Interview - Dr Kerryn Phelps, AMA President with Richard Glover, Radio ABC 702 Sydney, 'Drive' - Monday political forum - The Federal Government's proposed changes to Medicare

GLOVER: Is the Government rebuilding Medicare or destroying it? Dr Phelps.

PHELPS: I think that at the moment it's in a holding pattern and I think that the Australian public will be in a wait and see pattern for some time now before we see what effect these reforms are going to have.

There are some Australians who won't notice any difference when they go to see their doctor. If they're currently bulk billed and their doctor continues to bulk bill then that will be what happens.

GLOVER: Sorry. Can I stop you there? Because many people in Sydney, certainly myself and about 85% of Sydneysiders, do go to a practice which bulk bills. There's been a great hurdle in the way of practices changing that because they all know that then we'll have to pay up up front, which means finding the dollars and we also have the hassle of claiming back the money ourselves.

With those barriers removed, the convenience the Prime Minister is talking about, won't all the surgeries decide not to bulk bill any more or at least add a payment?

PHELPS: The question is this. We've see declining bulk billing rates over the last three years particularly. They've gone down to under 70%. The latest figures are out soon and I suspect that we'll see a significant decline under 70% of services that are bulk billed.

So some people are already paying, particularly if you live in parts of the major cities and in the bush, people are used to paying a private account for seeing the doctor. It will make it easier for some doctors to stop bulk billing the people who are not health care card holders.

The question is whether it was going to happen now or at some time in the future and the question that the government faced was whether they were prepared to fully fund Medicare which would have cost in the order of a billion dollars a year extra or whether they said, well, the money has to come from somewhere because doctors can't continue to prop up Medicare. It's either got to come from taxpayers, and they've made the decision that it won't, or it's got to come out of household budgets, that is people who can, in the government's eyes, afford to pay a gap on top of the rebate to see the doctor.

Medicare has been underfunded for many years. I've been saying that for quite some time and the decision has been made that the Government is not going to be able to afford or has said that they can't afford to pay what it costs.

GLOVER: OK, but make a prediction. Will it end up, as Labor says, a two-tier system in the end where middle class people will go ahead and basically buy their own health care whilst Medicare will exist as a safety net for poorer Australians?

PHELPS: I think there has been a seismic shift in the ideology of Medicare from being a fundamental payer for out of hospital services, as it was, I guess, meant to be in the beginning, although there was never any compulsion on doctors to bulk bill, it was just convenient for most, and it's really shifted to being more of a safety net for the disadvantaged.

The question of how good a safety net remains to be seen. I think it's very important that there is a form of safety net in place so that families who have a high burden of disease, for example if they have a number of kids with chronic illness like asthma and so forth, have a certain maximum that they have to pay out of pocket before Medicare kicks in at a higher level and traditionally my colleagues have always discounted their fees for people who they perceived were in a difficult position in paying medical fees so that they didn't miss out.

And I suspect that a lot of that will continue to happen but it's difficult for practices to continue to operate, they can't be viable in many instances if they continue to bulk bill all of their patients so some hard decisions are going to have to be made and GPs are just going to have to look at their practice finances and say, well, what can I do here?

GLOVER: OK, but just quickly, a lot of Sydneysiders are going to end up paying more for a visit to the doctor than they do at the moment. Surely.

PHELPS: It was either going to be more out of their taxes or more when they go to see the doctor so there are some who will find that when they go and see a doctor, if the doctor opts into this scheme to bulk bill all concession card holders, and privately bill non-card holders, they won't be up for the full fee up front, they will be up for the difference between the rebate and the fee the doctor charges.

GLOVER: There's the more convenient system. Michael Costa, is it rebuilding Medicare?

COSTA: It's certainly not rebuilding Medicare at all but let me say, with due reference to my colleague, the Minister for Health, Maurice Iemma, that we do have some concerns from the New South Wales government point of view. There needs to be a proper debate about the future of health care in this country.

The area of prime concern for us is whether this change - and we have to look at the details - means that more people will end up in our emergency departments in hospitals. Now, that is not good news for anybody and that will be the real test of what's been announced today, whether we put more pressure on the public hospital system and the government, the Federal Government, really does need to ensure that the funding is there because that's a possible likely consequence.

GLOVER: OK, but for the 30% or, as Kerryn says, it's growing, it might even be 32% of people who are currently going to a doctor who doesn't bulk bill, this is great convenience, isn't it? You don't have to pay up front, which can be crippling for a family budget, you can just pay the gap and there's the convenience of not having to claim it back yourself.

COSTA: The State Government's open-minded about discussing changes to the hospital system as long as the result's a better result for everybody in the community but if you're pouring people out of general practitioners into the hospital system, into emergency departments, that's not a good result.

GLOVER: Kerryn Phelps, just quickly, do you think that will happen?

PHELPS: I think we have to wait and see but there's no question that there is a greater strain on public hospitals where people perceive that they cannot afford the money up front to go and see a doctor. That's something that's going to have to be monitored.

GLOVER: Major General Peter Phillips is with us from Canberra. What do you think about the changes?

PHILLIPS: I must say, from a personal viewpoint, I'm just delighted that I won't have to go along to get my money back after visiting my doctor but my real concern in this whole issue was for veterans, particularly those on the gold card, and we've got over 180,000 World War II veterans, all in their seventies and eighties who were relying on the gold card and when doctors opted out it was a real concern for them.

GLOVER: So those people, do you think this will be a better system because it will encourage more people to keep in the system?

PHILLIPS: Of course, the veterans have been given a separate arrangement. It won't be tied to acceptance of this program. It's $3 over the 100% of the scheduled fee. It remains to be seen whether doctors accept that but it seems a fair offer to me.

I'm particularly concerned about rural areas, as to whether doctors in the rural areas will pick up the offer.

GLOVER: OK, but they were having problems under the existing system, were they, they gold carders?

PHILLIPS: Yes, I think the doctors who were opting out of the gold card arrangements - there were quite a number - but the real concern was in country areas.

Ends