E & O E - Proof Only
PHELPS: Thank you all for coming, it's that time of year again when we talk about what's coming up in the budget. And the point that we would like to make today is that health must be focused as a very high priority in the coming May budget.
The AMA has put forward its submission for the budget to the government, and we see the major priorities as refocussing the health budget. There does need to be more money put into health. You can't, as senior Ministers suggested in December of last year, have a health budget that doesn't increase year by year. You have the extra cost of technology, we have a growing ageing population, and we have greater expectations of our health system year by year.
We are calling for continued growth of the PBS, we are calling for support for general practice, including the White Paper, and we're looking for support for indigenous Australians and for the public hospital system. A continuation of the private hospital rebate, private health rebate. We're also looking for support in the area of medial indemnity.
We believe that the cost of health continues to increase. In order to support Medicare appropriately the government does need to continue to increase its outlays in the area of health.
I'm happy to take any questions.
QUESTION: You say in your submission that you want to increase the Medicare levy. The sort of things that you're looking at, it looks like you need to double it almost from one and a half to three per cent, is that the order of what you're looking at? Doubling the Medicare levy?
PHELPS: I think we'd really need to look at what you’re needing to spend in health to achieve the outcomes that you desire. Now, it should come as no great surprise that the Medicare levy ought to go into funding the shortfall in health. I should make the point that the Medicare levy doesn't go anywhere close to covering the cost of the health system.
Increasing the levy would only go some way to addressing the shortfalls in funding as it currently stands.
QUESTION: But what sort of increase are you talking about? You must have some broad idea?
PHELPS: Yeah, I could ask Roger Kilham, who is from Access Economics - he's in the room at the moment - as to the level that would be needed to cover the funding shortfalls at the moment. Roger?
KILHAM: Well, I think you're probably looking at something like about ...[inaudible]... $2 billion, whereas the Medicare levy itself is of the order of $5 billion. But then, you know, I think it also depends upon what you do to maintain the private funds.
QUESTION: Would one way be to remove the ability of people to buy private health insurance or simply to avoid the extra levy?
PHELPS: I don't think we'd ever suggest that you remove the ability for people to buy private health insurance.
QUESTION: No, you know how you can now, to avoid paying an extra Medicare levy by buying private health insurance, do you think that that possibility should be removed?
PHELPS: No, I don't think that that's the answer. I think that we have addressed areas of funding shortfall and the most glaring ones are the area of general practice, public hospitals are traditionally under-funded; indigenous health is traditionally under-funded. So if we were to look at looking at those major areas, like there are funding shortfalls. The Medicare levy is supposed to try and make up for some of the funding shortfalls and if we increase that levy, as Mr Kilham has suggested, by a factor of about less than one and a half per cent...
QUESTION: Do you think it's - oh, sorry.
PHELPS: Yeah. Then we would be able to achieve some gains in those areas.
QUESTION: Do you think there should be a patient/co-patient/co-payment to the GP [inaudible] have the situation at the moment where many well-off people happen to live in areas where they can get a bulk billing doctor. And then, of course, many disadvantaged families who can't get to a bulk billing doctor. Doesn't this seem to be very inequitable? And would a co-payment help to [inaudible]?
PHELPS: Well, there are a lot of concerns about access and affordability in general practice at the moment. The access issues relate to workforce shortages and some maldistribution. The affordability issues relate to differences in the rates that people have to pay depending on whether there's a bulk-billing doctor or clinic in their area.
Now, I think that what we need to do is move beyond the question of bulk billing. And I think we'd have to look at these issues of access and affordability.
If you continue - try to continue bulk billing without substantially increasing the rebate, then number one I don't think it's going to work any more because doctors no longer trust Medicare to continue in the future to appropriately fund general practice here.
So doctors who have given up bulk billing and gone to privately billing are very unlikely to turn around and go back to bulk billing again. So what we need to do is to actually look at the affordability issue, and that is the gap that people pay.
At the moment there's quite a lot of ...[inaudible]...with doctors trying to decide which patients are genuinely disadvantaged. They can't even look to the Health Care Card or concessions cards as an appropriate indication of disadvantage because there are so many of these cards out there and they don't seem to necessarily equate terribly well with the level of disadvantage.
And so doctors are having to make some decisions about which patients are disadvantaged and which patients aren't, and they'll discount their fees. They may discount them to a gap of zero, but they may just discount them down so that they're paying a minimal gap.
I guess the areas where we would see a possibility of a so-called co-payment, was where the doctor was able to directly bill the government for some of that patient's care and the patient paid a co-payment on top of that.
That hasn't yet been explored, but it's certainly something that should be on the table.
QUESTION: Could incentive payments bring more doctors back into bulk billing?
PHELPS: Incentive payments are a pain in the neck. They cost a lot of money to administer. Doctors don't like them. They don't want any more of them. We've made this abundantly clear and every time a new incentive payment comes in, more and more doctors say forget this bulk billing with incentive payments business. They're just, you know, I can't do it.
What we see is if you have a look at the progress report from the Productivity Commission, that was released just a day or two ago, it shows that on a conservative estimate it costs $10,000 per GP just to administer the current amount of red tape, only from Commonwealth Government programs. There are 46 separate government programs.
Now, if you start introducing more incentive payments, the only incentive it is to drop bulk billing, because what doctors want to do is to provide a service to their patients and to be adequately and appropriately remunerated for that service. And the contract is between the patient and the doctor.
The doctor doesn't want a third party payer coming in and saying, you know, 'We'll pay this if you jump through this flaming hoop.'
So we're really at a point where doctors are not prepared to accept more so-called 'incentive payments'. And, as I said, the only thing that they're as an incentive for is to privately bill instead of to bulk bill. Because doctors don't want to have their cap in hand to government every year looking at inadequate indexation of rebates, looking at how they're going to continue to run their practices for the paltry amount that Medicare reimburses them.
QUESTION: When an ordinary person gets a pay rise they often have to trade off some of their conditions or improve their productivity to get one. What are doctors prepared to do in return for a pay rise from the government?
PHELPS: Doctors don't get paid by government. Doctors get paid by patients. Medicare is an insurer that reimburses the patient...
QUESTION: If you're asking the government to increase the Medicare rebate...
PHELPS: No, I'm saying we've got...
QUESTION: ...so in return for an increase in the Medicare rebate what would you - what extra service would you give patients?
PHELPS: Staying in practice...
QUESTION: Well, it's the taxpayer that's paying for it.
PHELPS: Staying in practice. The taxpayer is paying the patients a subsidy for their health care. And I think what we have to do is to get away from this notion that doctors are in any way employees of government. They're not. They run private businesses. They employ staff. They have to pay staff superannuation. They have to pay rent; they have to pay mortgages on their properties if they own the premises where they practice from. They've got to pay for drugs, dressings and supplies, they've got to pay for all of the things that any small business operator has to pay for, including their medical indemnity insurance which, if you're a procedural GP, is growing all the time.
So to try and even put GPs in the same category as workers, is inappropriate. That's not the way it is. GPs are employers. They are running businesses. They - if they don't make a profit they don't say in business. It's really as simple as that. They have to be able to make a living.
So what we have to do is to not look at the Medicare rebate as a pay rise for doctors. Any increase in the rebate is reducing the amount of household income that goes into paying for health care.
So the debate that we have moved on to now is about not whether people can still get free health care, because nobody ever got free health care. That was always an unreal expectation.
What we had was the taxation system picking up most of the tab for health care. And, with time, that amount has reduced and the amount from household incomes has increased. And so where we need to really focus our attention now is, how much of the health dollar is paid out of taxation which ultimately comes from taxpayers, users of the health system, and how much actually comes from household incomes? That is, people who are using the health care system at any given moment. That's where we're up to. It's not about pay rises for doctors. They don't work for the government.
Doctors work on behalf of their patients. Their patients are responsible for their bill. If GPs are bulk billing, they are accepting the government's rebate, as a full fee. So that time has passed.
QUESTION: Just on indigenous health, the recommendation that the government doubles its allocation for primary health care for indigenous people. Roughly what sort of figures are we talking on now?
PHELPS:: Well the Deeble estimate was $245 million, and that obviously has to be indexed upwards because that figure is now four years old.
QUESTION: Four years old?
PHELPS: Four years old, yes. I don't think anybody debates that indigenous Australians are the worst off in terms of health outcomes. We've made very little advance, if any, in the last 20 years in terms of health outcomes.
We have examples of other indigenous communities, for example in North America and in New Zealand, where significant advances have been made, and there are a number of reasons for this.
There are programs in Australia that are working and working well. But certainly the key to this seems to be providing adequate primary care where people live, in remote indigenous communities particularly.
But it's not only about health care in the way we understand it - as in going to see a doctor or being able to get into a hospital. It's about fresh water; it's about adequate housing; it's about education for children. You must take a holistic community view of indigenous health and indigenous health outcomes.
So there's no question that we need to see a significant expansion in expenditure to achieve the sorts of health outcomes that any compassionate and reasonable society would be expecting.
QUESTION: And in a dollar by dollar term, the advances that have been made in Aboriginal health spending is falling behind the advances in the more general community?
PHELPS: Yes, it is. In order to achieve better health outcomes for indigenous Australians we have to spend more per capita than we're spending at the moment, and we certainly have to spend more per capita than we spend on non-indigenous Australians. That's not happening.
QUESTION: For medical indemnity you're advocating that the taxpayers pick up not 50% of large payments ...[inaudible]... but 100%. Why should taxpayers fund that expense rather than doctors through their own insurance [inaudible]?
PHELPS: Taxpayers are paying for it now. They're either paying for it through Medicare or they're paying for it in gap payments because it has to be passed on to patients. And it's really a matter of making sure that there is security in the system.
What we're suggesting is that there is, in the proposed legislation - which we are supporting because it is certainly going to provide a lot more security in the medical indemnity situation than we have had in the past and have currently.
But what we're proposing is that doctors are feeling uncertain - particularly those in the very high risk specialties such as obstetrics where they could be facing a court action that might go on for seven, eight, ten years. There's one in court at the moment that's 23 years old, and their insurance cap today will not cover what that payout might be in many years time.
So if you're looking at that, what, so-called 'blue sky' issue, what we want to see is put into place a long term care and rehabilitation scheme that will hopefully take out of the tort law system those long term care costs, which are very difficult for any judge to try and estimate.
And if we - and what they also do is delay the appropriate care and rehabilitation for people who are severely injured. And what we are suggesting, in order to avoid the moral hazard argument, is that we look at continuing the system that is being proposed by government now, which is that they pick up half of payments from two million to 15 million, which will be the insurance cap.
And then over and above that insurance limit, that if there is a payment that comes, that, an award that comes in in excess of that, that the government guarantees that amount in excess until such time as a care and rehabilitation scheme is set up.
It really is a matter of providing certainty for doctors to be able to continue to engage in high-risk activities like delivering babies.
QUESTION: What are you picking up in terms of federal intentions regarding the PBS co-payment?
PHELPS: We haven't had any indication as yet in regard to the PBS co-payment. I mean our view is that the PBS is one of the pillars of the health system and it needs to be supported not undermined. The rate of growth on average has been 10 to 11%. There was a blowout in one year but it seems to have settled back to the previous rate of growth.
And while we agree that there needs to be an improvement in some areas of efficiency, wherever that can be gained, we would support that provided that there were not adverse outcomes for patients, and that they still had access to newer and better drugs.
But, by the same token, we think that the rate of growth is realistic compared with the gains from the PBS. And it's not just about how much the PBS costs, because you can't see that in isolation.
You have to look at the PBS and pharmaceutical expenditure as how many people are we keeping out of hospital, how many people are we saving from disability, from early death, from illness? And unless you consider that in terms of gains in productivity, reductions in hospital outlays, then you can't look at the PBS as just a black hole that you sink money into. It actually gives us advantages. It provides us with gains in terms of population health.
QUESTION: Before, you mentioned bulk billing, you said that doctors ...[inaudible]..., doctors that have moved out of bulk billing into private billing and it was very unlikely that they'd move back. The Opposition are pledging that they're going to, you know, if they get in government they'll resurrect bulk billing, they'll say that the government says that they're alarmed at the fall and they'll do something to fix it.
But are you saying it doesn't matter incentives or what sort of new ideas they come up with, once a doctor says I'm going to dump bulk billing and go into private billing there's no going back?
PHELPS: That's my view. I'm, I'll be having discussions with the Opposition about health policy and about bulk billing in particular and the future of Medicare over coming months. And the point that I will be making is that doctors don't trust that Medicare will continue to - even if you, even if you provide so-called incentives to retain the current levels of bulk billing, that ultimately I think that what history has shown us is that Medicare is not going to keep up with the cost of providing services. And that there is a certain demoralisation of the medical profession that comes with this third-party paying system.
That they would rather have a direct relationship with their patients and have Medicare go back to its original concept of so many years ago, which was a universal health insurer. And then the issue of insurance is between the insured and the insurer and not the person who is actually providing the service.
QUESTION: ...[inaudible]... though isn't it, if you have a general practice and a bulk billing practice pops up on either side of you, you will bulk bill won't you? I mean the trend changes?
PHELPS: Yeah, not necessarily. I mean the interesting thing is that market forces don't apply to general practice. And in my travels around the country I go to a lot of different types of areas - rural, metro, outer metropolitan, urban - all sorts of different types of practices. And what's interesting is that in areas where there are higher numbers of disadvantaged patients, you will see low numbers of doctors quite often, but higher rates of bulk billing. Because the doctors who work in that area recognise that their patients may not be able to afford private fees. And so they continue to bulk bill, even to their own detriment.
And that's not because there's a guy down the road who's bulk billing, and he's competing with him or her, it's because they have a social conscience in that they would rather struggle on than change the way that they bill.
And in fact one of the pressures on the workforce in those areas at the moment is that doctors are saying rather than keep on practising here and change the way that I bill, I'd rather pack up and move somewhere where I can just start afresh, privately bill. And what happens to that area where there was previously bulk billing? It's not happening any more or there's no doctors or there's a workforce shortage which puts more pressure on the doctors who remain.
So in fact the market forces don't apply in this particular situation, and our Access Economics survey that we did last year - which looked at the GP workforce - actually proved this point.
QUESTION: Several years ago when the RVS came out, you estimated it would take a billion dollars to increase the Medicare rebate to a level that would keep doctors bulk billing. How much has, how much extra would it cost now? What's the figure now?
PHELPS: Well if you consider that the increase in costs of providing medical services is about 9 to 10% per annum, you just work it out. You add 9 to 10% cumulative over the last two years since that report came out.
QUESTION: You're no fan of bulk billing, but what is the alternative? Can you just expand on that sort of insurer/insuree idea?
PHELPS: Well that's actually what Medicare is. Medicare is not supposed to be the full funder of medical services. It's supposed to be an insurance scheme for every Australian for their health services. And the decisions that have been made by successive governments over time is, do we continue to fully fund the cost of health services so that, you know, bulk billing is a reasonable option? Or do we just erode it year by year, re-index it, you know, less than the cost of providing the services and, you know, maybe the doctors won't actually notice and they'll just absorb it into their practice costs.
Well two-and-a-half years ago one of the first things I said was that doctors had their backs against the wall and that they were not going to be able to continue to bulk bill because they couldn't continue to run their practices for that amount of money that they were receiving if they chose to accept that full fee, as their full pay, that Medicare fee as their full payment.
That prediction has come to pass. The writing was on the wall back then. And what's happened is that doctors have been waiting and waiting and waiting, very patiently, to see whether the government would respond. They haven't, and so doctors have said well I have no choice but to change the way that I bill in my practice.
So the question now for government and the Opposition, in terms of coming up with health policy, is what do we do about Medicare? Is Medicare going to be the universal, everybody gets the same amount back when they go and see a doctor? Or do we somehow work out some way of making it easier for people who are disadvantaged? But first of all we have to identify who those people are. But then how do we make it easier for them to access health care at an affordable rate?
Now there are ways we can go about this. Providing practice incentive payments which are linked to doctors being driven to bulk bill, if you like, are not the way to go. Doctors are not going to accept that.
I think that what we need to do is to look at how an appropriate safety net can be provided for people who are disadvantaged.
There are a number of ways of going about this. One is to look at whether everyone still gets the same rebate. Veterans don't, so there is certainly a precedent there.
The other way is to say well can people, in certain categories, make a co-payment, so that they don't have to have the full amount of the doctor's fee upfront, but they pay that little co-payment - whatever that might be. It might be zero, it might be five or $10.
So those are the sorts of issues that I think are worthy of community debate at the moment. I don't think that they can be imposed on the medical profession, because one thing that government should have learnt by now is that if they put in place plans that haven't been done in consultation with the medical profession, that don't have the support of the medical profession, it won't work.
And, similarly, if you do something that, that patients won't accept as fair and reasonable, then they're not, then the community are not going to accept that as a solution either.
QUESTION: So would you support any means testing? Should yuppies get bulk billed, should millionaires be able to get bulk billed simply because they live in an area where bulk billing rates are much higher? Can you, I know that's sort of a bit trite, but?
PHELPS: No it's not. I mean that's the very question that we have to ask.
QUESTION: Well should millionaires get bulk billed?
PHELPS: That's the question the community needs to debate.
QUESTION: What's your view?
PHELPS: I think that what we need to do is to have a look at what Medicare is all about, and I'm obviously going to evade that question right now because I think that it has to be one of the things on the table.
I don't, I don't want to impose my opinion on the community as to whether they think that their tax dollars should go to everyone getting the same Medicare rebate or not. But that's got to be on the table. It's got to be up for discussion.
QUESTION: What about private insurance? Russell Schneider is toying with the idea of offering private health insurance for GP visits. ...[inaudible]... how the AMA responded?
PHELPS: Oh we'd love another third party payer in general practice - not. I think what we need to do is to have a look at what private health insurers are suggesting. But, really, I can't imagine how that might be constructed. I think we'd have to really look at that, at who would have access to their private insurance being covered, what services would be covered, what wouldn't. That is something that really would require a fair amount of consultation with the medical profession to see what they had in mind, and ...
QUESTION: But you would be ...
PHELPS: ... and what sort of strings would be attached. What we want to avoid at all costs is a managed care style system - a la the United States. Where if you have a managed care organisation involved in the payment of doctors, that doctors have to ring and get permission from somebody in the HMO - or the managed care organisation - to order expensive tests or to prescribe expensive medication or whatever.
And we don't want to get into a situation where the doctor's clinical judgment is being dictated in any way by a health management organisation or a health care fund.
QUESTION: Do you think there should be co-payments, though?
PHELPS: We've always said that co-payments should be on the table.
QUESTION: And where is the co-payment that the Hawke Government introduced?
PHELPS: Well the Hawke Government tried to introduce that back in 1991 and it lasted, I think, all of about three months because it became a political football.
This is where I think that there is a great case for some bipartisan discussions about the co-payment and its attractiveness to the Australian community.
QUESTION: Are you talking about us, that same level of co-payment for everyone or ...?
PHELPS: No, I don't ...
QUESTION: ... two-tiered.
PHELPS: ... you can't do that. I mean the reason you can't do that is that depending on where you practice and the type of practice that you have, I mean you might be, for example, a GP working in a solo practice in an outer metropolitan area. Now your cost structure is going to be completely different, and you might provide, for example, a practice nurse or two, or you might, you know, have a locum that comes in a few days or whatever. I mean that's going to be a completely ...
QUESTION: ...[inaudible]... payments.
PHELPS: It, oh yeah, it's going to be a completely different structure to the person working in a corporate practice in the middle of a city. You can't have the same level of co-payment for everyone because the cost of providing those services would differ from place to place.
QUESTION: But isn't that essentially what happens now in terms of the level at which doctors set their consultation fees - the gap between?
PHELPS: The gaps are different depending on where you practice and what services you provide. And for example if you're bulk billing the gap's zero. If you are charging a fee it might be anywhere from $30 - which is about a $5 gap - to 55 or $60 - which is a 25 or more dollar gap, $30 gap.
So it really, the - it just depends on the services you're providing, where you are, what it costs you to run your practice. If you try and fix that co-payment level, then you're going to run into trouble. Because there are still going to be practices who will find that level inappropriate for their style of practice.
QUESTION: Do you charge over the scheduled fee for all of your patients in Double Bay?
PHELPS: My practice is not really up for discussion here at the moment. I'm talking about the health system generally.
QUESTION: But do you ever, would you ever bulk bill? If someone came - I'm not sure entirely what they might be doing in Double Bay - but if somebody, a low income earner came to your surgery in Double Bay and needed medical care and didn't have the money, would you bulk bill them?
PHELPS: I don't have bulkbilling facilities at my practice, but what I will do is what many doctors do and that is try and assess the patient's means and discount the fee appropriately.
QUESTION: So in terms of the actual practical difference about what you're talking about - given that many doctors have different levels of gap fees anyway - are you actually just talking about, the change, the substantive change would be new structures, a modest co-payment for the lowest income earners?
PHELPS: The choice would be then for the practice whether that co-payment was zero or whatever it was, and then patients would then have some choice about whether that was appropriate and affordable for them or not.
QUESTION: So your idea isn't - at present if you go to a doctor who doesn't bulk bill you've got to pay the full fee ...
PHELPS: Up front, yes.
QUESTION: ... it's up front. Then the patient goes to Medicare and gets it back. Your proposal is you bulk bill Medicare for the 24 bucks or whatever it is they provide and then charge the patient $2, $20 on top of that which they pay at the surgery out of their own pocket.
PHELPS: Same as they do for pharmaceuticals. But I don't think that fee, that amount should necessarily be fixed.
QUESTION: Why do you think the government hasn't introduced such a thing earlier? It seems to be the more streamlined way to go and easier, easier for the patient, easier for the doctor?
PHELPS: I think it's a political reason that that hasn't been done up till now, because I think what it would have to do is acknowledge that bulk billing is not sustainable. But I do think we've reached a time in political history where we can all say it's time. It's time to revisit this issue on bulk billing. It never was a free healthcare system. We always had to pay for it. And, up until recently, GPs have been the ones subsidising Medicare's deficiencies.
But now they're saying they don't want to do that any more, and fair enough, and so the question now is how much of that deficiency comes from household incomes and how much comes from taxpayers?
And, you know, the more that comes from household incomes the more you're actually putting the pressure on the sickest.
QUESTION: Can I just return to an earlier question. I just, I just want to clarify something. If you are earning $50,000 in Australia and you don't have private health insurance, you are, you're, an extra levy is attracted to your surcharge. Why should the surcharge be removed if, just because you get private health insurance, when a lot of people - especially young, young workers, that may be the yuppies and millionaires, are simply doing it to avoid tax? Do you support that?
PHELPS: Well it's really an, ...we support incentives for people to be in private health insurance. We support the rebate ...
QUESTION: No, even if they're not even using it, they're just doing it as a tax dodge?
PHELPS: They are contributing out of their own discretionary income to private health insurance - to the private health system. And that in itself will be taking some pressure off the public system.
QUESTION: But do you have a problem with the fact that that revenue then is not going ...it's, if they're diverted out of potential public health revenue into the private health sector?
PHELPS: I think it's very important that we maintain a blend of the private and the public system. That we know that if the balance goes out of kilter and there's too much pressure put on the public system because drop out of private hospitals, that the public system doesn't cope.
We also don't want to get to a situation where the private system is so prevailing that we don't have a vibrant public hospital system. Because that's where our teaching and research happens, and it's also where there's the medical conditions that don't make a profit, if you like, for the private hospital or the private hospital organisation. That's where those things happen.
So I think what we need to do is to make sure that there is the right blend of private and public. And certainly the situation that had been reached prior to the incentives was not only threatening the future of private hospitals but also putting such a strain on the public that it was also under threat.
It's about right at the moment. The balance is about right just now.
QUESTION: Have you discussed the idea of a co-payment with the Health Minister and what's her reaction?
PHELPS: We've discussed the issue of a White Paper in General Practice, and I think that's the fair and reasonable way to go because we do need to really look at issues like workforce and remuneration and these things all need to be discussed in, en bloc.
I have discussed, in part, the issue of co-payment with the Minister. There's been no commitment made.
QUESTION: How recently was that?
PHELPS: Oh - last week.
QUESTION: And what did she ...
QUESTION: Did she raise it with you?
PHELPS: No we raised the issue of a White Paper in General Practice.
QUESTION: But the co-payment, who raised the co-payment?
PHELPS: I'd have to get back to you on that.
QUESTION: So is she prepared to consider that?
PHELPS: No commitment was made at all into anything to do with the budget or anything to do with general practice, and we were told that there was a plan being formulated and that we would be consulted at the appropriate time.
QUESTION: Well talk about that plan, the plan. Some people have suggested this is a complete ruse, that they've just, they've come up with this billion dollar figure to try and divert the media's attention away from plummeting bulk billing. That they want us to think that they're doing something but there's actually nothing concrete to it. What's your view on that?
PHELPS: We've told that there, we've been told that they're working on plan, but we haven't ...
QUESTION: ...[inaudible]....
PHELPS: ... we haven't been let in on it at this point.
QUESTION: What's your gut feeling? Is there a plan or is it a nonsense?
PHELPS: Oh I think there's probably a fair bit of paddling going on under the surface but ...[laughter]
... we haven't seen any evidence of it just yet.
QUESTION: So for how long have you been discussing this co-payment issue with Senator Patterson, how long were those talks? She's obviously going to consult interested groups in the lead up to the budget. How long has that process been going on?
PHELPS: I wouldn't say that we've been having discussions with the Minister about co-payments. I would say that this is something that comes up as one of the issues that needs to be considered over, you know, certainly the last year. We raise a whole range of issues - this is one of them.
And I think, you know, to really illustrate the plight of general practice and why the bulk billing rates are doing what they're doing - I mean if you have a look at this chart, it tells you very clearly. If you have a look at the blue line, that's the AMA list of fees and what it's done since 1998 to 2001. And obviously this, you know, you can extrapolate.
The red line is the MBS, or the bulk billing rebate. So the blue line, or the AMA fee, and the green line, the average weekly earnings. The AMA Schedule has kept completely in line with average weekly earnings.
This is the Medicare rebate. Now, that gap has been subsidised by doctors for years now. And this is why, because that gap continues to increase - why doctors are saying, 'Can't do it any more'. And so this is why we have to, as a community, start looking at what the possible solutions might be. A co-payment is one possibility; private billing is another possibility; looking at a safety net for disadvantaged patients is an essential part of that formula.
QUESTION: What's the current AMA recommended fee for a standard consultation?
PHELPS: Fifty dollars.
QUESTION: On the nose.
PHELPS: Fifty dollars on the nose.
QUESTION: You don't have problems with that?
PHELPS: We try not to have each way bet. And that's been worked out using the RVS modelling. It's not just something that's come off the top of the head. It's actually been, we've gone back and used the economic modelling from the relative value study, we've said what are the costs and pressures on general practice, what are the wages that have had to be paid, what are the superannuation payments that they have to make to their staff, what does their equipment cost, what is their computerisation, accreditation, medical indemnity? That all has to go into the mix because it's all part of the cost of running a practice.
QUESTION: Can I, just using that chart, when did they last offset, what year were those figures ...[inaudible]...?
PHELPS: When did they last ...
QUESTION: Sorry I'm just, I just want to know when the red and the green and the blue dissect - what year's that?
PHELPS: Oh that's back in 1985.
QUESTION: So that's when it was last fair according to the AMA?
PHELPS: 1985 things looked reasonably fair, and it went downhill from there.
QUESTION: Dr Phelps, just in relation to again the idea of the, whether there's universality in terms of bulkbilling availability or there's been this idea around for quite some time that the government may move to a system where they understand and expect that higher income earners will pay an out of pocket fee, that they provide incentives to bulkbill for healthcare cards or so on or whatever.
Did you raise in your talks last week your concerns about that specific, did Senator Patterson say anything about that specific idea of incentive payments for GPs to bulkbill low income earners and your concerns of how your members are working that?
PHELPS: Look, the issue was raised in broad terms, but the point I made is the one I've made to you today, and that is that GPs don't want more hoops to have to jump through. They don't want more administration costs.
It's reached a point where GPs just need to assess in their own businesses what it costs them to run the practice and you know to be able to make a reasonable living and that's what they have to charge their patients.
But what we're stuck with is this issue of looking after people who are genuinely disadvantaged or who have high healthcare needs. And that's where the GPs run into this big dilemma, because they know that they're subsidising Medicare - happy to do so for disadvantaged patients - provided that there is reasonable remuneration across the board.
But if you happen to be in an area where 90 or 95% of your patients are deemed to be disadvantaged then that system just can't work.
QUESTION: Kerryn can you tell us about Moduretic and why spin bowlers shouldn't be using that to lose weight?
PHELPS: Elite athletes know that they cannot take anything - whether it's prescribed, over the counter or otherwise - without first checking with the Australian Sports Drug Agency as to whether that substance is appropriate to be taken for sport.
Now any elite athlete knows that their entire career could hinge on taking a tablet that is banned in sport.
The Australian Sports Drug Agency have a hotline that is open 9am to 9pm Monday to Friday, and it's also open nine till five on weekends and public holidays. So there really isn't an excuse for an athlete not to check and not to know ...
QUESTION: But his Mum gave it to him.
PHELPS: His Mum could ring the hotline. I mean you can't use Mum as an excuse, because Mum could call the hotline, and any parents of elite athletes out there, who are even slightly tempted to give their athletic offspring a tablet to take, ring the hotline and find out whether it's okay for your offspring to take this tablet, and be involved in sport. Because chances are they're gonna get tested. If they get tested and they've taken a banned substance they'll be sprung and they may well be banned from sport.
QUESTION: If Shane Warne were your patient and he came into your consultancy rooms today, what would you tell him?
PHELPS: I'd say don't take your Mum's tablets. I don't care who anybody is, they don't take somebody else's prescribed medication for a start, and if you're an athlete, for goodness sake check first before you take anything.
There's even a wallet size card from the ASDA that athletes can carry around with them which says what is safe to take for different types of conditions.
Now, you know, Shane Warne has said that he didn't take the diuretic for part of his shoulder treatment, so goodness knows what he was taking it for - unless he had PMS.
Any other questions. We'll wind it up there.
Ends