AMA Transcript - $7 GP co-payment

27 Nov 2014

Transcript: AMA President, A/Prof Brian Owler, ABC News 24, 27 November 2014

Subject: $7 GP co-payment

VIRGINIA TRIOLI: The Australian Medical Association has always been opposed to the policy. Its national President Brian Owler is in Canberra and joins us now. Thank you for joining us.

BRIAN OWLER: It is a pleasure. Good morning.

VIRGINIA TRIOLI: Is this a win for AMA?

BRIAN OWLER: I think it’s a win for health policy.  I think it’s a win for patients because the Government’s proposal did affect vulnerable patients in our community and that's one of the reasons the AMA is so opposed to it. 

The AMA doesn't oppose co-payments, we already have them in our health system, but only for those who can afford to pay them. We were asked to put up an alternative policy, which we did, and unfortunately the Government rejected that. 

I think it is good to have this off the table so that now we can have a debate and a discussion about how we tackle the problems of chronic disease management, prevention and invest in general practice.

VIRGINIA TRIOLI: I’ll just repeat what the Opposition’s Catherine King has just said on RN, which is what the Government can do is via regulation to reduce the fee that the Government pays to doctors via the Medicare Benefits Schedule and claw the money back that way. Would that be acceptable to doctors?

BRIAN OWLER: Well, it certainly wouldn't be acceptable to doctors.

VIRGINIA TRIOLI: Just to jump in there.  It means that your patients aren't paying it, the doctors are paying it, and if the concern was that it would hit lower income and older patients hard then perhaps it could be picked up by the doctors?

BRIAN OWLER: You can't take money out of general practice and expect general practice to continue along in the same way. It would mean that people would be pressured to spend less time with doctors. What we need for a sustainable health care system is to invest in general practice, so you actually encourage quality general practice, having their patients spend more time with doctors. So the idea of cutting the fee, cutting the rebate through regulation, I think, would be very poor policy, and of course not something that we would support because at the end of the day, of course, there would be a lot of pressure on doctors to pass those fees onto patients and that's not the sort of model that we want to see develop.

VIRGINIA TRIOLI: That was my next question. I imagine you would fight this, as you suggest, you would be opposed to that idea and you lost, would that fee, that back-door way, the reduction in the fee the Government pays you, would that then be passed onto patients?

BRIAN OWLER: Well, general practitioners have costs associated with running practices and of course there would be a lot of pressure to do that. I think the idea that there could be regulation introduced to reduce the fee is very unlikely. This government proposal not only applies to GPs, but also pathology and diagnostic imaging, another reason why the AMA didn't support it. It would be very difficult through regulation to do this for pathology and diagnostic imaging. For general practice you could, but it is a disallowable instrument in terms of Parliament. The Senate could use their numbers to block that change in the regulation. It's very unlikely we would see that happening. That would be a very cynical and unpopular political move on behalf the Government, and we need to get back to discussing health policy rather than dollar amounts, $5, $7, whatever it is.

We need to talk about health policy, prevention, chronic diseases management. Most of the population, over 65, end up having multiple chronic diseases, sometimes four or five. If we want a sustainable health care system, we have to look after those patients, manage them in the community and keep them out of more expensive hospital care. That's the sort of discussion we should be having, rather than the issue of whether or not someone is paying $7.

VIRGINIA TRIOLI: The issue may stay there, because the Government is trying to repair the Budget, to use its phrase, so what about a means-tested co-payment? Many prominent and wealthy Australians came out and said it was only fair that they be asked to pay, but not people on lower incomes. Many are prepared to pick up the shortfall. Is there a dollar figure the AMA could live with?

BRIAN OWLER: That was the essence of the AMA’s alternative proposal. We didn't use means-testing because it is a difficult and shifting thing to define in terms of co-payments, but we used the concession and under-16s principle which was actually a principle that is already there. Everyone had a co-payment under the AMA's plan, but the Government would essentially pay the co-payment for under 16s, and those on concessions, where as everyone else would be asked to pay $6.15. That essentially was the AMA's alternative plan, and as I've said all along, the AMA is not against co-payments per se, but mandatory payments for everyone, including vulnerable patients in our community, is not something that the AMA can support. 

I was up in the Northern Territory, Alice Springs, Darwin and out in some Aboriginal communities, and all of those Aboriginal community-controlled health care services have said there is no way they could actually charge a co-payment.

In fact, when they don't, they would lose the $7, plus an extra $9.25 per patient. That would mean defunding of Aboriginal health services, and this was a problem across the country. This idea that would affect vulnerable patients in our community is not an abstract concept. It was going to have really significant implications. So, I understand the idea of having, in the government’s words, a price signal for those people that can afford to pay but there are real consequences for people, vulnerable people in our community, and those were the issues that were never addressed by the Government.

VIRGINIA TRIOLI: Now, the other issue, of course, was that this co-payment was going to go into a research fund and the Government has committed to maintaining and somehow funding that fund. I would also like to share with you and viewers, a view that I was told by a leading doctor and researcher into cancer. The view of the research community he said is, and this is a quote, "Sod it, we don’t want your research fund if you’re getting it that way. We will fund it ourselves. We don't want primary care affected." Is this a general view in the research community?

BRIAN OWLER: There were a lot of people feeling very uneasy about the way the fund was established. Everyone is very happy to have the fund. The AMA supports the fund wholeheartedly, but the problem was that taking the money out of the pockets of sick Australians going to the doctor, and putting it into tertiary level research was never something that the research community felt comfortable with. We can still have a research fund. Only some was coming from the co-payment. We can still have a medical research future fund and accumulated over six years and get to $15 billion, or alternatively you could take an extra two years or so and get it up to $20 billion that way. 

The idea that it has to be $20 billion in six years is something we need to look at and actually there are compromises there that actually still get to a very significant fund that funds research into the future, and I think that's the sort of alternative that we should be looking at.

VIRGINIA TRIOLI: Brian Owler. Thanks for joining us today

BRIAN OWLER: It is a pleasure, thanks.


27 November 2014


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