Ambulance and emergency department wait times indicate a system in crisis: report

As Medicare turns 40, a Productivity Commission Report on Government Services says the primary healthcare system is in crisis.

Last Thursday marked 40 years since the introduction of Medicare with Prime Minister Anthony Albanese acknowledging the milestone as a proud Labor achievement. In a social media post he said Labor was, “working hard to strengthen it to benefit more Australians”.

But is Medicare still achieving what it originally set out to do? The Productivity Commission report suggests not – certainly not to the degree it once did.

That report notes a nationwide reduction in the affordability of primary healthcare services. As a result, it says people are avoiding or delaying seeing a GP, which has adverse knock-on effects for both patient and system.

Although not directly linked to Medicare, challenges in primary care have also led to increased strain on emergency departments and services. The report found that in South Australia, ambulances take as long as 55 minutes to arrive at the most urgent emergencies.

In NSW, 90 per cent of cases were reached by an ambulance in 32.8 minutes and in Queensland 27 minutes.

The primary care crisis, it says, is having a knock-on effect at public hospital emergency departments. Even category 1 cases, which are life threatening and require immediate resuscitation, are not always being seen in emergency departments within stipulated timeframes in Western Australia, South Australia, the ACT and the NT.

The Australian reports that no state met the target timeframes for emergency cases, the next most urgent category. The proportion of patients staying for four hours or less in an emergency department was 55.8 cent, down from 73.2 per cent in 2015-16.

How has Medicare changed?

As David Day, biographer of several prime ministers including Paul Keating, says, the credit for Medicare belongs “to Gough Whitlam’s introduction of Medibank in July 1975”. It was “later abolished by the Liberals only to be re-introduced by Hawke in 1984”, Mr Day said.

Medibank’s rebirth was marked on 1 February 1984 when then Treasurer Paul Keating opened Australia’s first Medicare office in Bankstown. The system restored the bulk billing introduced by Mr Whitlam, meaning Australians could see a doctor free of charge.

The system was initially funded by a 1 per cent levy on taxable income. In 2024, the levy is now 2 per cent, yet the Productivity Commission report indicates the system is struggling. Bulk billing has declined, leading to reports of a rise in the number of patients avoiding seeing a doctor.

This drop was flagged as a serious concern last year by the Royal Australiajn College of General Practitioners (RACGP). According to an RACGP report, annual bulk-billing rates hit their lowest point in more than a decade last August.

RACGP research blamed “enormously” accelerated costs of general practice as a key factor. Without a commensurate increase in the government rebate, that has forced many GPs away from bulk billing.

Bulk billing hit a historic low late last year, the RACGP said. The overall proportion of non-referred bulk billed GP services dropped to 76.5 per cent in the September 2023 quarter.

Restoring bulk billing

Mr Albanese says his government has turned the bulk billing tide. He claims there has been a 2.1 per cent national lift in the bulk billing rate since last year’s budget.

This, Labor says, is a result of its move to “triple incentives” to doctors in last May’s budget. Those incentives encouraged GPs to fully bulk bill pensioners, healthcare card holders and children.

That appears to be a step in the right direction. However, the number of Australians reporting GP avoidance due to costs indicates Medicare has some way to go to restore its former ‘glory’.

Has your GP moved away from bulk billing in recent years? Have rising out-of-pocket costs led to you avoid visiting your doctor? Let us know via the comments section below.

Also read: Centrelink and Medicare changes that could affect your finances. Are you across them?

Andrew Gigacz
Andrew Gigacz
Andrew has developed knowledge of the retirement landscape, including retirement income and government entitlements, as well as issues affecting older Australians moving into or living in retirement. He's an accomplished writer with a passion for health and human stories.


  1. You cover two problems in the article.

    1) Emergency Department Wait Times:-
    The fix for this is very complex and will probably take years to fix.
    There needs to be more ED beds available, which means that there also needs to be more to be more Hospital Beds.
    These will take time, they have to be designed by an Architect, a request for tender to build them, and then finally building them.
    Then there they has to be sufficient staff to service all these additional bed,, IE there need to be more Medical Staff trained. A Doctor is 5 year Undergraduate Program followed by an Internship. A Registered Nurse takes a 3 Year University Degree, then some in Hospital Training.
    Therefore, you need in excess of 5 years for the Medical Staff, and probably in excess of 2 Years for the Building Process before you will see a general reduction in ED Wait times.

    2) Medicare :-
    Thanks the the LNP Government of Abbot et al, the Medicare rebates were Frozen for several years, there were also multiple items removed from MBS, and many GP’s stopped Bulk Billing because of this, as the Rebates no longer cover the total cost of servicing/caring for, the patient.
    That is why single Practice Surgeries are now few and far between and have been replaced by Medical Centres with Multiple Doctors etc.
    This will take time and increased funding to fix.
    It may take several cycles of Government Budgets to get it right.

  2. I am still waiting for a reply to my letter which I sent to PM Bob Hawke (obviously I will never get) saying Medicare will never work unless it is correctly funded. It was another well intended idea but abused by so many.
    The correct way would have been to kill private health insurance so everybody paid the same (except for the genuine needy).

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