Medicare, aged care and the National Disability Insurance Scheme (NDIS) are all key parts of Australians’ lives. But for the federal government, each of these areas – especially growing demand and rising costs – remains a challenge.

In a bid to costs, last week the Minister for Health, Ageing, Disability and the NDIS Mark Butler announced changes^[1] to how children with mild to moderate developmental delay or mild autism, currently eligible for the NDIS, will be treated.

But parents and advocates are concerned^[2] about children falling through the gaps, especially after the new Thriving Kids program^[3] is rolled out.

Butler joined us on the podcast to talk about health issues facing Australians from childhood to aged care, including how the government’s vaping ban is working.

On NDIS reform, Butler said he wanted to get the states moving on offering different support for children with mild to moderate developmental delay or autism.

This was a recommendation from the independent NDIS review that there should be a different system for children with mild to moderate needs. And that was a recommendation accepted by National Cabinet way back in 2023. So it’s not a new concept or a new direction. It’s just, really, I tried to give it shape in a bit of urgency last week. Because the number of young children with mild to moderate needs continues to grow on the scheme, and I just don’t think that’s the right fit. This was a scheme designed for permanent and significant disability.

So we have to work with states to design a system really located in mainstream, broad-based supports, because this is a mainstream, broad-based issue, that ensures that states do lifting where they have particular advantages and the Commonwealth [government] does lifting as well.

On Australia’s bulk billing rates, Butler said progress is being made towards the government’s goal of having 90% of GP visits^[4] bulk billed by 2030 – but it’s not as simple as it might seem.

We don’t operate a health system like the British do, for example, where there’s a very direct lever between the government and what happens in healthcare settings like general practices. These are all private businesses. We have to put in place a pricing, or a funding mechanism, that leads GPs themselves and practise owners to conclude that they’re better off, and certainly their patients are better off, if they move to bulk billing.

[…] We know that the funding we put on the table would mean that three quarters of practices are better off if they move to 100% bulk billing. The other quarter might not, but they’ll still be majority bulk billing, most of them will still bulk bill pensioners and kids and so on. That’s how we got to our 90% figure. But you’re right to say […] there’s not a single general practice market in the country. There’s a bunch of different markets that operate with very different dynamics.

[…] We are focusing on particular markets where there are a problem. Our first round of bulk billing investments in 2023 saw some of the best increases in bulk billing in some of those markets I was worried about. Tasmania, for example, saw the biggest increase in bulk-billing.

On the delay to aged care reforms, due to have started in July but pushed back to November 1^[5], and the massive backlog of demand for home care packages, Butler said the extra time was needed.

The deferral of the act was really a product of feedback we got from aged care providers and consumers that, particularly because of the election taking place between the passage of the legislation and when it was due to start, there just wasn’t a long enough runway to get to what is a substantially new system.

[…] I recognise that there is a very steep increase in demand for aged care right now. The ageing of the baby boomer generation is really sort of hitting aged care, right now, the average age of taking up a home care package is generally the late 70s. And the average age of entry to residential care or nursing homes is 82 or 83.

Now, the oldest baby boomers are about in that age bracket now. That’s why that lost decade, where there was no aged care reform – up until we came to government – has been so critical. We had to concertina what should have been a rolling decade of reform into three years.

Asked about the government’s ban on the sale of vapes except through pharmacies, Butler said fewer kids are vaping now than when it “exploded” as a health problem during the COVID years.

The bans we’ve put in on vaping are working. You know, fewer kids are vaping. There’s no question about that […] We’ve got three waves of substantial research, two from the University of Sydney and one from the South Australian Medical Research Institute. Both of them show rates of vaping down among teenagers. And that really was our major focus.

[…] What we also know is some of the measures we’ve put in to reduce demand for vaping […] have been hugely successful. We’re now rolling out in every school a proven programme – published in the Lancet Medical Journal, a clinical trial, probably the preeminent medical journal in the world – that shows about a 65% reduction in willingness to vape among high school students who’ve done this programme […]

We’re in social media using influencers, advertising on TikTok, trying to get anti-vaping messages to kids who have until now been inundated with pro-vaping messages. I didn’t expect it to work overnight, but I’m really confident that we’ve seen the peak in vaping rates that were climbing at an alarming level year upon year.

References

1. ^{^} Mark Butler announced changes (www.health.gov.au)
2. ^{^} advocates are concerned (australianautismalliance.org.au)
3. ^{^} Thriving Kids program (www.health.gov.au)
4. ^{^} 90% of GP visits (www.health.gov.au)
5. ^{^} November 1 (www.myagedcare.gov.au)