The cornerstone of public healthcare in Australia, the Medicare Benefits Scheme (MBS), celebrates its 40th anniversary this year. There is no doubt the Medicare system has advanced access to healthcare for countless Australians. However, while it continues to discriminate based on both gender and migration status, it is not the inclusive, equitable and universal system that it claims to be.
Recent media attention has highlighted the urgent need for a review of the MBS due to concerning gender biases. For example, patients who require pelvic scans incur higher gap payments compared to patients undergoing scrotum scans. For women, gender diverse and non-binary people who are pregnant, the costs associated with obstetrics and gynaecology are even higher.
Yet, the disparities extend far beyond pregnancy. From contraceptives to pelvic pain and menopausal healthcare, our system fails to provide equitable access and quality of care by incentivising short appointments. As highlighted in our Submission to the Senate Inquiry on Issues Related to Menopause and Perimenopause, we need a well-rebated, long consult Medicare item for the comprehensive assessments needed for women’s health issues.
The truth is that our current MBS is a representation of the existing gendered and racialised inequalities in our society. Inadequate access to Medicare can impact ones capacity to access basic healthcare, quality of care, and can cause financial hardship and poorer health outcomes for migrant and refugee people in Australia. For those who are ineligible for Medicare and the Pharmaceutical Benefits Scheme (PBS), accessing healthcare, such as antenatal care, means juggling the uncertainties of a difficult to navigate migration and healthcare system, while paying a hefty price every step of the way.
It is also worth noting that the current health system does not provide adequate care to migrant and refugee women, who may require in-language or longer appointment times but are invariably rushed through the system. The lack of culturally responsive care has serious health implications and often results in lack or delayed diagnosis for many migrant and refugee women, non-binary and gender diverse people.
These inequities were also highlighted in our recent Building Bridges research when many migrant women told us that they had to see multiple healthcare professionals before finding a culturally responsive support service who truly listened to them and offered solutions. Some women experienced up to five repeated dismissals before they were taken seriously and received the support they needed. This indicates that despite the strong eagerness among migrant and refugee women and gender diverse people to access healthcare services, they face multiple barriers including gender and racial discrimination.
While the Strengthening Medicare Taskforce has laid the foundations for long-term reform and sustained investment into primary care in the 2023-24 Budget, amidst widening health inequities and increasing costs-of living, the Federal government needs to heed the call of women’s health advocates and practitioners to overhaul the Medicare system so that it is fair and equitable. This should be done with a gender-responsive, intersectional lens that prioritises the voices and experiences of those who face intersecting forms of discrimination and are made vulnerable by Australia’s healthcare and migration systems. We need to create a system where healthcare is available to everyone, regardless of visa type, socio-economic background and gender. It is only then will Medicare begin to live up to its name of being truly universal.
This article was first published in edition #132 of The WRAP on April 2024.