‘Australia is one of the wealthiest countries in the world and yet we cannot build a community-based health system.’

These were the words of one of this country’s leading health policy experts when we sat down to discuss the current state of our health sector.

We were talking about the crisis in general practice and hospital emergency departments, topics getting daily coverage as the COVID-19 pandemic shows few signs of disappearing.

While pressure mounts for more money for physical and mental healthcare, few are talking about reform models that deliver better outcomes for patients as well as more sustainable remuneration for health practitioners.

The APA, however, is doing just that.

Here’s how I see the problem.

Australia’s geography is unique in that we occupy an enormous landmass—almost an entire continent—with no land border and with a relatively small yet very concentrated population.

We are one of the most urbanised countries in the world, with close to 90 per cent of us living in cities and most of the population hugging the coastline, from Cairns to Perth.

Australia also includes thousands of inhabited islands in the Pacific, Indian and Southern Oceans and the Coral and Timor Seas, which are reliant on sea and air transport for goods and services.

Geography and demographics are important because we cannot compare our health system like-for-like to the United Kingdom or Denmark or the United States of America or anywhere, really.

We have differences that place distinct pressures on how we deliver health services.

We also have an extremely fragmented healthcare system, with responsibilities divided, and sometimes shared, between the Commonwealth and the states and territories.

Health funding and delivery cut across multiple layers of governance and bureaucracy and are dependent on the relationship between the different levels of government.

The highly regulated private healthcare insurance system only adds to the complexity.

This level of fragmentation and complication creates enormous difficulties for patients navigating the system, along with hindrances to access and continuity of care.

It’s what makes the system so difficult to reform.

The complexity of our health system is illustrated by an anecdote I recall in which a mental health consultant was commissioned by a non-government organisation to chart where funding for mental health services comes from.

After several weeks, she gave the grant back—it was not possible to trace myriad sources of local, state, federal, private and other funds across the country.

Mark Butler’s task, as Australia’s 44th Minister for Health (Walter Massy-Greene was the first, in 1921), is to try to deliver what we all want—appropriate and affordable healthcare, where and when we need it.

What we really want (and I am confident in making this assumption) is community-based healthcare—that is, local, accessible, affordable, interconnected healthcare, the type of ‘one-stop shop’ that is the basis of Aboriginal Community Controlled Health Organisations.

This model is based on finding out what type of healthcare each community needs (because the needs of inner-city Melburnians are not the same as those of Central Queenslanders) and then creating the services and supports that can deliver it.

‘Access’ is the word that most commonly comes to mind to describe the problems in primary care and health services.

I was in North Queensland many years ago with a federal minister when an elderly gentleman said to us, ‘There’s a [health] service ’bout 40 k [kilometres] away, but I cannot drive and there’s no transport.

'If you can’t access a service, it may as well not exist.’

This statement was a powerful reminder of the many aspects to take into consideration when designing health policies, so much so that we had it printed out and stuck on our Parliament House office wall.

If you cannot access a service, it may as well not exist.

To me that sums up the number one issue—access.

The second issue is affordability, the dollar version of the physical distance.

It is also true that if you cannot pay for a service, it may as well not exist.

Right now, we are seeing these problems of access and affordability with GPs.

The wait time to see a GP is increasing, bulk-billing appears to be on the decline and many physiotherapists and other health practitioners relying on GP referrals are affected.

Minister Butler said that fixing Australia’s primary healthcare sector is his main priority.

However, the minister only has $750 million in the Strengthening Medicare Fund to use.

With a health budget of around $100 billion annually, it’s really not that much—0.75 per cent.

This is how I see the solution.

Many opportunities to improve our primary healthcare system lie in unlocking affordable access to the skills and expertise of physiotherapists.

We have outlined our solutions in Future of Physiotherapy in Australia: a 10-year vision policy white paper and provided a detailed submission to the Strengthening Medicare Taskforce.

The APA is heartened that many health experts support new models that will increase access to physiotherapists and other clinical practitioners such as psychologists and nurses, allowing them to work to their full scope of practice.

Professor Stephen Duckett, leading health economist and former secretary of what is now the Australian Government Department of Health and Aged Care, said, ‘You’ve got to put the patient first—what actually will improve access for patients and services for patients.

'And I wouldn’t start with an increased [Medicare GP] rebate.

'I’d actually start with paying more for nurses and physios.’ (As quoted in The Sydney Morning Herald, 8 January 2023.)

The APA has publicly supported increased investment in primary care, but we also call for a more comprehensive and wideranging discussion about proper, systemic reform.

Physiotherapy cannot be left out of the discourse on primary care and funding.

Our health system isn’t just GPs and access block isn’t going to be solved by only focusing on general practice.

We saw what happened when COVID first struck.

Then Minister for Health Greg Hunt quickly brought in telehealth.

It is possible to implement even major reforms swiftly—when a sense of urgency arises, when it cannot wait anymore.

Funding more of the same won’t fix our health system.

Right now, we need major reforms that bring physiotherapy into primary care.

Australians cannot wait anymore.