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Dr Kerryn Phelps, AMA President, with Alan Jones, '2GB'

JONES: A big issue that you're addressing from time to time and in your correspondence is this question of bulk billing, which is fast becoming a thing of the past. Even major medical centres, we're now told, which until recently had total bulk billing, have cut back. Some of them have now stopped bulk billing at weekends or on weekdays after six, and the medical centres were really the last bastion of bulk billing.

But no doctor can afford to see patients for just over $22 to $24 a visit, which is the medical schedule fee. And the cost of running a practice has skyrocketed, particularly with the blowout in medical indemnity insurance. But still, the Federal Government refuses to adjust the rebate.

It's the most vulnerable who are suffering the most, people like Keith, an 81-year-old World War II veteran who wrote to me. He's a Gold Cardholder, so you'd think he'd get the best care available. But Keith has just been informed by his orthopaedic surgeon that he can no longer accept his Gold Card. The surgeon said he had to reluctantly make the decision not to see Veterans' Affairs pensions because the rebate is so low he can no longer afford it.

So if Keith, an 80-year-old war veteran, wants to see him, he'll have to pay the up-front fee. Surely to God, if anyone's entitled to free medical treatment, he should be. Yet, because Medicare is a total mess, he's not. And all the Government seem to be wanting to say is that if your doctor starts charging, find another one. Hardly an answer.

Kerryn Phelps has had something to say about this. She's the federal president of the AMA and she's on the line.

Kerryn, good morning.

PHELPS: Good morning, Alan.

JONES: What should happen?

PHELPS: We're very worried about people like Keith and others who are on pensions and low fixed incomes who just can't find the money up front quite often to have their operations done, and so they have to wait longer for them or they have to think twice about whether they see their doctor.

Many doctors, of course, are still discounting their fees quite heavily by bulk billing or reducing their fees. But I don't think that we can afford to, as a community, take a haphazard approach to what's happening with Medicare, and I would certainly like to see the Government sit down with the medical profession and, in a very serious way, say 'Okay, we now recognise that there is an issue here and what are we going to do about it.'

JONES: Wasn't there a relative value study commissioned by the Federal Government several years ago which recommended the fee be raised to $38?

PHELPS: Well, by the end of December 2000, the results of this came through and it found that a standard GP visit, for example, was at that time around about $45. It's now at $50 because we've been using that same…

JONES: That's in a relative value study?

PHELPS: That's in a relative value study, which was sponsored by the Government.

JONES: I mean, it costs more than that for a plumber or an electrician, doesn't it?

PHELPS: It certainly does. And this is one of the reasons why we are seeing the demise of bulk billing because doctors simply cannot afford, as small business operators, to continue to pay their staff, pay all of the costs that they have to pay, and provide a quality service for virtually no profit.

JONES: So basically, the system is under siege, isn't it?

PHELPS: It is under siege, and we're seeing in particular areas - it started really in the rural areas where bulk billing virtually collapsed many years ago and it's certainly hitting the cities and the outer metropolitan areas now because doctors are realising that they can't look to government to solve this problem now and they're having to charge.

I mean, there are solutions. It's a matter of government having the will to sit down with the medical profession.

JONES: But when are we going to admit, ……, the lie of free universal health care? That is a lie. It's not free and it's not universal, is it?

PHELPS: No, it's not and it never was. Our Medicare levy has never paid for the cost of medical treatment, and doctors have to pay their costs like any other business people.

JONES: Haven't all state health ministers written to Senator Patterson, the Federal Health Minister, demanding the schedule fee be increased?

PHELPS: Yes, they have because there is pressure now on the state's public hospital system because people who are not willing to pay a fee to go and see their doctor or not able to pay it are increasingly visiting emergency departments, and that's putting an increased strain on the state's hospital emergency departments.

JONES: Yes, absolutely.

PHELPS: Patients who should be seen in general practice. But the Gold Card issue is another issue again.

JONES: I mean, can I just ask you - I should have asked you this before, Kerryn. Sorry to interrupt you there. Is the rebate for veterans actually lower than the normal Medicare rebate?

PHELPS: The rebate for veterans is a little above. But the problem was that the Gold Card system was supposed to be a compensation measure for people who put their lives on the line for this country and provide them with basically the equivalent of private medical care.

Now, unfortunately the amount of money that has been allowed for this so-called private care has been eroded to the point where it's worth a lot less than private patients. And so doctors who are running their businesses are saying, 'Well, unless the Department of Veterans' Affairs and the Government do their bit, I don't see why doctors should be discounting those fees.'

JONES: Absolutely. But I mean, there's got to be an answer other than say, 'Oh well, if your doctor starts charging, go and find another doctor.'

PHELPS: Well, that's a real worry because one of the mainstays of good medical treatment is continuity of care...

JONES: Continuity, yes.

PHELPS: …and having the one doctor or one small group of doctors, specialists and so forth who are very mindful of your case and your situation and who you can turn to in times of need. And to say, 'Oh, just go and see another doctor is really ignoring that important fundamental of medical treatment.'

JONES: Do we abolish Medicare?

PHELPS: I think we still need to have a form of universal health care. I don't think we should go down the American path where they have 44 million people uninsured and with very little access to good medical care. And Medicare really has underpinned improvements in health care in Australia. But we do need to make sure that it's properly maintained and we do need to make sure that the disadvantaged are looked after.

Now, whether that means increasing the rebate for people who are genuinely disadvantaged so that they don't have as much of a gap to pay or whether it means saying let's go back to looking at Medicare as it was intended to be, which is a health insurance scheme, so that you go to the doctor and maybe the doctor can accept your rebate and then pay a co-payment on top of it to cover the doctor's extra costs.

Now, there are a number of different ways you can approach this.

JONES: Yes, it needs debate, doesn't it? It can't go on like the way it is at the moment.

PHELPS: I've been raising the debate because we are also, at the AMA, getting a lot of phone calls and faxes from people saying, can you represent us here and do something about it.

JONES: That's dead right. Same here. We'll keep in touch with you.

PHELPS: Thank you, Alan.

JONES: Thank you for your time. Big issue that, and it certainly needs widespread debate. Basically, the Government's going to have to come up with the money. You can't go on paying $24 to a doctor and expect the system to prevail.

Ends

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