AMA Transcript - AMA President, A/Prof Brian Owler, 666 ABC Canberra, 26 June 2014

PHILIP CLARK: On other negotiations though over important things to come out of the budget there were some developments too.  The President of the AMA, Professor Brian Owler - you’d know him from all the billboards around the country advising people to slow down because they risk an accident and brain injury if they don’t.  Brian Owler met with the Prime Minister yesterday and the Health Minister too on the somewhat confused future of the $7 GP co-payment.  As you know this co-payment was announced in the budget meant that – well if it comes in to force it will mean that if you go to the doctor you’ll have to pay $7 for the doctor visit and also of course there’ll be some extra co-payments on prescriptions as well. 

Brian Owler met with Prime Minister Tony Abbott yesterday, who appeared to concede that perhaps the scheme could be modified in some way.  Brian Owler joins me on the line this morning.  Professor Owler good morning.

BRIAN OWLER: Good morning.

PHILIP CLARK: What’s your own view of this $7 co-payment scheme anyway?

BRIAN OWLER: Well look the AMA’s not against co-payments per se.  I mean many of our doctors privately bill and charge a co-payment that’s far in excess of $7.  So what we are against is this proposal which not only includes a co-payment for general practice but also for pathology tests and radiology.  And when those co-payments come about they tend to add up quite quickly and for someone with an illness or a chronic disease that can mean quite an expensive episode. 

So we’re not against co-payments per se, but what we are against is the current proposal.

PHILIP CLARK: Hmm.  Because as it stands, that’s right, if you go to see the doctor you have to pay $7 for that but really if there’s something wrong with you, you almost always come away with a pathology request or some other further test or scan to be done and you also have to make a co-payment for that.  So the actual bill for the consultation as a whole could well be $30 or $40 couldn’t it?

BRIAN OWLER: Well that’s right.  So we’re not just talking about $7.  What we’re actually talking about is multitudes of $7 and because there are changes in terms of radiology where they lose their bulk billing incentive which applies to all patients currently, not just concession patients, and combined with the cut to the rebate and the $7 co-payment, it would mean that unless the radiologist was willing to go broke, they’re going to have to charge much greater co-payments than $7.  The CT scan for instance in the order of $50 or $60. 

So our concern’s not just about our practitioners in terms of the viability of their practices and general practice, pathology and radiology, but of course the effects on the most vulnerable patients in our society because there are people that even $7 is a substantial financial barrier in accessing healthcare.

PHILIP CLARK: Actually Judith has just rung me with what’s a common enough question Brian.  I hope you can answer it.  Judith, hello.

CALLER JUDITH: Hello.  I’m just totally confused about all this.  I usually – I have never been bulk billed.  I pay a fee at the doctor’s and does that mean I pay $7 on top of what I usually pay?  It’s usually $55, sometimes $70 when I visit my GP.  Does that mean I have to pay $7 more on top of that?

BRIAN OWLER: I can answer that for Judith.  What it will mean is you different.

BRIAN OWLER: It is going to happen with pathology tests and x-ray tests as well.

CALLER JUDITH: Okay.

PHILIP CLARK: Okay.  Thanks Judith.  I hope we cleared that up for you.  I appreciate that, because I think a lot of people are confused, Brian, about this.  How did the meeting with the Prime Minister go?  I mean there’s been a lot of opposition to this scheme based on the issues that you raise and also the practicalities of doing it as well and whether it’s in fact going to be easy to collect in the first place.  How did the meeting with the Prime Minister yesterday go?

BRIAN OWLER: Well I think it was a very constructive meeting. Minister for Health was there as well and we outlined all of our concerns around the implications for practitioners, for patients, for preventative healthcare and chronic disease management and as you say the practicalities of introducing this sort of proposal. And I’ve got to say he listened.  There was a process that’s been set up to look at alternatives. 

I mean we haven’t struck a commitment to take on an alternative but I think there is a process now that we can look at alternative models but won’t necessarily deliver for the Government the savings that they want to achieve in terms of delivering the money that the Medical Research Future Fund requires.  But at the end of the day we’re happy to work with the Government and come up with a sort of co-payment proposal that does put a greater value on general practice for people that can afford to contribute to their healthcare and – because you know I think even at $36 which is the bulk billing rate now, general practice is very much undervalued.

PHILIP CLARK: Yes, I think a lot of people would agree with that.  Twenty to nine.  Brian Owler’s my guest, the president of the AMA.  So what in your view’s a better system?

BRIAN OWLER: Well look I think we have to go through and work on that with the Government and to do some of the modelling that unfortunately wasn’t done beforehand.  But that’s a process that we’re going to have to go through.  But I think the key things for us are that we don’t want to see the patients’ Medicare rebate cut.  We think that the money should stay in primary healthcare and general practice because that’s the answer to sustainability of the healthcare system. 

We need to acknowledge that there are people in society that truly cannot afford a co-payment and we need to make sure that we protect those people and people in aged care residential facilities are a good example.  We need to make sure that when people do get sick and have some form of chronic disease that they’re not financially punished for doing that.

PHILIP CLARK: Because I mean this is the issue isn’t it, I mean most of the healthcare in Australia, the vast bulk of it is used and is concerned with people at the back end of their life because that’s when we get sick. I mean that’s when we’re seeing the doctor and that is also a time of course when we’re actually most vulnerable in terms of our ability to pay for things.

BRIAN OWLER: Well, that’s right. I mean we are living longer and we are enjoying better health than we ever have in the past and that’s because of our general practitioners and other doctors and everyone else that works in the healthcare field, providing those services. Now, Australia’s expenditure on healthcare is not out of control. When we look at the affordability and the amount that we spend on health compared to other countries in the OECD, it’s – Australia ranks very highly. We actually have a very efficient healthcare system for the amount of money that we spend. We get very good results from it and when you look at the rise, the expenditure is not rising as a proportion of GDP.

PHILIP CLARK: So, you think though that it’s in general not a bad thing for people for have to pay something to see the doctor?

BRIAN OWLER: No, I would – the Prime Minister and the Government obviously want to send what they call a price signal to discourage people from using care unnecessarily. Now, I’ve got to say I don’t think people generally do that but I think we need to put some value on seeing general practice. And I know that there’re a lot of doctors in our community and general practitioners who feel the same way, that there’s an expectation of bulk-billing but they’re having some contribution for those who can afford to pay to see a GP. I don’t think it’s a bad thing and I’m sure our general practitioners, many of them feel exactly the same way. But they do need the flexibility to be able to bulk-bill people when they feel that that’s right as well.

PHILIP CLARK: That’s right.  Exactly. This notion that and it was unfortunately given currency by Tony Shepherd, not a doctor, who was running the Commission of Audit, who made the comment that we see the doctor too much and he says I just don’t think we’re that crook. The truth is people don’t wander off to the doctor willy-nilly anyway and there’s no evidence that they do, is there?

BRIAN OWLER: No, absolutely no evidence that that’s the case. And I think we’ve got to be very careful about some of those sweeping narratives that people just seem to accept. I mean most people see the doctor only when they need to; they’re not going there just because they feel like it and at the end of the day I think general practice is actually keeping people well, keeping people with chronic disease out of hospital and one of the frustrations for the AMA is that this policy for the current proposal actually ignores all of those aspects of healthcare policy that we’ve been working on for years to try and encourage primary healthcare, encourage people to see their general practitioner, encourage people to have preventative healthcare, their cholesterol checked, their hypertension managed, their kids to have vaccinations. So, we need to be actually putting more money and investing in primary healthcare and general practice rather than taking the money out and putting it into tertiary level research…

PHILIP CLARK: Yeah, sorry, go on.

BRIAN OWLER: Now… well, I was going to say I mean look research is obviously important and as someone that’s done research and struggled to attract funding for brain tumour research and all sorts of things, I understand the frustrations of researchers but I think a lot of researchers also agree that you’ve got to invest in primary healthcare and if they’re going to fund a research fund, the money does need to come from an alternative source.

PHILIP CLARK: Okay. Good to talk with you. Appreciate your time.

BRIAN OWLER: Pleasure.

PHILIP CLARK: Hope we get a reasonable result out of it. Professor Brian Owler, the president of the AMA and his meeting with the Prime Minister and Health Minister on the cloudy future of this $7 GP co-payment.

26 June 2014

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