The missing piece in Australian primary healthcare

While GPs are a critical part of our healthcare system, primary healthcare is much broader than a single appointment or service. At its best, it provides a coordinated approach to preventing illness, promoting wellbeing, and helping people manage their health throughout life.

Australia's healthcare system has delivered significant health gains over many decades. Yet many preventive and essential services remain difficult to access because of cost, fragmented funding arrangements, or long waiting times. As rates of chronic disease continue to rise, there is a growing need to reimagine primary healthcare as an integrated system that supports the whole person rather than treating individual conditions in isolation.

Primary healthcare should be the foundation of a healthier population. It should provide timely access to a range of services that identify risk factors early, support prevention, and address health problems before they become more serious and costly to treat.

What is primary healthcare?

Primary healthcare is a person's first point of contact with the health system. It includes GPs, nurses, allied health professionals, mental health services, oral health and community health services, with a focus on prevention and ongoing care.

What does Medicare not cover?

Medicare remains one of Australia's most important public institutions, helping millions of Australians access medical care. However, many services that contribute significantly to health and wellbeing are only partially covered, or not covered at all.

Mental health

Mental health is one example. While important reforms have expanded access to psychological services, affordability and workforce shortages continue to create challenges for many Australians. Early support for anxiety, depression, and other mental health concerns can help prevent more severe illness and reduce demand for acute services later. According to ABS, in 2024–25, 19.7% of people who needed to see a health professional for their mental health delayed seeing one or did not see one at all because of cost.

Allied health

Allied health services also play a critical role within primary healthcare. Physiotherapists, dietitians, exercise physiologists, occupational therapists, and other allied health professionals help people prevent and manage chronic diseases, improve mobility, maintain independence, and adopt healthier lifestyles. Yet access often depends on an individual's ability to pay, despite the clear contribution these professions make to preventive health.

Hearing health

Hearing health is another area that deserves greater attention. Hearing loss can affect communication, employment, social participation, and quality of life. Early identification and intervention can improve outcomes and help reduce social isolation, particularly among older adults. However, access to hearing assessments and follow-up care remains uneven across the population.

Vision care

Vision care provides similar opportunities for prevention. Routine eye examinations can detect vision problems early and may also identify signs of conditions such as diabetes, hypertension, and other chronic diseases. Supporting access to preventive eye care can help maintain independence and quality of life while reducing the burden of avoidable vision impairment.

Why is dental care left out of Medicare?

Among the gaps in Australia's primary healthcare system, oral health stands out as one of the most significant and persistent.

Despite strong and growing evidence that oral health is closely linked to overall health, dental care remains largely excluded from Medicare. For many Australians, visiting the dentist involves substantial out-of-pocket costs, leading some people to delay or avoid care altogether. According to the ABS Patient Experiences survey, 16.1% of people delayed or did not see a dental professional when needed because of cost in 2024–25. That rises to 23.1% in the most disadvantaged areas, compared with 9.6% in the least disadvantaged.

The consequences extend well beyond the mouth. Poor oral health has been associated with chronic conditions including cardiovascular disease, diabetes, and adverse pregnancy outcomes. Oral infections and untreated gum disease can contribute to systemic inflammation, while people living with chronic diseases often experience poorer oral health outcomes.

The separation of dental care from mainstream healthcare sends an outdated message that the mouth is somehow independent from the rest of the body. Modern evidence tells us otherwise. Oral health is an essential component of overall health and should be recognised as such within primary healthcare policy and practice.

Importantly, excluding dental care from Medicare does not eliminate the cost of oral disease. Instead, those costs are often transferred elsewhere through avoidable hospital presentations, emergency care, lost productivity, reduced quality of life, and worsening management of chronic conditions. In 2023–24, the AIHW recorded about 88,600 hospitalisations for dental conditions that could potentially have been prevented with earlier treatment.

What if a health check included your mouth?

A truly integrated primary healthcare system would encourage collaboration across professions rather than operating through isolated services.

Imagine attending a routine health assessment where your GP, nurse practitioner, oral health professional, and allied health team work together to identify risks early and coordinate care. Screening for chronic diseases could include consideration of oral health alongside other important indicators of wellbeing.

For people living with diabetes, cardiovascular disease, dementia, or other long-term conditions, this integrated approach could improve both health outcomes and patient experiences. It would also align healthcare delivery more closely with the realities of how health conditions interact in everyday life. Maintaining good oral health is also an important part of healthy ageing, supporting nutrition, communication, social participation and quality of life.

Such models are increasingly recognised internationally as important components of effective preventive healthcare. By focusing on early intervention and coordinated care, health systems are better positioned to reduce avoidable illness and improve long-term outcomes. The World Health Organization notes that oral care is usually not part of national universal health coverage benefit packages, even though nearly 3.7 billion people are affected by oral diseases worldwide.

Recent reviews from Torrens University researchers have highlighted growing evidence linking oral health with broader health outcomes and have called for stronger integration of dental services within primary healthcare systems.

Can Australia afford prevention?

Discussions about expanding primary healthcare services often focus on costs. Yet the more important question may be whether Australia can afford not to invest in prevention.

Chronic diseases account for a substantial share of healthcare expenditure and continue to place increasing pressure on health services. Many of the factors contributing to these conditions can be identified and addressed earlier through preventive care, health promotion, screening, and timely intervention.

Investing in services that support better oral health, mental health, hearing, vision, and allied health care is not simply an added expense. It is an investment in reducing future disease burden, improving quality of life, and creating a more sustainable healthcare system. Preventive services are often among the most cost-effective investments health systems can make because they reduce the need for more intensive and expensive treatments later.

Why does preventive care matter?

Preventive care helps find and manage health problems early, before they become more serious, harder to treat and more costly for both individuals and the health system.

Where should reform start?

Strengthening primary healthcare does not require rebuilding the system from scratch. Instead, it requires a broader understanding of what primary healthcare should encompass and a commitment to integrating services that currently sit at the margins of funding and policy discussions.

A staged approach could look like this:

1. Stage 1: Improve access to preventive dental care for the people at greatest risk, including those living with cardiovascular disease, diabetes and other chronic conditions.
2. Stage 2: Embed oral health screening and referral pathways in existing primary healthcare assessments and chronic disease programs.
3. Stage 3: Extend funded early care to mental health, allied health, hearing and vision as the evidence and cost savings become clearer.

If Australia is serious about prevention, equity, and long-term health outcomes, primary healthcare must extend beyond medical consultations alone. It should include oral health, mental health, allied health, hearing services, vision care, and other essential supports that help people stay healthy throughout their lives.

Primary healthcare should not simply help people manage illness. It should help people stay healthy, independent and connected throughout their lives.