Australia's universal healthcare is crumbling. Can it be saved?

Australia’s Healthcare Crisis: A Crumbling Universal System

From her office overlooking the stunning coastline of Streaky Bay, Victoria Bradley, the town’s sole permanent doctor, jokes about having the most scenic medical practice in Australia. However, the idyllic facade belies the harsh realities of a healthcare system under immense strain. Inadequate funding is exacerbating a critical shortage of healthcare workers, like general practitioners (GPs), leading to ballooning wait times and rising costs for patients. This crisis is impacting universal healthcare access, a cornerstone of Australian society, forcing many to delay or forgo essential care. This article examines the healthcare crisis that is gripping Australia.

A Doctor’s Perspective

For Dr. Bradley, Streaky Bay is far from idyllic. For years, she was essentially on call around the clock, managing both the hospital and the GP clinic. Her schedule was relentless, often without breaks, compounded by frequent hospital emergencies.

Exhausted, she resigned two years ago, causing a near-collapse of the town’s healthcare services.

The Unraveling of a ‘National Treasure’

Streaky Bay reflects a national predicament: insufficient government investment is intensifying a deficit of essential healthcare staff; delays are growing; doctors are instituting their own fee structures, and patient expenses are surging.

Australia’s once-respected universal healthcare system is disintegrating at all levels, relying heavily on the dedication of doctors and local communities.

Consequently, an increasing number of Australians, irrespective of their location, are postponing or forgoing necessary medical attention.

Healthcare has surfaced as a pivotal concern for voters leading up to the nation’s election, with promises of substantial additional funding from both major parties.

However, experts suggest that these proposed solutions are merely temporary fixes, while the system requires comprehensive reforms to its funding model – reform hindered by a lack of political will.

Australians express to the BBC that the nation faces a critical juncture, necessitating a decision on whether universal healthcare is worth preserving.

The Cracks in the System

Renee Elliott’s healthcare concerns were minimal until she discovered a cancerous lump in her breast in 2019, followed by another four years later.

Accessing the necessary expertise and treatment in Adelaide, approximately 500km away, required Mrs. Elliott to invest significant time and money, all while raising three sons and managing a business.

Despite recovering some costs through government programs, the experience added financial, emotional, and physical strain to an already challenging period.

“Trying to recover while juggling all of that was incredibly difficult.”

Medicare’s Promise and Current Reality

Four decades ago, Australia’s modern healthcare system, underpinned by Medicare, promised affordable, high-quality care as a fundamental right. However, the system faces significant challenges today.

Health funding is intricate, shared between state and federal entities. Medicare allowed Australians to present their card at medical facilities, with the government covering the costs through tax-funded rebates.

Patients received either fully subsidized (“bulk billed”) care through the public system or heavily subsidized treatment in the private sector, offering more options for those who desired them.

Medicare quickly became a cherished national institution, envisioned as combining the strengths of the UK’s National Health Service and the US system.

However, many industry insiders now fear that Australia risks ending up with the drawbacks of both systems.

The Growing Crisis in General Practice

Australia’s healthcare system excels in emergency care. However, the core of the election debate centers on general practice (GP) services, primarily delivered by private clinics. Historically, public clinics were unnecessary, as most GPs accepted Medicare rebates as full payment.

This is becoming less common, with doctors citing that these subsidies don’t cover the actual cost of care. Staff shortages, persisting despite international recruitment efforts, exacerbate scarcity and drive up costs.

Government data indicates that about 30% of patients now face an average out-of-pocket “gap fee” of A$40 for a regular doctor’s visit.

Experts believe the actual figure is higher, skewed by seniors and children who receive mostly bulk-billed appointments. Additionally, a growing segment of patients avoids medical care due to rising expenses.

Brisbane electrician Callum Bailey exemplifies this situation.

“My mum and partner keep telling me to go but because the cost is very expensive, I tend to ‘suffer in silence’.

Every dollar is crucial right now. According to the 25-year-old, “At my age, one should be planning for housing… [but] even groceries are expensive.” “[I] simply cannot manage.”

James Gillespie consistently heard this story.

His startup, Cleanbill, investigated whether an average Australian adult could receive a free, standard GP appointment and found that, out of approximately 7,000 GP clinics nationwide, only one-fifth bulk-billed new adult patients. In Tasmania, they found none.

These results resonated with many Australians, highlighting that this issue is nationwide.

And that’s just primary care.

The rarity and overburdening of public specialists—with unsafe waiting periods—steer a majority of patients towards notably costly private care. The same applies for an array of non-emergency hospital treatments or dental care.

There aren’t any set caps on the amount that private specialists, dentists, or hospitals can charge, and neither private health insurance nor the limited Medicare subsidies consistently provide substantial relief.

Healthcare Affordability and its Consequences

The increasing cost of healthcare has led people to rely on charities for food, forgo dental care for years, or deplete retirement savings to pay for treatment. Healthcare affordability is a serious issue.

Some are borrowing money, taking out loans to buy medication, remortgaging homes, or selling possessions.

Kimberley Grima routinely decides which of her chronically ill children can see their specialists, while her own health needs become secondary.

The Regional Disadvantage

“Decisions you’d rather not make,” says the New South Wales Aboriginal woman.

“But when you are short of funds…you have no other options. And it is heartbreaking.”

Another woman disclosed that prompt appointments would have led to a quicker diagnosis and slowing of her multiple sclerosis, a degenerative neurological condition.

“I was very disabled by the point of my diagnosis,” she adds.

Missing medical services tend to disproportionately affect those most needing them, as per experts.

Peter Breadon (Grattan Institute think tank) notes, “Healthier and wealthier parts of the country often have notably more care compared to poorer and sicker parts of Australia.”

All of this exacerbates an already overstretched system, strengthening inequalities, and boosting general distrust.

All of these issues are heightened in regional areas.

Streaky Bay has abandoned affordable healthcare to focus on maintaining any access at all.

Therefore, Dr. Bradley remained away only three months before “guilt” prompted her return.

“A connection goes beyond the GP duty… you are part of this community.

“I felt I had abandoned [them]. This is precisely why I had to come back.”

She returned to a sustainable three-day week at the GP clinic, while Streaky Bay competed against other desperate locations for costly fly-in-fly-out doctors to bridge the staffing void.

This expenditure further burdens a town already funding a healthcare system meant to be supported by state and private investments.

Penny Williams, who helps oversee the community organization owning the GP practice says, “We do not want deluxe service, we want equal service.”

When the clinic neared closure, the town rallied to acquire it. When it struggled again, the local council rerouted funds from other locations. And notably, standard patients—barring concessions, children, and seniors—pay ~A$50 per visit.

This implies that the locals foot the bill up to three times, claims Ms. Williams: through their Medicare taxes, council rates, as well as out-of-pocket “gap” fees.

The Question of Funding: Who Pays?

According to Elizabeth Deveny, of the Consumers Health Forum of Australia, “Surely, this is not the Australia that we aim for.”

Like many affluent nations, the nation is challenged by a growing, aging, and sicker population.

A minority holds the opinion that it is time to part with universal healthcare, as it is known.

The aim of some doctors, economists, and conservative politicians, is to recognize Medicare as a safeguard, rather than universal relief.

Health economist Yuting Zhang distinguishes free and universal healthcare.

She says that the government-raised taxes for Medicare barely sustain the system, implying severe discussions about additional funding, or reasonable fees for those able to afford them.

“There is always an exchange… With limited resources, one must assess what the efficient and effective use is.”

Danielle McMullen (Australian Medical Association) reports that the original promise of Medicare has been “undermined by long-term neglects”, and many accept the need for financial responsibility towards their care.

She mentions that payment plan freezes (between 2013 and 2017 by both entities) failing to keep pace with inflation were ” the straw that broke the camel’s back”. Since then, the clinicians have subsidized many cases.

Both the Opposition and Coalition accept the crisis, and trade accusations.

Peter Dutton (Opposition Leader) says that the government is investing A$9B, including more mental health support and funding for regional university trainees.

Health spokesperson Anne Ruston conveyed to the BBC in writing, “Health is a victim of the Albanese’s cost of living crisis and that it has never been so hard or costly to visit a GP.”

On the other hand, Albanese references Medicare whenever possible, to remind voters of Labor’s beloved system and highlight Coalition’s previous views and Dutton’s proposed Health spending cuts.

“This election involves keeping this Medicare card,” Albanese expresses.

According to Albanese, his government has initiated reform and pledged A$8.5B towards GP training, additional public clinics, and subsidized medicines.

A key highlight is increasing Medicare funding and providing increased bonuses to doctors who bulk bill.

Due to Labor’s proposal that was later agreed upon by the Coalition, around 9 out of 10 may eventually see a GP, for free, says both parties.

“This is a great soundbite,” says a Tasmanian doctor. He—plus other clinicians—claims the money isn’t adequate, notably for longer consultations and complicated issues sought after increasingly by the patients.

Labor disagrees, and presents its research, which says the proposal will be beneficial, and accuses clinicians who want relief “without strings.”

However, what the BBC reporters heard from patients, is mostly that they’re skeptical that differences will be apparent.

The patients offer their wish list; training and retaining rural doctors, regulating private fees and investing in public specialist clinics more, funding children’s health, medicine, and allied health more.

Experts (like Mr. Breadon) state that the key solution should be overhauling Medicare. Healthcare access can be made universal when governments give clinicians budget based on the size and health of the population served.

Also, the longer that the governments take to invest in reform, the greater the cost.

Mr. Breadon adds that “The stars may be aligning now. This is for real, and delaying the changes would be very dangerous.”

In Streaky Bay, locals (like, Ms. Williams) wonder whether things are already irreparable. Things are hazardous.

She shakes her head and states “This is the cynic in me.”

“Universal is defined as everyone being entitled to the same, but as we know, that isn’t true.”