QUESTION: So what are the clever, long range solutions?
PHELPS: The AMA has, by coincidence, produced a paper looking at the future of general practice. We've provided that to government and asked government to work with us to produce a white paper on the future of general practice. That document and that work contain ideas for the future.
QUESTION: Can you outline some of those ideas at all?
PHELPS: There are a lot of ideas that need to be discussed with the profession and with government but it has to do with issues such as looking at the workforce that we have now, planning that workforce for the future. There can't be any kneejerk reactions to this.
I think the other thing that's important to note is that these bulk billing statistics show…?
PHELPS: The reason doctors are getting out of bulk billing is that it's a complete waste of their effort now. In order to bulk bill a patient you have to take a discount of 50% on the real cost of providing that service so many doctors are, in fact, working for minimal wages just to keep their practices running, to pay all their costs, to pay for their staff and their equipment and their rooms.
If the Medicare rebate were not so paltry then I think a lot more doctors would be able to hang in for longer except that doctors have lost confidence in Medicare now. They don't believe that any government will put into Medicare what it costs to run health care and so they're saying, "well, the only thing we can do is to charge what our services are worth."
QUESTION: This is about more than giving doctors more money, isn't it?
PHELPS: This is not about giving doctors more money. Doctors are charging their patients so that they're receiving a reasonable fee for the service that they provide. What patients are having to do now is to say, "well, I'm going to have to contribute something to this too because my taxation dollars, Medicare, is not paying for my health care."
QUESTION: What if the Federal Government does introduce these payments? Do you think GPs will take them up or have they done that with other incentive payments?
PHELPS: A lot of GPs have taken up practice incentive payments because it's their only way of keeping their head above water. If they introduce more of these blended or non-fee-for-service payments then I think it will be seen as coercion. I think it will be seen as an admission of defeat by the Government that they cannot fund Medicare or that they will not fund Medicare.
And so unless we see solutions that are going to work, I believe that we will continue to see a decline in bulk billing and Australians will need to get accustomed to the fact that they have to pay a gap to see their GP.
QUESTION: You've said, and the Health Minister has said that practice incentives involve more paperwork. What exactly is the paperwork involved?
PHELPS: There are mountains of paperwork to be done for practice incentive payments. You need to have a staff person who gathers the data, who collects it, who sends it into the government, who monitors the figures coming back from the government, who then has to distribute it amongst the doctors who are working in the practice. There is an enormous amount of administration required and generally speaking what we've found is that the practices who are better resourced, who have more staff that they can put onto this task, are the ones who are accessing the practice incentive payments, not the practices who really need it, who are working in disadvantaged areas with very few resources.
QUESTION: To save you repeating yourself - I came late - but what does the AMA see as being the solution to the bulk billing crisis?
PHELPS: The solution doesn't come with a flick of the finger. We need to sit down carefully, looking at responsible, long range solutions that will be acceptable to patients and to doctors, and unless we really take care to get it right this time, then Medicare will not be surviving.
QUESTION: Does that include bigger Medicare rebates?
PHELPS: Medicare rebates are really just a measure of how much gap patients are going to be paying, whether it's zero in the case of bulk billing or whether it's $25 or $30 if the doctor is charging over and above Medicare. It's a matter for the doctor and what their practice costs are and what it costs them to survive, to keep running their practices.
So Medicare rebates are really a matter now between the Australian public and the Government.
QUESTION: Would you support Medicare being scrapped given that it's in such a mess?
PHELPS: Medicare can be repaired but it's going to take will and it is going to take some more dollars because it's fallen well behind the cost of providing services. There are many people who depend on Medicare for their health care and I think it's very important that those people have a safety net, particularly if they're disadvantaged, if they're chronically ill, if they're low income families.
This current suggestion by the Government is not the way to go but we can sit down with government and try and work through some solutions that will benefit the Australian public.