Australia keeps trying to fix its health system at the most expensive end.
Emergency departments are crowded, hospitals are full, ambulance ramping becomes a political crisis, and governments respond with more hospital funding.
Some of that is unavoidable. Hospitals are essential. But a system that underfunds early, continuous care should not be surprised when late, acute care keeps growing.
The uncomfortable truth is that Australia is underinvesting in one of the most efficient and effective parts of healthcare: general practice.
GPs manage chronic disease, detect illness early, coordinate care, keep older patients safely at home, absorb mental health demand and prevent avoidable hospital presentations. Yet Medicare still treats too much of this work as a series of short transactions rather than the infrastructure that keeps the rest of the system functioning.
The arithmetic should trouble any treasurer.
In 2024–25, GP non-referred attendances accounted for more than a third of all Medicare services. That represented 167.7 million GP services in one year, with Medicare benefits paid of about $9.7 billion. In the same year, about 83.8% of Australians had at least one Medicare-subsidised GP attendance.
Few parts of the health system touch more people, more often, for a lower unit cost.
The broader spending picture is just as stark.
The latest full national health expenditure data shows Australia spent $270.5 billion on health in 2023–24, or 10.1% of GDP. Hospital spending alone was $113.8 billion.
No one should pretend hospitals can be replaced by general practice, but many hospital presentations begin as problems that could have been managed earlier, more cheaply and more humanely in the community.
That is the false economy at the heart of Medicare.
When patients cannot afford timely GP care, they do not stop needing care. They present later, sicker and more expensively. Poorly controlled chronic disease becomes an admission. A missed medication review becomes a fall or delirium. A mental health problem that could have been supported early becomes a crisis presentation.
The savings from good general practice are often invisible, because they are measured in events that never happen. The costs of neglect eventually appear somewhere else.
The funding model has not kept pace with the job. Modern general practice is not just coughs, colds and certificates. GPs manage multimorbidity, polypharmacy, mental health, disability, aged care needs and social complexity, often in the same patient and often in the same consultation. They are expected to practise prevention, coordinate team care, manage risk and help patients navigate a fragmented system.
However, Medicare still too often rewards speed over complexity. Longer consultations are harder to provide when rebates do not reflect the real cost of care. Practices face rising wages, rent, insurance, technology, compliance and accreditation costs, while patients face higher gaps when clinics cannot survive on bulk billing alone.
In 2024–25, the average patient contribution for patient-billed GP non-referred attendances was $49.14, up from $44.89 the year before. For many households, that is the difference between early care and delayed care.
The bulk-billing figures should be read carefully.
The national GP non-referred attendance bulk-billing rate was 77.9% in 2024–25, only slightly higher than the previous year.
That number can sound reassuring until it is viewed from the perspective of patients who cannot find an affordable appointment, or practices in outer-suburban, regional and rural areas trying to remain viable. A system can report millions of bulk-billed services and still have a serious access problem.
The federal government has effectively conceded as much.
The 2025–26 Budget included $7.9 billion to expand bulk billing, aiming for 18 million extra bulk-billed GP visits each year by 2030, $859 million in annual patient savings and nine in 10 GP visits bulk billed.
But this is an access target, not a health system strategy. Bulk billing matters, however counting bulk-billed visits does not tell us whether patients are receiving longer, continuous, complex care, or whether practices are being pushed further into high-volume medicine to make the numbers work.
Medicare should not confuse a cheaper visit with better care.
The same problem appears in other policy fixes. Expanding the scope of practice of other health professionals may provide convenience for some patients and has a role in clearly defined, team-based care.
If it is used as a substitute for properly funding general practice, it treats the symptom rather than the cause. Fragmenting simple tasks away from general practice may make the system look busier, but it does not build the continuity, diagnostic accountability or whole-person care that keeps patients out of hospital.
New bulk-billing clinics deserve the same scrutiny.
In communities with poor access, additional services may be needed. But in areas already served by existing general practices, opening another subsidised clinic is not necessarily good policy if the real problem is that current clinics cannot afford to bulk bill.
It can duplicate infrastructure, distort the local workforce market and compete with practices that have provided continuous care for years.
The better question is not whether government can create more shopfronts, but whether it is funding the care model that makes existing practices affordable and sustainable.
The usual objection is that every part of healthcare wants more money. That is true, but it misses the point.
The case for general practice is not simply that it deserves more funding. It is that underfunding it pushes costs into more expensive parts of the system. In any other sector, this would be called poor capital allocation. A business that underinvested in maintenance and then complained about emergency repair bills would not be praised for discipline. It would be criticised for short-termism.
Health is no different.
Australia cannot hospital-build its way out of an ageing population and rising chronic disease. More beds may be needed, but beds are the most expensive answer to problems that often begin years earlier.
Poor access to primary care means delayed diagnoses, preventable deterioration, more time off work and more pressure on carers. Chronic disease is not just a health budget problem; it is a labour market problem.
A better model would fund what general practice actually does. It would support longer consultations for complexity, not just rapid throughput. It would strengthen team-based care around the GP. It would reward continuity, prevention and chronic disease management. It would make high-quality care viable in communities where the market alone will not deliver it.
And it would recognise that the value of a GP visit is often measured by the hospital admission, specialist referral or crisis presentation that never happens.
None of this is an argument against hospitals, pharmacists, nurses, allied health or urgent care services. They all have important roles. But substituting around general practice is not the same as strengthening it.
A fragmented system with more entry points but a weaker generalist core will not be cheaper in the long run. It will simply move patients between more providers, with more duplication, more handovers and less accountability.
Australia has built a system that pays premium prices downstream while underpricing the care that prevents people arriving there in the first place. General practice is not the cheap front door of the health system. It is the foundation.
If Australia wants a more sustainable health system, it should stop treating GPs as a budget pressure and start treating them as one of the best investments Medicare can make.
Dr Ramya Raman is a specialist GP and practice owner. She is a candidate for the presidency of the Royal Australian College of General Practitioners.
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