Medicare Turns 40: Is Australias ‘little Green Card Keeping Up With Changing Health Needs?

As Dr Brian Morton became a GP in 1977, the cost of health insurance is the leading cause of personal bankruptcy in Australia.

Morton treated bankrupt patients on several occasions. “If anyone shows up, they won't be turned away,” he said.

Access to hospital care depends on having private health insurance or the ability to pay out of pocket.

Those who couldn't afford treatments like joint replacement had no other choice,” Morton recalled. “People with knee or hip arthritis have to live with it and deal with pain and disability.”

Life expectancy is low, and many people die in their late 60s and early 70s without receiving the care they need.

Even those with private insurance may only be covered for a certain number of days of hospitalization and find that those days expire during the stay.

Things changed when universal health insurance, now called Medicare, was introduced in 1984.

“Medicare represents a sea change in terms of reducing benefits for everyone, especially for those living in hardship and for families who bring their children with them,” Morton said. “Access to traditional medicine has changed radically.”

This does not come without controversy. As Neil Blewett, the health secretary, admitted when Bob Hawke introduced universal health insurance last weekend, not even the government of the day expected Medicare to last for 40 years.

As Medicare celebrates its 40th anniversary on Thursday, health experts say it's time to ask whether Australia's "little green card" is achieving all its goals.

“Tooth and Nail” Fighting Program.

The first version of Medicare, Medibank, was introduced by the Whitlam government in 1975 but operated for only a short time before the government was dissolved.

The new Fraser government has overhauled Medibank. This includes changes to contracts with the province regarding the amount of money hospitals will receive, limits on benefits and core payments, as well as cuts for people with private insurance.

These changes were largely reversed by the Hawke-led Labor government in 1984. Then, on February 1, Medicare benefits began.

I suspect Australians don't realize how lucky they are

Current Health Minister Mark Butler believes the plan was strongly opposed by John Howard's Liberal and National parties, as well as doctors' groups, as they initially feared it would lead to a similar dispute with the UK's National Health Service;

“Universal health insurance was perhaps the most crucial failure of national policy in this country…until the Liberal Party finally abandoned its formal commitment to completely abolish Medibank and Medicare in the early and mid-1990s” , Butler said. .

Elizabeth Devaney, chief executive of the Consumer Health Forum, said Australians "love their little green cards" but often find that Medicare pays for something when they give it to someone, most commonly: a GP.

“I suspect Australians don't realize how lucky they are to have a healthcare system that is not only universal but also mobile across the country,” Deveny said.

It's time to think

Professor Steve Robson, president of the Australian Medical Association, said that, as with "every milestone anniversary", Medicare's 40th anniversary was an opportunity to pause and reflect on future developments and whether the organization was reaching its goals. its objectives.

“The healthcare landscape today is very, very different than it was 40 years ago, but we have to remember that the Medicare architecture was built 50 years ago,” he said.

Australia's population today is much larger than it was 50 years ago, and some of the most common conditions requiring treatment are chronic illnesses and mental health conditions, which require ongoing multidisciplinary care, Robson said.

“And Medicare wasn't designed for that.” Medicare is designed for a period of treatment where, if you have a gallbladder problem, you go to the doctor, talk about it, and go home. »

Robson said the program's next step will be to create multidisciplinary teams to treat chronic diseases. For example, Australians with diabetes need educators, nurses, specialist care from an endocrinologist and perhaps an exercise physiologist.

“We don't want patients to have to drive everywhere,” Robson said. “Bringing teams together to fight diabetes is an example of what the future will look like…”

"There is a lot to do. Big government projects are like aircraft carriers. It will take a long time to build them again."

Deveny agrees that a big challenge for Medicare is adapting to the growing burden of chronic disease.

“Right now, the universality of Medicare is in jeopardy,” he said. “The Consumer Health Forum is concerned about some comments that have emerged in the industry in recent years that view Medicare as a safety net for the most disadvantaged groups rather than a system of universal access for all.”

Deveny said costs are now high, meaning the system no longer provides free, universal health care.

“Health care is now free, but you have to pay for the rest, which is why health care consumers often tell us they can't afford health care and decide not to take it.”

Deveny said doctors who have worked in the system for more than 40 years say Medicare is a "huge relief" because they no longer have to decide whether or not to foot the bill for patients in financial difficulty.

Family doctors are once again faced with the dilemmas of the past, he said.

“How do they help people stay healthy, which is their top priority, while protecting their business, health and employees?” Deveny says:

“We believe universal healthcare is important, and those who believe it is important should take that into account and not let the current system collapse.”

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