E & OE – PROOF ONLY
DR TALL: We're here from the AMA. We've got Dr Bill Glasson. He's the Federal AMA President and ex-Queensland President of the AMA. The AMA is here to talk to doctors on the ground. We're here to discuss the issues in the public hospital system here. Also to talk to the GPs and find out how the health system is working here in Cairns and in the health districts surrounding Cairns.
Of course the health district here is a very unusual one. It covers a very large area - the Cape, for instance, larger than the State of Victoria and there are some very special areas. We've got a very itinerant population here, around 60,000 tourists coming in and out. And also the tidal flow of tourists means that the system needs to be very elastic to accommodate the extra people coming in and out.
Also 15% of the population here is an indigenous population, the ATSIC population. And they have very special health care needs. There's a very high incidence of diabetes amongst the indigenous population, a very high need for dialysis which is very expensive. Just the disposal of the loan costs around $30,000 per person on dialysis per year and this needs to be taken into account when it comes to the budgeting in the health system here.
The indigenous population - they have a much higher requirement for hospitalisation, around two to three times the incidence of hospitalisation amongst the Caucasian population. And the costs per hospitalisation stay are around 30% higher.
Now much of this isn't factored into the health funding for this particular area. And the tragedy is that despite having a very special population that often needs more hospitalisation, the number of hospital beds in this area is around a quarter less than per capita throughout Australia. On average there are around 3.1 hospital beds per thousand population. Here in Cairns, there's only 2.3 hospital beds per thousand. And this is ridiculous in the face of an increased demand, and particularly with redevelopment of Cairns Hospital, we have around 100 fewer beds here in Cairns Hospital.
So they're working harder and faster to try to make ends meet. The other problem is a doctor shortage in this area. GPs are faring quite well within Cairns itself and that's to be commended and it's very lucky for the local population that it's not so difficult to see a GP. However, to see a specialist, they're running on around 60% capacity. So to see a paediatrician or a psychiatrist in this area can be a lot more difficult, and there's a chronic shortage.
And the problem also is it's very hard to get doctors to where the needs are, to where patients are. And they have designed a very special Outreach service where doctors and paediatricians and psychiatrists go out to the outlying areas to where the services are needed, to meet the people on the ground and to deliver this kind of service is very expensive. And they do an excellent job doing that here.
QUESTION: I mean you'll hear a lot of the concerns tonight. But overall are [indistinct] of the GPs happy or unhappy?
DR TALL: GPs across the nation are generally quite unhappy. Morale is very low. There's a lot of talk about the woeful Medicare rebate, the patient rebate which is around $25. We have a multimillion dollar six year study which was commissioned by both sides of government and the AMA called the Relative Value study and that shows that the true cost in value of a general practitioner's consultation, standard consultation, is $50 and yet the patient rebate for such a consultation is only $25. So that's a 50% discount to the true cost in value of a general practitioner's consultation.
So both sides of government are just throwing morsels from the table. They're trying to rescue what are but billing rates, but really they're tyring to throw a lifeline to something that's dead, bloated and floating in the water. It cannot be rescued with the offer of $1 to $6.30. It just can’t be rescued.
And really general practice is chronically underfunded. It's chronically under-resourced and GP morale is very low. They're very stressed. They're overworked. There's too much red tape and we're seeing a national shortage of doctors. And the whole workforce is only acting at around 60% capacity. People are just pulling out of the profession due to low morale and poor [indistinct] scheme.
QUESTION: What's the future, do you think?
DR TALL: We need to reinvigorate general practice. We need to capitalise it appropriately. Now the government insurer is the Health Insurer. The government isn't going to appropriately fund Medicare rebates, then it's going to have to come from somewhere else. It will have to come either from the consumer, from their pocket, or it will have to come from private health insurance, and we need to see more funds coming in direct to general practice. And very soon the issue won't be about the patients having to fork out more co-payments, more gap as the average is around $12 or so at the moment. The issue will be whether they can get in to see a GP in the first place.
So when you have a sick child or when you have a fever, you're worried about it being meningitis, the first port of call is the general practitioner. And if you can't see them for two or three days, then you people are in dire straits.
That's my pleasure. Good. [Laughter]
[Hand over chat]
QUESTION: Dr Glasson, [indistinct] concern?
DR BILL GLASSON: Absolutely, I think it's an opportunity for us to come up here and actually talk to the doctors at the grassroots and find out what are the real concerns. And I can suggest to you that we can anticipate what they're going to be.
One is around the Medicare issue and the Fair Medicare package which has a lot of difficulties which the doctors brought up with it. The other one is around medical indemnity and, if there's one issue that the profession is facing and continues to face, it's the declining workforce associated with the rising indemnity premiums.
Now State Government and the Federal Government have done a lot to try and stabilise the situation. But [indistinct] is that we have an affordable product. And unless this is addressed across the board, we're going to find that there'll be less and less doctors to see as more and more doctors actually retire out of the system.
And also that the costs of actually seeing a doctor will increase because I keep reminding the government it's not doctors that pay premiums to insurance companies, it's we the patients. And so the doctors will have to charge higher and higher fees to try and address the every-rising indemnity costs. I do feel that the current model we're looking at is not sustainable. It's not workable. I don't feel it's fair to the patient, the doctor, and I think we've got to go back to the drawing board to try and get something that's more workable.
QUESTION: [indistinct] position it's been in before?
DR GLASSON: Absolutely, I think this is the most parlous state that the medical profession has been in, in history, combined with the, I suppose, the under-funding of Medicare, combined with the rising costs of running a high quality general practice. And I keep reminding the government - no one talks about quality - it's all talking about bulk billing. I hear doctors talk about what patients want. The patients want time with their doctors. They want high quality care and somebody has to pay.
I keep telling them, reminding the government's insurance arm and they are the ones that fund Medicare. And essentially they are to fund Medicare adequately to allow the doctor to provide high quality general and specialist practice. At the moment they're not.
QUESTION: Are you confident of getting the response you want from the government though?
DR GLASSON: I think so. I think government will have to sit up and listen because it, in a sense at the end of the day, it's the patients that vote at the ballot box. And if the patients go to the ballot box and feel that the government has not done enough as their insurer, then obviously they will demonstrate that in their voting behaviour. So I think the government will be forced to listen if they're going to maintain the power base that they currently have.
QUESTION: Thank you.
Ends