AMA Transcript - AMA President, A/Prof Brian Owler, 2UE Sydney, 19 June 2014

JUSTIN SMITH: Running a piece in the Sydney Morning Herald today is the President of the Australian Medical Association, and this seems to be the definitive word and the official policy of the Australian Medical Association. They are not happy with the $7 co-payment that had been handed down in the Budget, and looking at the polls – as I said at 3 o’clock – looking at the polls, doesn’t look like anyone’s particularly happy about the $7 co-payment.

Professor Brian Owler is on the line. He’s the President of the AMA. Brian, thank you for your time.

BRIAN OWLER: Oh, it’s a pleasure.

JUSTIN SMITH: Is this the definitive policy from the AMA now that you are fully opposed to this?

BRIAN OWLER: Yeah, so we’re not opposed to co-payments per se. It’s very important, and I say that in the article. But what we are opposed to is this particular proposal because we are concerned about the effects on the practices, not only of GPs but of course radiologists and pathologists, but also very concerned about the effects on the patients, particularly those most vulnerable in our society: those in aged care, children, and really, people that can’t afford to pay this sort of co-payment.

JUSTIN SMITH: So what is the difference between this co-payment and say, a co-payment that you would support?

BRIAN OWLER: Well first of all, the safety nets are not there. So we would – our members actually charge co-payments for about 20 per cent of consultations, and many times they’re about $7. So we would support a co-payment that – to those that can afford to pay, but there would have to be safety nets for those people with chronic diseases, which are not covered under this policy. The only safety net that’s there is a $7 co-payment times 10 – basically, 10 co-payments for those on concession cards and those under 16 years of age. But if you’re working and develop a chronic disease, you could have – you know, if you start on Warfarin for instance, is a good example.

JUSTIN SMITH: Yeah.

BRIAN OWLER: You could end up with maybe 30 or 40 co-payments throughout the year, because it also applies to pathology and diagnostic imaging, not just general practice.

JUSTIN SMITH: Professor, what are you going to do about this now? How are you going to show your displeasure at this form of co-payment?

BRIAN OWLER: Well, we’re obviously speaking to the government about our concerns and I’ve met with Peter Dutton and expressed those to him as well.

JUSTIN SMITH: How did that go?

BRIAN OWLER: Well, look, we’ve had a fair hearing about what our concerns are. I have offered to work with him on a proposal that would be more acceptable and maybe provide some of the objectives that he’s after but not necessarily all of the savings that has those safety nets. But at the end of the day, they are very determined to pushing ahead with the proposal that they announced in the Budget and so the next step is that they have to get this proposal through the Senate. If it does get through the Senate by some means – and obviously Clive Palmer…

JUSTIN SMITH: I think you were about to say: by some miracle, then.

BRIAN OWLER: Well yes, I mean. Well it really depends on what the cross-benchers decide to do. But if they are able to get some form of co-payment through the Senate then it’s going to be very difficult to implement and it’s going to be something that I think everyone that goes to the doctor is going to be reminded about. Everyone that has a blood test or an x-ray is going to be reminded about... in the years to follow, right up through the election.

JUSTIN SMITH: Could this have all been avoided, Brian? With some consultation before the announcement?

BRIAN OWLER: Well that’s one of the points that I make, is that this policy is very much in the context of achieving economic and financial objectives. It is not a policy that’s been framed in terms of health policy; all those things that we know do achieve the objectives of sustainability of the healthcare system. Our GPs who manage people keep them out of the expensive hospital care. Preventative healthcare, making sure that we keep people well and healthy.

And so if we’d had the ability to have that input and advice about ways that we could shape a policy that’d achieve those objectives, then yes, I think we could have had a much better policy and something that would have been much more palatable to the rest of the community as well.

JUSTIN SMITH: Part of the argument for people that are pushing the co-payment, or the co-payment in this form, is that it adds a value to medicine. Is that if you go and see a doctor, and if you have to put your hand in your pocket, you value it a bit more. Do you see anything in that way of thinking?

BRIAN OWLER: Yeah I do, and… you know, $7 really undervalues general practice. Quality general practice is actually worth a lot more than $7. But the issue is, not only have we got the $7 co-payment, but we’ve also got a cut to the Medicare rebate. So it actually is taking money out of general practice, and we’ve got to remember that. We’ve also got to remember that there are those people for whom bulk billing is a safety net, because they truly cannot afford to pay not just $7 once, but $7 many times over. And that’s where the principals of protecting those most vulnerable in our society, particularly those that are sick, need to come into play.

JUSTIN SMITH: Well forgive me, I have to ask this, but if you weren’t losing money out of it, would you support it?

BRIAN OWLER: No, it’s not… I mean there are many components to it, and even if you get back into diagnostic imaging and pathology, I mean there is not just a loss of a $5 rebate; there is a loss of a bulk billing incentive that applies to all patients, not just concession patients. And that makes many of those practices unviable.

Now, even if it was not about the viability of practices, we still have the issues to do with those most vulnerable in our society and the safety nets that have to be there to protect them. Because at the end of the day, the AMA is going to protect the interests of its members; that’s what we do, we’re a membership organisation. But doctors also put patients first, and one of the things that the AMA has always done, is to campaign and advocate on behalf of patients, to make sure that their interests are looked after as well.

JUSTIN SMITH: Is it… would you rule out any form of - I don’t quite know how to put this for doctors - but industrial action?

BRIAN OWLER: Oh, no, no one’s been talking about industrial action. I mean, this is an issue that is in general practice, and there are many things that we can do to make our opinions known about this type of proposal, and one of the things that doctors are doing all the time is getting feedback from their patients and talking to patients every day, and so… you know, we can talk to people about healthcare policy, not just their own health. And doctors do that on a regular basis.

JUSTIN SMITH: It’s good talking to you, thank you very much.

BRIAN OWLER: My pleasure, thank you.

JUSTIN SMITH: Professor Brian Owler, the President of the Australian Medical Association.

20 June 2014

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