AMA President, Dr Steve Hambleton, 5AA Adelaide, GP co-payments

MATTHEW PANTELIS : Shortly we'll speak with the Australian Medical Association's Dr Steve Hambleton he's the Federal President on the proposal for a $5 co-payment fee. When you go to the doctor, be slugged $5 to help basically balance the budget.

CHERYLEE HARRIS : Yes, yes.

MATTHEW PANTELIS : And what effect will it have? Interesting - look, $5, it'll certainly hurt some people, no doubt about that.

CHERYLEE HARRIS : But the pensioners are exempt, so if you've got concession cards or pension - but certainly families with a lot of children...

MATTHEW PANTELIS : Yeah.

CHERYLEE HARRIS : ... it may make them think twice about going to a general practitioner. I mean if you do go to a GP and you've got three children and they all catch the same bug going around in a family, it all adds up.

MATTHEW PANTELIS : It does, doesn't it? So yes, we'll find out what their point of view is on that. But just well - oh, in fact here he is now. Dr Steve Hambleton joins us. Morning, Steve, how are you?

STEVE HAMBLETON: Good morning, very good.

MATTHEW PANTELIS : Seasons greetings to you. What's your view on the $5 co-payment?

STEVE HAMBLETON: Well, we do have some concerns of course. The most efficient place in the health system is actually general practice. We've had to see people diverted either to ambulance or to the emergency department. We need to make sure people get access to GPs, get that wellness and that health maintenance done and as I say, keep out of the expensive side of the health business.

CHERYLEE HARRIS : Do you think it will have an effect, one on Medicare long-term and, two on the public health system as far as the hospitals are concerned?

STEVE HAMBLETON: Well, I guess both those effects could happen. We're still yet to see a lot of the details. This is a proposal to the Commission of Audit to see whether it's going to get up to government so there's a lot of discussion to be had between now and then. But we've got to really step back and say, well, what are the problems we're trying to solve here. And the main problems we've got with our health system are the growing amounts of chronic disease and I guess the - our ability to treat lots of diseases that we couldn't treat that well in the past. If we're really thinking about long-term health care costs, we've got to talk about health maintenance, wellness maintenance, keeping people out of hospital.
And I wonder if this is the right solution. We should be targeting things like tobacco, alcohol, over-nutrition and under-exercise. That's where the real payback's going to be.

MATTHEW PANTELIS : So you are concerned though that this might clog up hospitals basically, waiting rooms, et cetera, which is exactly what the Government wants to try and avoid anyway.

STEVE HAMBLETON: Well, that's right and we know already that people with $5 or $6 payments, when they're getting their pharmaceuticals actually do say, well, choose, well, I'll get this one this month, this one next month, and $5 will make a difference and certainly when we've got ambulance services that are already putting together strategies to stop people from calling them unnecessarily. And emergency departments concerned about low acuity patients. We've got to think about the whole system before we introduce something like this.

MATTHEW PANTELIS : Do you get the chance to put a submission in to the commission?

STEVE HAMBLETON: Well, we certainly did and we made our points - along the lines of improving efficiency and productivity of GP services and getting rid of some of the red tape that exists now. If this proposal gets up any further there'll be obviously more opportunity to provide feedback. But the things we're talking about are the authority's telephone system where you need to ring up - and how many times have you ever sat in front of a GP while they've been listening to that on hold waiting music just to get a medicine that the GP wants to prescribe.
 
And the other thing I guess we've said to the Government is look, there's the chronic disease MBS item numbers that are tied up in red tape as well. If we could improve that then we can actually have more time with GPs and we know if you spend more time, there are more services delivered, there's more health prevention and promotion done.

CHERYLEE HARRIS : So, will this actually mean that they'll completely axe the bulk billing?

STEVE HAMBLETON: Well, it would seem that this is the proposal, that there's a mandatory co-payment for a lot of people and there's proposals already to limit that to certain parts of the population. Look I don't - I'm not sure that there're unnecessary GP services - there's a real problem. And most people don't go there for minor problems. Maybe some do but there's other strategies that we could use. If you are going to bring in a proposal like this, we need to look at I guess all of the aspects of it and whether it has the best incentives built in.

MATTHEW PANTELIS: Yeah. Obviously, just going back to emergency departments, they're flat out at the moment. Is there anything else that can be done to reduce the waiting times in those - this, as we suspect, may increase that, but can anything be done in the short term apart from pouring money in?

STEVE HAMBLETON: Well, it's interesting, you know, WA they pioneered this and that was actually to look at reorganising how the hospital is set up. Much of the problems in emergency departments are actually people who they've decided are coming into hospital, they just can't get them out of the emergency department into the ward. Now, part of the reason for that is we can't get people out of the wards and either back home or back into the community.

 In Western Australia they had a whole of the hospital review and were able to get those emergency department waiting times way down simply because they got people home efficiently, they actually got them into hospital and out of the emergency department efficiently without spending a dollar. So those sort of things should be introduced everywhere. We should also think about, well, the big issues about emergency, and we're going to see it again tomorrow night (new Year’s Eve), and that's the misuse of alcohol.

MATTHEW PANTELIS: Yeah.

STEVE HAMBLETON: Which puts a lot of people in emergency departments who simply shouldn't be there. It's something like 30 per cent in some emergency departments at 2 am are just alcohol related, and that's a terrible statistic.

MATTHEW PANTELIS: Yeah. Terrible, indeed. So are the AMA leading a campaign on alcohol at all?

STEVE HAMBLETON: Well, we certainly are and we're certainly pushing very heavily for responsible alcohol use. Today, even in WA, we're talking about making sure that if you're going to drink, don't drive and make sure people you know don't drive either, because that's a huge problem and a huge cost to our health system.

MATTHEW PANTELIS: Yeah.

STEVE HAMBLETON: Tomorrow night, by all means enjoy yourself, have a good time, but make sure that, you know, you choose less alcoholic drinks. That's something we're - you know, have some non-alcoholic drink in between alcohol drinks and just remember that the recommended level from the Health and Medical Research Council are very, very low; two standards drinks for a man or a woman on an average day, no more than four in one day.

MATTHEW PANTELIS: Yeah.

STEVE HAMBLETON: We can measure the harm if you go above that and I guess we see it all the time.

CHERYLEE HARRIS: Are we preaching to the converted a little bit though? Like, the younger kids are the ones that are not listening and they're the ones that are ending up in hospital through, you know, violence in the night clubs and they're still being allowed to serve alcohol and large quantities of alcohol and they're the ones that aren't listening. I mean, they may not be drink driving, but they're certainly getting into fights and ending up in hospital. So the adults are - majority of adults - are responsible when it comes to drinking and not driving and drinking at a reasonable level.

STEVE HAMBLETON: Well, I think there's a whole lot of things we have to think about and, you know, the public acceptance of drunkenness, for example, in general is a real concern in our community and, you know, we do learn attitudes from our parents and, you know, I love that ad on TV where dad gets the son a drink, the next thing you know the son's grown up, he gets the next son a drink or asks the son for a drink. We do need to think about every single time we actually have a gathering, it seems that alcohol is there, and is that really that important?

I mean, if you had a barbecue and you said there's no alcohol, how many people would turn up? And it's startling when people say, well, no one would come. If that's really true, that's really very disturbing.

MATTHEW PANTELIS: Yeah. Steve, just while we've got you, another story that's in The Advertiser, the local paper here, today that basically school children seem to be ditching exercise, that they've halved - half the number are walking or cycling to school in a single generation, so that number's gone down by 50 per cent, and many also shunning exercise and physical activity in their lunch breaks. That must be a trend that concerns you.
STEVE HAMBLETON: Well, it very much is. If we're talking about really getting healthcare costs down, there's a great example of what we need to do, and that is get our children exercising, get them, you know, out, off the screen, outside.

CHERYLEE HARRIS: Yes.

STEVE HAMBLETON: And, you know, it's not just the health system that will save health costs, it's being able to go to the shops and walk, it's actually taking our kids to school on their bicycles, it's all of those things. Better nutrition, more exercise, you know, that'll make a difference, and that'll save us healthcare costs in the long-run. So, you know, maybe we need to broaden our view when we're talking about long-term cost savings.

CHERYLEE HARRIS: Yes.

MATTHEW PANTELIS: Alright. Steve, thanks so much for your time today.

STEVE HAMBLETON: You're very welcome.

MATTHEW PANTELIS: Dr Steve Hambleton, who's the Federal President of the Australian Medical Association, on a few topics there, especially the co-payment.

30 December 2013

CONTACT: John Flannery  02 6270 5477 / 0419 494 761
 Kirsty Waterford  02 6270 5464 /0427209753