Dr Kerryn Phelps, AMA President, with Chris Uhlmann, Radio 2CN

And it's worse when you cross the border to Queanbeyan. The electorate of Eden Monaro has the lowest bulk billing rate in the nation, with just 42 per cent of patients having the full cost of their trip covered.

So is bulk billing a thing of the past? The President of the Australian Medical Association is Dr Kerryn Phelps. Good morning.

PHELPS: Good morning.

UHLMANN: I guess you're not surprised about the decline in bulk billing around the country?

PHELPS: No. For some years, I've been saying that the rates of bulk billing will inevitably decline, and I think that we will now see an acceleration of that because of the medical indemnity crisis and the increased cost to doctors to run their practices.

UHLMANN: Why do we see such a big difference across the country, across different electorates?

PHELPS: Well, I suppose it has to do with the cost of providing services in a particular area and it has to do also with the number of doctors who are available in any given area. But I think we were seeing it first in some areas, for example as you've pointed out, Eden Monaro has one of the lowest areas of bulk billing in the country. But we will see that repeated right around Australia.

UHLMANN: So we're expecting a similar picture to emerge everywhere over time?

PHELPS: There's no question that bulk billing is on the way out. And the reason for that is that Medicare rebates, which is all that the doctors get when they bulk bill of $24.95, is just not enough to cover a doctor's costs and for them to be able to make a reasonable living.

UHLMANN: What would be a reasonable price?

PHELPS: Well, a reasonable price is somewhere between $45 and $50 on average. It might cost more than that in some areas to run the practices. It may cost a little less than that in some areas. So it just depends on where the doctor is practising and what their costs are.

UHLMANN: Should the Government chase that sort of figure? That would effectively double their Medicare bill for GPs?

PHELPS: Yes, but I think it's unrealistic for the Government to do that because it would add an enormous cost to the Medicare budget. However, if the Government does have a real commitment to bulk billing, then that is what they have to do. And how they go about that is really, you know, a matter between government and the electors.

But the thing that I can say is that doctors are no longer prepared to subsidise Medicare to the extent that they have done, traditionally.

UHLMANN: What does the AMA want? Would you like to see the Government attempt at least to try and get close to that figure? Perhaps go part of the way?

PHELPS: Well, I think what needs to happen is for the Australian community to realise that it costs money to provide medical services. And that the Government is not providing the full cost of that care now and they are not showing any intentions of providing it in the future. And so what we need to do is to, I think, to show some concern for people in the community who are disadvantaged and who may be put off seeing a doctor because of a $20 out of pocket cost or more. And I think that there needs to be a special plan in place for those people. The question is identifying the disadvantaged people.

Doctors no longer have any faith in the validity of the Health Care Card, generally, because there are so many of them that are issued. I think there are something like eight million Australians who have access to a Health Care Card now. So I don't think that's a particularly good way of determining somebody who is disadvantaged. So, you know, that needs to be cleared up. And there needs to be a plan in place to look after people who are disadvantaged so that they are not put off seeing a doctor because of an out of pocket cost.

UHLMANN: So in essence, though, you're calling for a root and branch change of the Medicare system?

PHELPS: Well, I think that the Government needs to really get a grip on the situation, particularly for disadvantaged people. And perhaps come clean for the rest of Australians and say, 'well, you know just like with every other type of professional service you receive in the community, you're going to have to make a contribution because the Government is not prepared to pay the full price of providing that service.'

UHLMANN: Finally, you spoke of rising costs to doctors, are you disturbed by comments from the liquidator of United Medical Protection, that it's going to take a lot longer than expected to work out the financial position of that insurer?

PHELPS: We're not at all surprised that the UMP liquidator has said it's going to take them longer than they expected, because we always expected that it would take longer. The time frame has been too tight from the beginning. And the main thing that we want to hear is that the government is prepared, if necessary, to extend its guarantee to UMP so that the appropriate reforms can be put in place in every state that will hopefully bring about a containment of the increase in costs.

But I believe that eventually we're going to have to see a fundamental change in the way that health care complaints are dealt with, rather than through the adversarial legal system. Because it's the adversarial nature of the way that adverse events are dealt with through the courts that has caused this dysfunction and the fact that some medical specialities have become unaffordable.

UHLMANN: Dr Phelps, thank you.

PHELPS: Thank you.

Ends