Interview - Dr Kerryn Phelps, AMA President, with Nicole Haack, Radio 5AA - The declining number of doctors offering bulk billing

The number of doctors offering bulk billing is continuing to decline, and that means that those who can least afford it are having to find money to pay the gap.

Kerryn Phelps is the President of the Australian Medical Association, and she joins me now. Welcome to the program, and thanks for your time.

PHELPS: Hello Nicole.

COMPERE: Is my assessment of the current situation with regard to bulk billing fair - in terms of referring to it as a disaster zone?

PHELPS: I think it's a disaster for people on low incomes, although GPs have been propping that up, as they have done for many years, by subsidising Medicare for those people, even where they privately bill the majority of patients in their practice, they will still, I guess, do a kind of informal means test and provide a discount for patients who are disadvantaged, or who have chronic disease, or are perceived to be in need.

COMPERE: You referred to an informal means test on the part of some doctors. We saw yesterday that the Federal Health Minister has ruled out means testing accessing to bulk billing.

PHELPS: Mm. Yes.

COMPERE: What's your views on that?

PHELPS: Well she has. But I think we really do have to find some reliable way of working out which patients are genuinely disadvantaged. We have eight million Australians with access to a health care card, so that's a farce. Doctors can't rely on the health care card any more as a measure of whether somebody's disadvantaged, so we're going to have to look at a better method than that, and up until now, GPs have been either relying on that health care card, but those days are over, or they've been making an assessment themselves about a patient's means.

COMPERE: I saw that you were quoted as saying today that Government inaction has meant that bulk billing has passed its used by date.

PHELPS: Yes. Absolutely. I think, you know, if Medicare were a patient, you'd have to say it was terminal, and I think it's probably gasping its last breaths at the moment.

COMPERE: So I mean, we're not seeing any response. The Howard Government is saying that they're looking at their options and they're working on a plan to make the system more equitable. But as to what that plan involves - do you have more information than we do?

PHELPS: No. I'm told that the Government will consult us a little further down the track, but my preference would be for us to be consulted in any development phase, because I can tell them at a glance whether doctors are going to accept a plan or not, based on its philosophy and its general direction.

For example, GPs are not going to accept anything that requires more paperwork. The Productivity Commission yesterday released a survey that showed that paperwork - at the moment I think there were something like 46 separate Commonwealth Government programs - this is not counting state government programs - where GPs have to fill out paperwork and do red tape, and the cost of that, conservatively, is at least $10,000 per doctor.

So if you're looking at incentives for doctors that have this paperwork attached, it costs you almost as much, if not more, to actually retrieve the incentive payment in paperwork and administration as it does - as you're receiving from the Government.

COMPERE: And one of the issues, it would be fair to say as well, is that we have a shortage of doctors across Australia.

PHELPS: Yes, we have. And I think it's very misguided for people to say that in areas where there is a shortage of doctors, that's where bulk billing is highest. In fact - is the lowest. I think that's actually quite wrong to say that, because what we see is that where there are the highest levels of disadvantaged, no matter how many doctors there are, the doctors struggle on, trying to provide discounted services to their patients, even to the detriment of their own practice.

And so it doesn't follow market principles at all. What we really need to do is to step back and take a look at the whole system. How many medical students should we be admitting to medical school, how many people should we be training?

I mean, at the moment, if you're looking at people going into general practice training, a third are overseas-trained doctors this year. But we can't keep importing overseas-trained doctors to plug the holes in our own workforce, because other countries around the world are also facing shortages and are draining doctors towards them to fill their workforce problems as well - Canada and the U.K. are just two examples.

COMPERE: Well I know just on - I guess on a personal level, trying to get into the doctor nowadays - you're generally looking at sometimes a two or three day wait. And that's pretty difficult when you're not well and you really want to see your doctor.

PHELPS: It's very hard, and obviously it's a huge dilemma for the doctors too, because they want to be able to provide acute and timely service for their patients. There's nothing much you can do about it, you know? It makes it very difficult, and it leaves the doctors in a situation of having to close their books, and that means that anybody new coming to a town or to a district may well find it impossible to get in to see a GP and to have a general practice that looks after their primary care needs.

I think that's tragic, and it's something that we really have to address. We can't address that in the short-term - I think we need to look at long-term, medium-term, and short-term goals. The AMA has suggested a white paper on general practice. We've put together a framework for such a white paper, and it's something that I think is - has become a matter of urgency.

And I do think the time has come to move away from a focus on bulk billing levels, because I think that time has passed. I think what we now need to do is to focus on access and affordability. What is the access to a GP if you come into a country town, if you move into an area, can you find a GP who's appropriate to your needs, and can you afford, given your means, to pay for that service?

The other thing that I think we must move beyond is a notion that health care is free. Health care's not free - it's a matter of what balance you find between household incomes paying for health care, and taxes paying for health care.

And there is a combination of both of those things going into paying for health care now. The question is, where should the balance lie.

COMPERE: So if, for example, you're in a situation where you can't afford to see your doctor, or you can't afford that gap between the Medicare rebate and what the doctor's charging, how do we meet that?

PHELPS: Well, I think this is once again something that needs community consultation, and definitely consultation with patient groups and with doctors, because doctors can't subsidise Medicare - it's not fair to expect doctors to subsidise Medicare. But they have been.

Any doctor who bulk bills now is subsidising Medicare to the tune of about $25 a consultation. At least. And so, you know, that's just for a standard consultation with no added extra services being provided.

So that situation can't continue, and I've been saying it for several years now. And we've really reached a point now where it's evident to everybody that bulk billing can't continue - certainly can't continue in the way it was first envisaged 30 years ago, because neither side of Government has a plan in place at this point to be able to preserve bulk billing.

And I don't know that there is the will to preserve it, to be quite frank. So what we need to do is to look at how we best support those people, with a safety net, who cannot afford to pay that gap, whatever that gap might be, and we also maybe need to revisit this notion of people being able to insure themselves for what Medicare wont cover, which they can't do at the moment.

COMPERE: Well, I think we're going to hear a lot more debate on this issue, and I am aware of the fact that you don't have a lot of time to spend with us this afternoon, so I do appreciate the time you've given us...

PHELPS: Thankyou, Nicole.

COMPERE: And no doubt we will catch up and talk to you about it again in the future.

PHELPS: Talk to you again soon. Bye.

COMPERE: Thanks very much. Dr Kerryn Phelps there, who is the Federal President of the Australian Medical Association, on this issue of bulk billing, which we are seeing starting to disappear - well, it's been going on for several years now - it's been in decline, it's been in significant decline. In fact, suggestions that, you know, the Government knows bulk billing is in crisis - it's still working on a plan to make the system more equitable, to ensure that you have access to doctors, and that you're able to pay for that - or you're able to afford it, rather. It's just a question of how on earth they're going to do it.

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