Radio Interview - Dr Glasson with Jeremy Cordeaux, Election Health Policy, Part 2

DR BILL GLASSON:   I mean, I think we've got to look at the various aspects of the health policy and there's various elements to that.  But if we look specifically around the Medicare issue, as you know, in the last ten years or more, the Medicare system has been under funded dramatically to the extent that you probaby  - it reflects about 50 per cent of the costs of providing a medical service.  And so the poor old GPs particularly out there have been copping the brunt of this and they've been trying to live within the Medicare rebate. 

                                      And the situation is that this has led, I believe, to the workforce shortage that we find in the country at the moment.  We have general practices that are closing, we've got patients not being able to access GPs at all.  If they can access them it takes quite some time to get in.  And therefore we have to re-look at this whole workforce situation.

                                      Specific to the policies, obviously we welcome the money from both sides, they've gone in to underpin the Medicare system. 

                                      The only think I will say about the money that the Labor Party has put in, which unfortunately is linked to bulk-billing.  And I've got nothing wrong with bulk-billing, but the reality is that when you ask a doctor to bulk-bill, you're asking them actually to give a 50 per cent discount.

And it's been proven that doctors cannot provide the service that patients require. 

                                      Patients want time, that's what they really want, they don't want six-minute medicine, they want to spend time with their doctor so that they can have all their problems addressed at the one sitting.  And from the doctor's perspective, they feel more important as far as being able to actually address the whole patient rather than address a symptom, such as a sore throat or whatever, so they can be more of a professional. 

                                      So the Labor Party's, I feel, and I've said this to Julia Gillard, is please don't link it to bulk-billing, just put the money into the system and the doctors will do the hard work for you, and that's decide who needs not to be bulk-billed. 

CORDEAUX:                But the government can't make doctors bulk-bill.  Just, this is a fixation with the Labor Party, isn't it?

GLASSON:                   You're absolutely right, they can't make them bulk-bill.  To actually talk about 80 per cent bulk-billing targets is a nonsense in relation to the workforce situation.  If you had doctors on every corner with nothing to do, well, maybe you could get bulk-billing up to 80 per cent. 

                                      But the reality is that doctors have never been busier in their life, because there's very few of them out there.  And also they got burnt last time with this bulk-billing issue in the sense they tried to do the right thing.  Governments didn't fund it, and they never will by the way. 

                                      And the other concern about bulk-billing, Jeremy, is that when I bulk-bill, I work for the government.  when I rebate, in other words, when I just charge the patient whatever they get from the Medicare rebate, in other words I give them a bill, I work for them.  And my concern is that I want to work for my patients, I don't want to work for the government.  And once I start working for the government the government starts telling me what I can and can't do with the patients.  And this is what we're reaping the adverse consequences at the moment.

                                      So, on the Medicare side, I think that the Coalition are in front, only because of the fact they've got... they have unlinked it to bulk-billing, full stop.

                                      On the top side, now the government has got the safety net in place, we obviously support that safety net.  It's another form of Medicare.  It's just really -  I think that Medicare as exists at the moment is just a safety net anyway.  So you've got two safety nets, one at the top of the - one side of the cliff and one on the other side of the cliff.

                                      So for those who fall into that safety net, and that should be anyone of us who have a major medical expense, if our children get sick or I get cancer tomorrow, I'd like to think the system comes along and picks me up.  And it is there for those people who utilise medical services, you know, over and beyond the normal sort of amount.

COMPERE:                   Extraordinary, unexpected event.

BILL GLASSON:          Exactly, exactly.

COMPERE:                   Well I can't understand what the Labor Party's got against a safety net, a safety net sounds like a fairly good idea to me, quite a benign idea.  They say they don't want it.  Can you see the logic?

BILL GLASSON:          No I can't, I don't understand it because the reality is it's money that's going to the Medicare system, full stop.  It can either go into this Medicare system at the bottom, as I said, or it can go into the safety net at the top. 

                                      And I think, as I said, both are safety nets anyway and they pick up patients on either side.  If it needs to be jigged or re-jigged further down the line so be it but I think in principal it's a great idea.  And I'd just like the Labor Party to say: well listen, we'll look at it, we won't throw it out, we'll look at it and if it needs adjusting we will.  But I think to come out and say we're going to get rid of it I think it's unfortunate.

                                      Because I think the public out there who are utilising it at the moment - particularly our pregnant mums - they like it - particularly in that nappy belt sort of area - because it gives them two things: it gives them affordability and it gives them security.  And that's what patients really require.

COMPERE:                   Yeah.  Well it just sort of amazes me that the fixation is with bulk-billing when it should be with health.

It shouldn't be with ideology, it should be about that link between the doctor - and the idea of a co-payment seems to me to be a good idea.  I will think twice if I am putting in a bit myself.

BILL GLASSON:          I agree, Jeremy.  I think if you've got to put something in, even if it's a dollar, say to people just put a dollar in, it makes you think about the fact do I need to access that service or not?

And so our comment to both parties is that don't use the BB-word - the bulk billing word - use the AA word - the accessed affordability.

                                      Patients want to access a doctor in the first place, in an appropriate and timely manner, and they want to make sure that service is affordable.  Now what's affordable?  For some patients it may be zero or even a dollar, for other patients it may be $5 on a GP consultation or $10.  But as long as you feel as though you're getting value for money, you know, I go down the shop I buy something.  If I'm getting value for money I go back and I buy it next time.

                                      So I think that you're empowering your GPs, you're making your GPs feel as though they're worth something, and if there's something I would love to do as the President of the AMA in my two year term is to really re-empower my general practitioners because they have been demoralised, and they are sitting out there, you know, chipping away at the coalface really feeling undervalued. 

                                      Not so much from a monetary point of view - but that is an issue - it's really feeling undervalued from the personal point of view because they have really tried to do the right thing by the system, tried to do the right thing by the patients and as usual governments will screw people.  And they've screwed the profession - particularly general practice - by not indexing rebates properly such that doctors have been trying to provide services at a lower and lower cost and hence having to put patients through faster and faster.

COMPERE:                   And don't doctors have to spend more and more time, and more and more money, handling the bureaucracy?  Is it not over ...

BILL GLASSON:          Jeremy, the red tape is extraordinary.  Some of these GPs more or less spend a day a week filling out forms.

COMPERE:                   But why do you put up with that?  Why don't the doctors, through their union, just simply say 'no, this is silly?'

BILL GLASSON:          I mean what I say to my doctors is if you don't value yourself nobody else will.  You should just have a contract between you and the patient, forget about the government.

There can be contracts between patients and governments but you, the doctor, have to actually try and prove your independence and maintain independence of government, and that you should be there advocating for your patients to make sure the government gives your patient the most appropriate rebate that reflects the fee that you have to charge to provide the service - the quality service.

                                      And no-one talks about quality in medicine, it should all be about quality service that you the patient requires.

COMPERE:                   And just quickly, does either side of politics put any solution to the waiting lists?

BILL GLASSON:          Well, not really.  I mean the reality in the public hospitals is that we do not have enough beds.  And we don't have enough beds in our public hospitals and over the last 10 or 15 years we've reduced the number of beds in our public hospitals by about 50%.  And that was done with the view that because we're doing so many more day procedures that we wouldn't need the beds.

                                      But the reality is that we've got an ageing population, we've got a lot more people with much more complex co-morbidities - in other words multiple disease at any one time - and therefore the demands for these beds are actually greater now than ever before.  And so I as a surgeon often can't operate on my patients because I can't find a bed to get them into. 

                                      And so the reality is that the states have to have ultimate responsibility, they're the ones that drive the ship, they're the ones who actually deliver the policy.

The Commonwealth put half the money, or more than half the money in, Jeremy, and don't actually have - are able to get any accountability out of the system.  So the Commonwealth gets frustrated, so I commend the Labor Party's $1 billion they're putting into the system but the states have to put an equivalent amount of money into the system to try and balance that up.

Ends