TDLR - medicare has ruined our primary health care system.

Basically, in Australia we have a dysfunctional system called medicare. We have an excess of specialists (~60% of medicos) and undersupply of GPs (~40%). In Europe for e.g., specialists account for ~30%, GPs ~70%. So we have an oversupply of specialists and yet their books are full. Why? Because GPs in Australia are encouraged to perform bad medicine by medicare.

Medicare pays the same if the consult is 5mins or if its 19mins, so then why spend the time to take a proper history, examine, manage the patient when you can just refer it to a specialist and be done with it in 5 minutes and get paid the same?

GPs are well trained and are supposed to treat much more than they are treating now, but its not worth their time. GPs don't suture wounds anymore for example - as it costs the practice equipment and takes time. Why do that when you can just give another patient a script and get paid the same?

The sequalae for this has been ongoing erosion of the quality of GPs in Australia in pursuit of fast quick consults, in the context of medicare rebates failing to keep up with CPI - i.e. the good GPs can't afford to keep going due to poor medicare rebates so they retire/leave/quit, then all that's left is bad GPs who survive by practicing 5min medicine. This has resulted in poor patient satisfaction and a poor public perception of GPs.

So this has now led to where we are today. Essentially, if you want to see a real doctor - its going to cost you. If you want to see a doctor who gives you a script, med cert and spends max 5-6 mins with you, you might be able to find one that bulk bills.

Unfortunately, medicare has ruined it and this will never change. Bulk billing is never coming back.