive affects their bottom line. So, for Mia and Caden, their regular GP will probably continue to bulk bill and see what their finances look like in another six months.

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For Andy, I don't think the news will be so good. In Canberra, most practices now charge a $45 to $55 gap fee for their standard consultations. So, an increased bulk-billing incentive of $20.65 doesn't go far enough to cover that gap. Most practices like the one that Andy goes to have already gone through a painful process of educating their patients about the need to cease bulk billing them and will not relish having to reverse course now and maybe having to change that yet again in a few years' time when the bulk-billing incentive and Medicare rebates inevitably fail to keep pace with inflation.

For one of the major underlying flaws of Medicare is that Medicare rebates are indexed at a lower rate than the Consumer Price Index. This means the real value of Medicare rebates keeps falling over time. I estimate the Medicare rebate I get for a service is worth half as much as it was in the 1990s when I first started working in general practice.

General practitioners, in effect, take a pay cut every year for following the dictates of their conscience.

Another major flaw of Medicare rebates is how it fails to reward GPs for providing longer consultations.

In the Australia of today, chronic diseases are the major drivers of ill-health. A Medicare system that rewards GPs for providing short consultations is not the right system for the management of chronic diseases.

Many doctor organisations have come up with ideas of how to reward GPs for working with chronic diseases and it is important that federal, state and territory governments commit to working with doctor organisations to deal with this problem.

As for the urgent care clinics the federal government has also committed to funding, I think they are a band-aid solution that will end up being a waste of money.

We have already seen how walk-in clinics, despite being electorally popular, ended up being a lot more expensive than GP consultations and actually resulted in increased referrals to Emergency Departments. I predict urgent care clinics will end up with the same outcome.

But, given that this is what the federal government had already signalled it was going to do many months ago, they couldn't go back on their word and end up with egg on their face, could they?