AMA Transcript - AMA President, Dr Steve Hambleton, Doorstop Interview, 22 May 2014

Subject: GP co-payments

STEVE HAMBLETON: Well, thank you, ladies and gentlemen, for coming out today. I did want to say one or two words about the significant change we see in the Budget. Today the Federal Council of the AMA is meeting in Canberra. I've got senior doctors from all round the country. I've got representatives from every specialty and I can certainly report back that the doctors aren't happy at this stage. We certainly see a very simple system, a bulk-billing system being replaced by a very complex system with $7 co-payments which - and there are very strong financial reasons why doctors will have to charge that. We - it's so complex that we're finding difficulty that even in Parliamentarians explaining the system to the satisfaction of the people who are asking questions.

We've got confusion out there in the public with some patients believing that it's already been implemented and some practices finding that they've had reduced presentations. Whatever change we make to the health system must make our health system stronger. To make our health system strong we need to actually boost primary health care. We need to allow people to spend longer with their GP. We don't want to turn away mothers from vaccinating their children. That's a very important part of health promotion, health prevention. We do want to actually implement our chronic disease programs to keep people out of hospital because that's the expensive part of the health system. So, we have this new plan, this new co-payment and we do know that there are sectors of the community that will have difficulty managing to - these co-payments.

It's more general practice and for radiology and pathology, those diagnostic services that we use to try to assist our patients to get better care. So, those are the issues that we want to talk to the Minister about, to actually understand where this fits in, into the overall plan for our health system. How does this - going to make our health system better? We do need to make sure that those areas where people have very low incomes continue to get access to primary care. They're the ones we've been concerned about. We've raised this issue. Aboriginal and Torres Strait Islanders Australians performing - their illness rates are actually something three times the rest of the population. We need to make sure we continue to close the gap.

The aged care is a real issue for us. We're travelling to nursing homes, raising fees in nursing homes, something new for GPs and we don't want to see GPs carrying change purses around when they go to nursing homes. We want to make sure that the very low income earners don't not come to the doctor. So important that they are bringing their children, they come themselves, we can manage chronic disease. So, we are prepared to work with the Government, we don't have a strong focus on rejecting this outright but we do need to work with the Government to make sure that the right people get the right services at the right time. Not delayed, not in a more expensive way.

QUESTION: Dr Hambleton, the Prime Minister and the Treasurer don't seem to understand who's going to have to pay this $7 fee themselves. Do you think they've underestimated the impact it will have, particularly on chronically ill patients and given that they thought it didn't apply to them, do they - should they now reconsider this measure?

STEVE HAMBLETON: Well, it's clearly a complex measure. It's something that - it's difficult to understand initially. There are two separate safety nets and we see that the chronic disease patients don't necessarily - are not necessarily low income earners or concession card holders. Even if they are, they'll still pay the co-payment on the way the thing's been set up. The Minister's repeatedly said that this bulk-billing is at the discretion of the doctor. However, the way it's set up is that there's something like a 25 per cent reduction in the revenue going to a doctor who chooses to bulk-bill. That's really unsustainable in a private business.

So, it's highly likely there will be co-payments. Look, the extra benefit to practices that the Minister claims will be chewed up in the extra administrative costs. So, there's no actual great benefit to general practice from this. If we're going to bring this in, we need to understand the reason, we need to understand how this is going to increase exposure to GPs and allow to do our job better. And if it's going to do the opposite, we need to think about another solution.

QUESTION: Would you support the measure if it were a 10 per cent discount or a 15 per cent discount rather than the 25?

STEVE HAMBLETON: Well look, I think we need to actually boost income for GPs. We're talking about resetting the health system for the 21st century problems. We need to make sure we are squarely focused on general practice and have good access to GPs. So increasing the remuneration to GPs is something the AMA's been calling for, for a long time. Our view is that to deliver a quality service to general practice the AMA rate which is about $73, not the rebate which is $36, will allow a GP to spend longer with a patient, deal with more of the preventive health care. Build more comprehensive service, help them to actually avoid that - expensive secondary costs that we see in the hospitals.

QUESTION: The Minister says that some doctors are using bulk-billing inappropriately, that is to take market share away from other doctors instead of it being a safety net to provide for the most needy. How - is that correct?

STEVE HAMBLETON: Well, no I think we find ourselves looking at the number of presentations per year in this country compared to the OECD average and we're doing about average. It's about 5.6 presentations per year. People have good access to general practice, with that they have good access to preventive health care. Clearly we've got to make some changes. The Minister's of the view that people should contribute to their health care because they'll value it higher. We're not particularly concerned about that. We probably support that view but we don't want to make - we want to make sure that people with low incomes don't miss out.

QUESTION: What's your view about bulk-billing? What is the role of bulk-billing in the system? Is it just as a purely safety net?

STEVE HAMBLETON: Well, bulk-billing of course is a significant discount on what we say GPs need to provide a quality service. Now some GPs have structured their business models to allow that to occur. But we think if you spend longer with a GP, you'll get better care, you'll get more comprehensive care and we say, that if you increase a remuneration for GPs, that's what will drive a better outcome.

QUESTION: Why do you think people are being - why do you think people are unsure of when the co-payment comes into place?

STEVE HAMBLETON: Well, I think there's been a lot of complexity and we certainly talked about July as a start date. Of course it's July 2015 so there is confusion and we have had some reports from practices reporting that patient numbers are down. Down to the point where one practice has actually sent SMS messages to its patient list to say we're open for business. We're still bulk-billing, we're still available.

QUESTION: Are you concerned that some practices particularly in Western Sydney won't be able to abandon bulk-billing? They'll have to take a hit to their incomes and that it might drive down six-minute medicine to five-medicine and in fact drive up the number of people who go to the doctor because you might have to go five times instead of gong once and getting five problems.

QUESTION: Is the Government misleading consumers about the need for this charge, and are they misleading consumers about who's going to be affected by it?

STEVE HAMBLETON: Well, I think the consumers, the public, the population do need absolute clarity and there's still confusion out there. It is true that our costs in our health system are rising. It is true that if we don't make a change, the trajectory is really unsustainable. Today, we can afford it. It's really five or 10 years from now that we've got some concerns. So, if we're resetting how we do our health system, the population, the profession, all of us need a proper explanation about where we're going, why we're going there, and how we're going to get there. If we get that, we can start to engage in the process.

QUESTION: One of the claims the Government makes is that in time down the line it'll be useful to have this medical research fund, because we'll be able to drive down costs with medical breakthroughs. Is that plausible or is the Australian contribution to the global medical research effort just a drop in the ocean?

STEVE HAMBLETON: Well, there's two issues there. Australia's work in the global research and development area has actually been extraordinarily punching well above its weight. So, there's a really good reason to actually support first world countries with new opportunities and perhaps new export opportunities. That's a very good thing. I've forgotten the last - the other half of the question…?

QUESTION: As to whether or not it'll actually make a difference…

STEVE HAMBLETON: Oh, yeah.

QUESTION: …driving down outcomes in the future?

STEVE HAMBLETON: Look, the reality of life is when we get breakthroughs, they often cost more, not less. We've seen - brand new drugs, they cost more. We see new treatments, they cost more. We build a new machine, that costs more. We need to be able to afford those new changes by actually decreasing costs on things that we can change. You know, if we had a 20 per cent overweight and obese rate rather than a 60 per cent, we've got a lot of cash in the bank to actually pay for those increase services.

Our life expectancy is very good and growing. We need to make sure we continue to support that. We need to think about all sorts of things to save money in health, but that's how we can afford these new things. But it's probably a furphy to suggest that we're going to decrease costs with research. It'll cost us more; we just need to be able to afford it when it comes.

QUESTION: So is the fund a bad idea?

STEVE HAMBLETON: No. I think the fund is a very good idea. It's - if we have a good capital base in that fund, we can fund research over a long period of time. It gives confidence to the researchers to continue to do their work. It's probably an industry that we need to build. Our primary industries eventually are going to run out. We need to be a smart nation doing smart things and selling those - our goods and services to the rest of the world.

QUESTION: But should it be funded by sick people who need treatment today paying more for a possible cure in the future?

STEVE HAMBLETON: I think that's a very good point. We need this fund, but we don't need it at the cost of decreasing access. So we must have both, and one must not be at the cost of the other.

UNKNOWN SPEAKER: Thank you.

STEVE HAMBLETON: Thank you very much, ladies and gentlemen.

22 May 2014

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