Funding challenge shadows Health Care Homes

The impact of the extended Medicare freeze is adding to uncertainty about the feasibility of the Government’s Health Care Homes (HCH) plan, the Consumers Health Forum says.

“We have strongly welcomed the Government’s announcement of a “revolution” in primary care enabled by Health Care Homes because it holds the promise of better integrated, patient-focused care.  This shift in the way primary care is coordinated and delivered will also benefit the sustainability and effectiveness of our health care arrangements in the longer term: countries with the highest performing health systems have a strong primary health care backbone.  

However we are concerned that the level of funding to support service delivery as well as the changes required to put in place this new model and the risk of a decline in bulk billing caused by the Medicare freeze combine to pose barriers to the success of the scheme,” the CEO of the Consumers Health Forum, Leanne Wells says.

“Health Care Homes is at a critical stage of development and there are a number of factors important to success.  Chief among these are consumer confidence and commitment to voluntarily enrolling in this new model of care and a general practice community that is supported and ready to embrace the model and put in place new or enhanced arrangements to deliver more comprehensive care to people with complex and chronic conditions.

“The Royal Australian College of General Practitioners is expressing concern about what they fear will be an inadequate level of payment to practices under HCH.  In addition, the college says in its recently published General Practice Industry Report that its member GPs are likely to drop bulk billing in the future in the wake of the extended Medicare rebate freeze.

“These are very worrying signals from the general practice community and we are concerned about the effects they will have on the implementation of Health Care Homes (HCH) at a time when it is becoming increasingly pressing that Australia takes steps to strengthen, not erode, primary health care and better integrate primary care with other settings such as aged care and community services to keep people well and out of hospital.

“The need for more support of those with chronic illness, and measures to prevent such disease, are underlined by the 100,000 new cases each year of diabetes, a largely preventable illness for which patients require coordinated care by a mix of health professionals in the community.

“The RACGP says that many GPs are abandoning bulk billing and that means more patients will face out of pocket costs, adding an additional barrier to HCH.  Experts* have made it clear that if HCHs are to make an effective difference to community-based care, there needs to be significantly more resources to ensure the adequate flexible funding that would give general practices the autonomy to provide the comprehensive wrap-round services that many patients  need.   That would include an appropriate level of care by allied health practitioners such as physiotherapists.

“Patient out of pocket expenses remain a significant impediment to access. Not everyone who will be part of a HCH will be bulk-billed and to date there has been no information on how this will be addressed. Consumers need to know what their out of pocket expenses are going to be as part of their informed decision-making on whether or not to participate in Health Care Homes.

“What if anything will HCH do to address access to allied health at an affordable price? Allied health services are outside bundled payments and capped at five services in a year under Medicare. Even with Medicare coverage people can incur significant out of pocket expenses as services are not necessarily bulk billed.

“If Australia’s primary health system is to make the most of evidence-based care, we also need to see clearer plans and funding for innovations like health coaches to help people better look after themselves and get the right care, along with other steps such as  pharmacists working in general practices.

“These measures would also require adequate support for general practices to redesign their services.

“The Primary Health Networks, as indicated by the Government, will have a key role in commissioning the support services to provide comprehensive care.  The PHNs are a central part of the Government’s health plans and have the benefit of grassroots advice from clinicians, consumers and the community.  We need to see more evidence that they are to have a key role in both supporting general practices to make the necessary changes to support HCH and in ensuring the integration of the HCH Programme with other regionalised services, Ms Wells said.” 


*See expert roundtable report at:


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Jenna Gray

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