Speech to the AMA Parliamentary Breakfast, President of the AMA, Dr Kerryn Phelps
Parliament House, Canberra

Honourable Members, Senators, AMA Federal Councillors, ladies and gentlemen - good morning.

I won't talk for too long, because I am sure you will have a few questions about the major health issues of the moment and I will be happy to answer them.

This is the first AMA breakfast for many of you, and maybe even your first experience of the AMA up close and personal as it were.

For your benefit, I will tell you a little bit about our organisation before moving on to what we see as the big health issues in this election year.

The Australian Medical Association - AMA

The AMA is an independent organisation that represents more than 26,000 doctors across Australia - in the cities, the suburbs, the regional centres, the country towns, and in the outback.

Our members are specialists, GPs, salaried doctors, teachers, researchers and young doctors.

The AMA is the only truly independent voice for all GPs in Australia.

The AMA is the public face of Australian medicine.

Our members see millions of people every week. Our patients talk about their own health, the health of the health system and the health of the nation.

The AMA is a broad-based, grassroots organisation.

Our policy - our direction - comes from the bottom up.

It's the doctors in general practice around the country, the doctors in the hospitals, the specialists - the people at the coalface of medicine - who steer the AMA ship.

If the members aren't happy with the leadership and the direction of the organisation, they don't renew their membership.

I'm pleased to report that our membership is currently on the rise.

In representing our members, the AMA is an agent of change, a voice of reason, an independent leader of social values, and a champion of social equity and social justice.

Doctors are trusted and respected members of the community. People listen to doctors.

The AMA listens closely to its members through meetings, surveys, fax polls, focus groups and day to day one-on-one contact.

And doctors are not happy with some key elements of the health system in Australia today.

On that note, I'd like to talk now about some of the major health policy problems as identified by the AMA - as identified by doctors and their patients.

The Relative Value Study - RVS

R - V - S spells Medicare.

The RVS - or Relative Value Study - is a six year joint AMA/Government study of the Medicare Benefits Schedule, which was backed by both Labor and the Coalition parties.

The Medicare Benefits Schedule has not been comprehensively reviewed for nearly 30 years. A lot of change to clinical practice has occurred in that time.

And a lot of change to the costs of running a medical practice has occurred in that time. For example, medical indemnity insurance for most specialties could have been purchased for $100 in the 1970s. For some specialties in some States, it now costs well over $50,000 a year. More on that a bit later.

Conducted jointly by the Government and the AMA, the RVS shows the huge cracks that are appearing in Medicare.

Unless the Government acts and acts now, universal health care under Medicare will be a thing of the past.

A 15-minute GP consultation is currently valued at around $27.00. Compare this to other professionals. Our independent modelling of the RVS shows that the real value is around $44.00.

We support doctors being able to charge a gap above the rebate but the gap must not become a chasm, particularly for rural patients and needy groups.

With our Budget Submission - you should all have a copy - the AMA has offered the Government a plan to revive Medicare.

We have put forward a plan for affordable health care for the next 20 years.

The cost of fully funding the RVS is at least $1.5 billion a year, starting this year with the May Budget. That is the extent to which Medicare has fallen behind the cost of providing medical services.

On behalf of doctors, patients and the future of the Australian health system, the AMA is today asking all the political parties to "Say Yes to the RVS".

Any political party wishing to claim a commitment to Medicare will need to commit to implement the RVS. The alternative is that the decline in bulk-billing seen in the past four years will continue to drop off and Australians will be paying bigger and bigger gaps. This will not appeal electorally.

Doctors support Medicare.

Patients - voters - support Medicare.

All politicians should support Medicare.

Supporting Medicare is not the same as supporting bulk-billing. There are advantages in patients paying some co-payment for services.

You will note from our budget submission that the AMA is equally committed to our public hospitals and the aged care system. They need to be adequately funded. They are not at the moment.

Federal/State cost shifting and blame shifting on hospitals and aged care issues must be addressed through national leadership.

We are calling for more funding for indigenous health.

We need to do more to combat smoking, alcohol abuse and illicit drugs.

We need funding to keep young people aware of the ill effects of smoking, alcohol and drug abuse.

More needs to be done about mental health.

And we need to provide a whole range of services and support to GPs - the face of the health system for most Australians.

Good health policy is central to social cohesion and social equity. If the health system's suffering, so is the community.

The AMA Budget submission is not a wish list - it is a needs list.

Trade Practices Act

If the Australian health system needs a doctor, the Australian health system also needs a vet because the competition watchdog has distemper.

Professor Fels has accused the AMA of running a scare campaign on rural doctors.

The only people scared are the doctors who have to become trade practices experts if they are to work cooperatively with colleagues on rosters, work sharing, negotiating with hospitals or determining which patients to bulk-bill.

We have raised our concerns over and over again - in meetings and in writing - with Mr Fels and the ACCC. Their replies are via press releases and news bites, but never provide an answer.

We have also spoken with all the major parties.

John Anderson has realised the extent of the problem and has offered his support to rural doctors. We hope other politicians will join him.

Medical Indemnity

Mr Fels is not the only scourge of the medical profession.

Most doctors are suffering under the weight of medical indemnity insurance premiums.

This is not a problem - this is a crisis, particularly for specialists such as obstetricians and neurosurgeons.

Very few, if any, rural doctors - specialist obstetricians and gynaecologists or GP/obstetricians - can afford the premium required if they are to continue to deliver babies.

We are not escaping from cases of genuine malpractice. These cases will continue to be pursued, and rightly so.

The blowout in premiums is being driven by relatively few but an increasing number of very high cost awards - some over $10 million - which the system just cannot afford.

However, often plaintiffs get nothing or very little, and legal costs absorb over half most awards.

Only one-third of doctor indemnity premiums go to compensation awards to patients injured by negligence. The rest goes to lawyers and administration.

The system is slow, costly, unpredictable and frequently unfair to the patient, the doctor, or both.

Because of this situation, some areas of Australia are seeing not just services disappear, but doctors too.

I am pleased that after almost a decade of AMA work and lobbying, the NSW Government recently made some moves in the right direction in tort law reform.

The AMA is hopeful that other states will follow suit and that the NSW initiatives lead to further reform.

At a Federal level, we are pushing for a system of structured settlements for indemnity cases to allow periodic payments to replace lump sum awards.

This involves relatively easy change to the taxation system. Such change is strongly supported by the states, doctors, patient groups and insurers and would be revenue positive for the Commonwealth.

We seek your support in this area.

Corporatisation

A development in the news a lot lately is corporate medical practices.

Corporatisation is the latest trend in medical practice as doctors seek more security and flexibility in their lives by letting someone else worry about the ACCC and all the red tape and bureaucracy that now swamps general practice.

The AMA does not oppose corporatisation per se, as long as doctors are not put into a situation where their clinical independence is threatened, or where they face a conflict between profits and best practice.

We are actively developing a range of proposals to put to the big corporate groups so that we are effectively representing doctors who have joined or are considering joining a corporate group.

We want to help doctors make an informed decision and protect the rights of patients.

Fundholding

Speaking of informed decisions, the AMA is informed and has made a decision on what it thinks about a process called 'fundholding'.

The Department of Health and Aged Care is actively pursuing fundholding and senior members of the Department have confirmed this to us.

The AMA actively opposes fundholding.

Fundholding occurs when individual doctors or groups of doctors are given a budget to cover the delivery of health care in, say, a particular region, and are told to ration services to meet the budget.

It is not clear whether this is formal government policy or something the Department itself has decided to pursue.

Either way, it is a practice that has been a disaster in the UK that should not be encouraged in Australia.

I've talked for long enough. In closing, allow me to reiterate where the AMA sits in the health policy scene.

Conclusion

The AMA is an independent organisation.

We represent a large and influential number of Australia's medical practitioners.

Through them, we represent the views of millions of Australians - the patients, the users of the health system.

If patients have a complaint about the health system, we know about it.

If patients praise elements of the health system, we know about it.

If patients or doctors think the health system is sick, we act.

And that time is now.

The AMA is not party political.

If the Government does something we think is good, we say so publicly. We did that with the private health rebate and Lifetime Health Cover.

If we think more needs to be done, we say so publicly. We are doing that with the RVS and our calls for the revival of Medicare.

We know the Australian public is listening.

We hope Australia's politicians are listening.

The AMA has a health plan for Australia. We hope all the political parties pinch it in its entirety for the coming election campaign.

Thank you.