Duckett: the government will get its 90% BB rate

3 minute read


But that’s not to say the prominent health economist is fully convinced by the promised reforms.


A photoshopped image of federal health minister Mark Butler’s face over that of a knife-brandishing Paul Hogan in Crocodile Dundee is not necessarily what one expects in a presentation from a leading health economist, but Professor Stephen Duckett had a point to make.

Speaking at the RACGP’s Practice Owners Conference on Sunday, Professor Duckett told the 700-strong audience to consider Mr Butler as (hopefully) using the proverbial bowie knife of policy to cut through governmental inertia and opposition to reposition the health system into a place where it can meet the quintuple aim.

After all, the idea of introducing a blended payment model in Australia was first raised in the early 1990s. And again in 2009 and 2021, before finally being realised in the form of MyMedicare in 2023.

“You puzzle about why it has taken so long,” Professor Duckett said.

“Well … [first] there has to be acceptance that an issue exists – and to some extent, the profession didn’t really accept that we needed to move away from fee-for-service payment.

“You’ve got to have an evidence base of what works. You’ve got to have the political will to do something about it and, of course, we’ve got to remember that every dollar of health spending is a dollar of health incomes.

“If you fiddle around with payments, some people are going to win and some people are going to lose.

“And you’ve got to have the management skill to do something about it, which is not always present.”

MyMedicare, Professor Duckett acknowledged, “has no real incentives for either patients or general practices” to sign up yet. 

“Surprise, surprise – apart from me, there are only [about] three other people in Melbourne who have signed up to MyMedicare,” he said.

“Over time, the government has to change this so that there are real incentives for people to sign up to MyMedicare.

“I’m absolutely of the view that the idea of an attachment to a practice is a good thing.”

When asked about the Healthcare Homes trial – widely viewed as a failed early iteration of patient registration – the former Grattan Institute health program director said he viewed MyMedicare more as a platform to effect change rather than a solution in itself.

“You will not get me to defend the Healthcare Homes trials,” Professor Duckett said.

“As I said earlier in my speech, I’m not surprised MyMedicare has isn’t doing much [right now], because it’s not doing much.

“It’s … there to create a platform, which hopefully will happen, that will improve things into the medium term.”

When it came to the new bulk-billing practice incentive payment and expanded bulk-billing incentives however, Professor Duckett was confident the government knew what it was doing.

“The impact of [the $8.5 billion incentive package] on your practice will depend partly on your ideology – are you a fan of bulk billing or not? – and partly on what your current out-of-pockets are – the bigger your out-of-pockets, the less likely the incentive is to be viable,” he told delegates.

“My own view is the government will achieve its target of 90% [bulk billing], but not everyone shares that view.”

The 2025 RACGP Practice Owners Conference was held at the Melbourne Convention and Exhibition Centre on 24 and 25 May.

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