Dr Kerryn Phelps, AMA President - Radio 2GB

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RICHARDSON: With me is Dr Kerryn Phelps, the boss of the AMA - the Federal President - she's on the line. Hello, Kerryn.

PHELPS: Hi, Graham.

RICHARDSON: Now, you heard what Michael Wooldridge had to say. In terms of this gap, I think you'd agree, wouldn't you, that it would be better if doctors did tell their patients, in advance, what they're in for?

PHELPS: Yes, it's definitely the AMA policy, and has been for a long time…

RICHARDSON: …that's right.

PHELPS: …to have informed financial consent, and I think we have to look at a couple of the arguments that the Minister made. But first, he said what a tremendous thing it was that

70 per cent of hospital services are now no-gap and then said that the voluntary code is not working. Well, indeed, that would say to me that the voluntary code, indeed, was working. If the 70 per cent of services provided no-gap, of that remaining 30 per cent, I would say, the vast majority would involve informed financial consent.

RICHARDSON: We don't actually have a figure on that, do we? We don't know how many of the 30 per cent didn't know what they were in for or whatever the correct supposition is?

PHELPS: Well, that's right. And, I think, introducing a sort of mandatory code would be unnecessarily punitive, and quite unnecessary under the circumstances. And the other thing that I think we need to be very wary of is that the reason for the gap is not "excessive" medical fees, it's in fact the deficient Medicare Benefits Schedule (MBS). And you would be aware of the Relative Value Study which was a six year study that looked at what the real value of medical services ought to be and it found that the MBS, and that's what these things are rebated on, so, for example, all health funds are pretty much tied to the MBS, or a percentage of it, and if that's deficient, then the gaps must be bigger. So, the only way we're going to actually address this gaps issue in a really healthy way is to have a look at what the rebates are and …… set the MBS on a realistic level.

RICHARDSON: …there's no question about that. Personally, as Health Minister, I wanted to do this but the Labor Party didn't like the idea. I always thought that some form of gap insurance was absolutely necessary, because I just thought it would be impossible to hold people in private health insurance unless you offered it. But I think we'd all agree it would be best if more and more doctors came to somewhere near an agreed fee, wouldn't it?

PHELPS: Well, of course, the ACCC won't allow doctors to discuss an agreed fee. But we also don't believe that the health funds should be the ones to set the fees, particularly given that the Commonwealth MBS is way behind, in fact, probably decades behind where it ought to be. And the RVS will attempt to actually address this issue, and we have final results of the RVS, and it's really a matter of the Government sitting down with the AMA and saying, 'Well, where do we go from here - what can we do about this issue?'

RICHARDSON: Can I ask you, with the RVS, working it out, and how you charge for these things, or how doctors charge…I can remember the thing that infuriated me about the Schedule was that, basically, doctors who are ophthalmologists doing laser surgery on eyes were getting paid the same amount of money for operations that used to take some hours to do, the same thing which required, obviously, a different skill rather than pointing a machine at something and doing it that way. Now, clearly, they couldn't do the 10 or 12 operations a day, they can do 12 or so a day now. Does the RVS suggest that that should change?

PHELPS: Yes, it does. There have been a number of operations, particularly where the technology has improved and the skill levels have improved to a point where they do take a lot less time, and no less expertise, I have to say, but less time, and things like cataract surgery, simple prostate surgery, arthroscopes - that sort of thing - have actually come down in cost, whereas things like consultative processes, services issuing from a general practice practitioner…the recommendation is that they need to be increased.

RICHARDSON: …If you visit a GP, according to the Relative Value Study you are getting it too cheap right now…

PHELPS: …very much so. The RVS showed that the average 15-minute consultation should be around the $45.00 mark. At the moment, it's rebated at about $23.45. So, it's way behind. So, you know, this is the whole thing, if you're looking at procedures, there are a lot of the procedures that are behind the mark, fairly significantly, and particularly in areas like obstetrics and gynaecology.

RICHARDSON: You know, I actually think that there's not much question that you are right about that, and I hope that it gets sorted out. It would require some sorting out by governments over a period of years, it would cost too much to fix it in one year. But they ought to start trying, that's for sure. Thanks for talking to us, Kerryn.

PHELPS: Pleasure.

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