Election health debate: Timely access to medicines, fixing hospital logjams and Medicare reforms must be top election priorities

A health debate hosted by Joe Hildebrand set the scene for former Health Department chief and former Grattan Institute health policy expert, Professor Stephen Duckett, Medicines Australia’s CEO, Liz de Somer, and President of the Australian Medical Association (AMA), Dr Omar Khorshid, to discuss why timely access to medicines, hospital logjams and Medicare reforms must be top election priorities for both political parties.

In referring to the recent policy from both parties to cut PBS co-payments, Medicines Australia Ms de Somer said “Prescription medicines change people’s lives and save people’s lives. The cost of living and the affordability question is huge in this current election so any reduction in the out-of-pocket expenses to access life changing medicines must be welcomed. However, it is only applying to the general co-pay – medicines that would normally cost you $42.50. A large proportion of patients who have a concessional card, and already pay a lower fee for their medicines, are not going to be impacted at all. It’s not going to be cheaper for them.”

Professor Duckett added “This policy is actually part of the turf wars between the pharmacy board and the pharmacy discounters. It undercuts the business model of the discounters so there’s not going to be as many discounted pharmacies as they used to be because they don’t have the opportunity to discount an already lower price.”

AMA’s Dr Khorshid commented “They like to talk about the cheaper medicines and 10 to $12 out of pocket sounds like a really good discount. But the fact is that the measure only costs $150 million at $6 per Aussie over four years. Very few Australians are actually going to benefit from it and it will not make a big difference to the average Australian’s overall healthcare costs.”

Ms de Somer reflected on the importance of health literacy impacting consumer decisions in taking medicines. She said “When you’re making choices about what are you going to spend your money on, we see people readily spending money on complementary medicines or herbal treatments that may not have any clinical value and then forego their prescription medicine which has a huge body of clinical evidence. When you’re making those decisions not to take prescription medicine and your health deteriorates, it’s going to have a flow on impact to everything that you do in your community, workplace and how you get through each day.

“Australian patients wait too long to get access to new and innovative medicines approved by the Therapeutic Goods Administration. Patients are waiting hundreds to 1000s of days for that decision on subsidy to be made. There is a structural problem there when we wait too long to get access to innovativeness.”

Professor Duckett addressed the hospital logjams and elective surgery waiting lists. He said “Before COVID there were long waiting times in every state. The public hospital system was under pressure back in 2019. The first pandemic period caused two sets of problems – elective procedures were cancelled and also people didn’t go to their GP when they should have. The situation we’re in now in 2022 is way worse than 2019. The deferred care and the backlog is not going to be cleared in the next six months because it’s just too much of it. Both the government and the opposition have put their head in the sand. Neither side is committed to share in the COVID related costs of clearing this backlog.

“The states are in dire straits, and we need to be investing in this to bring the waiting lists back down. Neither the government nor the opposition want to talk about COVID during this election. We’re in this conspiracy of silence,” he added.

Dr Khorshid noted “We’ve got half the number of beds we had 30 years ago per head of population over the age of 65. The Prime Minister has made it very clear that hospitals are a state issue and they’re just not interested. The Labour Party has said they’ll talk, at least an acknowledgement of the reality.”

On the primary care bulk billing issue Dr Omar Khorshid said “It’s important that we don’t measure the success of primary care by the bulk billing rates. Bulk billing is about accessibility but it says nothing about the quality of general practice or the impact that it has on a broader health system.

“Due to the nature of Medicare and the fact that it hasn’t been indexed properly since it started, the value of the rebate that a patient gets [in a 6 to 10 minute consult] when they go to a doctor has been eroded. It it is very difficult for a bulk billing practice to make ends meet and deliver high quality medical care.

“We’d like to see reform in general practice by funding care that is not just episodic and looking at ways to support not just access to the GP but access to a nurse, podiatrist, dietician and diabetes educator within a general practice. You can then better manage chronic conditions in the community without people having to turn up to ED or an outpatient clinic of a very busy public hospital.”

Professor Duckett added “We need to re-engineer the primary care system to encourage general practices to manage chronic diseases so that patients do not end up in ED taking up beds. We’ve got to get the flow right. You want a politician to stand up and say ‘we’re going to make sure that no one is in a hospital bed who shouldn’t be there’…It costs less to keep someone in a residential care facility than an acute hospital bed.”

Ms de Somer, Professor Duckett and Dr Khorshid commented on the most urgent task in healthcare that needs to be addressed by the government that is elected.

Ms de Somer said “It’s setting the vision for access to medicines. The National Medicines Policy (NMP) should be the vision document that says we want patients to have timely access to medicines when they need them. There’s been a House of Representatives Inquiry with multiple recommendations on how to do that. There is also a Health Technology Assessment (HTA) review about to commence which is going to look at how do we value medicines.”

Dr Khorshid said “The new government needs to sit down with the states and work out how they’re going to fix the public hospital logjams and the crisis that’s leading to people dying in the backs of ambulances and at home before the ambulance gets to them.”

Professor Duckett commented “COVID is real and climate change is real. And you need to deal with both.”