AMA Doorstop Transcript - GP co-payment - President A/Prof Brian Owler

Subject: GP co-payment

BRIAN OWLER: Alright, well thank you everyone for coming out this morning. I want to talk about two issues on behalf of the AMA. The first one is obviously around the new GP co-payment proposal, and the second thing I wanted to talk about was road safety over the Christmas period.

First of all, in terms of the new co-payment proposal. The AMA was pleased that its efforts in terms of advocating for vulnerable patients, carving out those concession card holders and under 16s from the co-payment proposal was successful. But what we are not pleased about are some of the other measures that have been introduced as part of this proposal without any consultation with the profession.

Over the past week, the AMA went out to its members and asked our GPs what they thought of the new co-payment proposal and what we received back were some of the angriest emails the AMA has received over any issue in a long time. There are three elements that have angered GPs. First of all is the rebate cut. We know for non-concession patients over 16 there will be a rebate cut of $5, and GPs will be able to charge that $5 directly to the patient. Again, this is taking money directly away from general practice; it means that there are more costs for patients going to see the GP.

The second issue is the rebate freeze. Now, the rebate freeze applies not only to general practice but of course to specialists. It is a rebate freeze over the next four years. We have already had rebate freezes over the past almost two years, and for the viability of any general practice, but any small business, to have a freeze of that duration and expect people not to be able to have to pass on those costs to their patients is certainly inconceivable. So it is absurd that we have a situation where we have a freeze in rebates, and we're not being expected to pass those costs on directly to patients.

Now that affects of course not only the non-concession group, but also the concession group. And over time, as the rebate no longer reflects either the cost or the value of the service provided by general practice, but also specialists, it is only going to be the case that people are going to have to pay more out of their own pocket.

The third aspect of the co-payment proposal is perhaps the one that's angered our GPs the most, and that is the change in terms of the level A and level B rebates. So, previously the differentiation has been on complexity; the Government has now said that they will change the regulation such that consultations taking less than 10 minutes will be level A consultations. Now as many experienced GPs have said to the AMA, those experienced GPs that are efficient, that can actually diagnose a problem by examining the patient and taking a history, and prescribing a management plan and explaining that to the patient, that can be done for many patients in eight or nine minutes. We had an example only yesterday provided to us of a young woman with a breast lump who could be- have a history taken, an examination, a management plan, referrals for the appropriate test, and also an explanation as to why that GP felt it was a benign lump but why it needed to be investigated. And that can be done within eight of nine minutes.

Now why that should- that consultation, that quality care, should be worth only $11 now, compared to the $37 that it was worth last week, is certainly not something that the AMA supports and we will be lobbying hard to make sure that that change is disallowed in the Senate.

I just want to talk about road safety over the Christmas period. As a neurosurgeon, particularly a paediatric neurosurgeon, in NSW many people know I've been involved in road safety campaigns over the past four years. The reasons I do that basically are because of the heartache that we see in the families and also the victims of road trauma. All doctors involved with treating victims of road trauma experience this. Dr Parnis is an emergency physician, he knows full well the impacts of road trauma, the people that have to come to the emergency department, the lives that are lost - but also the many injuries that we see.

Last year, the road toll was lower over the Christmas period, it was 28 across the country compared to 47 the year before. My plea is again this year that people don't speed on our roads, but they also take time to think about the decisions that they're making: whether they should overtake someone, whether it is safe to do so, to drive the conditions, to manage fatigue. But the most important thing is not to speed, and I think just to display some judgment and to think carefully about the choices that you make on the roads.

Many of the victims and the tragedies that we see are good people making bad split-second decisions. So please, we want a quiet Christmas. We want to make sure people are safe, spend it with their families, and enjoy the Christmas and holiday period. And so that is my plea to people on our roads.

Happy to take questions.

JOURNALIST: Mr Owler, what do you think the impact of the new co-payment proposal and the other Medicare changes will be on people with chronic illness who might have to see the doctor quite regularly but may not have concessions?

BRIAN OWLER: Well there is clearly going to be more cost. And so it is not only going to be about the $5 in terms of the optional, so-called optional co-payment. I mean, every GP practice is going to have to pass that payment on, that cost on to their patients. But I think the long-term issue is, particularly with the rebate freeze, we are going to see the value of the Medicare rebate - which is the patient's rebate - actually be devalued such that the cost, but also the value of the service that is being delivered actually bears no resemblance to what the Medicare rebate is. And I think that's a real issue for the Medicare system, for our health system, and for all Australians. And so whether you have got a chronic disease or not, those people that need to see their GP, those people that need operations, are going to have to pay more out of their own pocket.

I think the rebate freeze for specialists is a really important one as well, because what that affects is not only the rebate in terms of the Medicare rebate, but the rebate in terms of the schedules that our private health insurers have. Last year we saw- or this year rather we saw Medibank Private not pass on any indexation. It said we're not indexing our schedule until the Government does. Many health funds did so, but we don't know what they're going to do over the next four years. And so what's going to happen is that as specialists, and GPs' practice costs rise, they're going to have to stop bulk-billing, they're going to have to stop using no-gap schedules, and people are going to have to pay start to pay more out of their own pocket.

I think that's a question for all Australians is is that the direction that they want the health system to go? Now, we have been talking about the sustainability of the health care system, but I think we need to protect some of the foundations of our health care system as well, and I think there needs to be a conversation about what we want the health system should look like.

I would very much like to also move away from the discussion about co-payments and cuts that are being made. There are a whole range of issues to do with quality practice, issues that we can actually address, some of the ideas that help us address some of the issues around chronic disease management, that require some investment but will pay off in the long term. That is the sort of nuanced policy discussion that we should be having with Government, not these discussions about the effects of all of these cuts that are going to have on the hip pocket of all Australians.

JOURNALIST: What is the cumulative impact of those changes to the rebates? How much would that be passed on to patients?

BRIAN OWLER: Well for instance, GPs are not going to be able to continue to bulk-bill the number of people that they've been doing so now. Now, there are some concessions there for the concession patients and those under-16s, but as I said, over time this rebate freeze really starts to take effect. There will be many GPs that are even questioning that. Certainly the cut to the rebate will mean that every GP will have to pass that $5 on, that is not an optional co-payment. And of course this change in the level A and level B rebate is a real- probably bites the most. Because there will be many consultations - in fact 26 per cent of consultations that were level B consultations will now be level A. And so those consultations, those rebates will go from $37 to 11.

So to think there won't be implications for access, but also the costs and the- which will have to be passed on to patients, I think is inconceivable. So, again, we have this absurd situation where the Government has introduced these changes, these changes to the level A and level B rebates in particular, that they want introduced on 19 January. The explanatory note said that there was no reason to consult with anyone on this, so there was no regulatory impact statement. I think it is an absurd situation that you can introduce these things, which they say are minor changes but impacting greatly on general practice, without even consulting with the profession in any way.

And I ... this is not the way to run health policy. We're very happy to talk to the Minister and the Government about the impacts of these changes, but that should be done before the announcement. Now we're going to have a situation where over the Christmas period where we've got practice managers on leave, locums seeing patients, a slowdown for most practices over this period, trying to introduce changes to their whole practice, to 26 per cent of their consultations which would fall now within level A, compared to three per cent before. I think that is an enormous burden on those practices, which at the end of the day are small businesses, and for a Government that wants to not only rebuild general practice but is also about small business, I think they're incredible changes to be making without any consultation and in such a rushed manner.

JOURNALIST: Dr Owler, there's three elements to the changes the Government has announced, yet it's only letting GPs charge $5 of those cuts. Has the AMA calculated the cumulative effect of the loss to doctors' incomes of those three measures?

BRIAN OWLER: Well I think it's not a matter of loss to doctors' incomes. What we're going to see is $3.5 billion pulled out of general practice. That's what it amounts to. The level A and level B change for instance takes $400 million per year out of general practice.

Now, general practice cannot survive those sorts of changes. So it won't be a change to doctors incomes. What it will mean is that GPs will be forced to pass these changes on to their patients in terms of costs. As our costs rise for staff, for rent for rooms, for indemnity, for sterilisation of equipment, all of the costs which are fairly significant in running a general practice, those costs will be rising over this period of the next four years as well. GPs will not have a choice, they will have to pass these costs on to patients, so this really-

JOURNALIST: But that's what I'm asking you. What is the size of that cost [indistinct]?

BRIAN OWLER: Well that $3.5 billion that the Government is saying will have to be passed on to patients. So it won't be a cut to doctors of $3.5 billion, at the end of the day these costs will have to be passed on to patients, it will hit their hip pockets, and I think people need to understand that that is what these changes mean.

JOURNALIST: There's some estimates of a $45 hit within three years reported this morning. Does that ring true to you?

BRIAN OWLER: Well look, I think that could be a conservative estimate in some cases. We have had other estimates that are much higher than that. But I think at the end of the day people are going to have to start changing the way that they approach billing of patients. Now, bulk-billing is certainly valued by the community, but also valued by general practice- practitioners who know that particularly sick patients, there is a safety net there, they can bulk-bill those patients. There's some patients that it's quite appropriate to bill privately, they can afford to contribute to the cost of their care and the AMA has always supported that. But I think we need to realise the magnitude of the changes that are going to be made, and the magnitude of the costs that are going to have to be passed on to patients.

It's going to be very difficult for us to actually at this point in time say what that is going to mean for each particular patient. But for instance, just the level A and level B change means that instead of the doctor now getting a $37 rebate, that the rebate is going to be about $11 for a level A consultation. Even though they're providing quality practice, quality general practice within that eight or nine minutes. And I think that's a real problem.

Now, the other thing to say is that the AMA does not support practices that are purely based on volume. We are not supportive of practices that just want to push people through within six minutes. We've always said that. But what we are hearing from our GPs, from our experienced practitioners in particular, is that the 10-minute floor on the level B consultation is going to impact on their ability to see the number of patients that they need to; it's going to impact on the ability of patients to access general practice; and there are going to have to be changes made to the way people bill. They will have to pass those changes on to patient.

And I think GPs are feeling very insulted by these changes. A, that there was no consultation, but B that an experienced GP, sometimes dealing with a complex problem, who can deliver quality general practice, their time now is only worth $11. And I think that is raising a lot of anger amongst our general practice member.

JOURNALIST: Is this likely to increase the waiting times patients face to get in to see their GP?

BRIAN OWLER: Well look I think we've always had an issue in general practice of people being able to access their GP in the time that they would like to. Sometimes people have to wait a few days for appointments and we'd like to see that improve. Now, if GPs decide that they have to spend extra minutes with a patient just to make up- to get up to the 10 minutes for the rebate, that means that there will be less slots available for consultations, they will be able to see less patients in that time period. And that will mean that appointment times will have to increase and access will be more limited. And I think that is a real problem.

Again, all of these impacts which really should have been considered before these announcements were made have not been. And that should have been done prior to the announcement to make sure that GPs had the time to inform the Government of what the real impacts of these changes are going to mean, and how the profession was going to react.

JOURNALIST: Can I just ask you about the siege and the argument we're now having- debate we're now having about gun laws, and some people are calling for gun laws to be liberalised. What would doctors say to anybody calling for a weakening of gun laws given [indistinct] doctors deal with the trauma of gun violence all the time?

BRIAN OWLER: Well thankfully we don't have to deal with gun violence all the time, but I can tell you it's a growing problem, particularly in places like Western Sydney. You've only got to listen to the media reports to hear the number of people wounded, taken to hospital, particularly places like West- sorry, like Westmead with gunshot wounds. I think it would be a very bad move to suggest that we would be loosening gun laws. You have only got to look at the statistics from the United States and compared to Australia to know that we're a much safer society by having less guns on the streets. And I think loosening the gun laws is a ridiculous reaction to the problem that we have seen and the sadness that we have seen with the Sydney siege.

JOURNALIST: Would you like to see them tightened?

BRIAN OWLER: Well I think that has always been a question. I think we've probably have the right balance at the moment. I think the real issue is not about tightening the gun laws particularly for people like farmers, I think the real issue is making sure that the illegal guns that are on the streets are taken off the streets. There are far too many illegal weapons that are around at the moment and we need to make sure we get those off the streets. And I know that the Police Commissioner in NSW and the Premier of NSW are going to be working very hard to do that.

JOURNALIST: Thank you.

18 December 2014

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