AMA Transcript - AMA President, Dr Steve Hambleton, Sky News, 20 February 2014

DAVID SPEERS: We're going to talk a bit more about health right now and as we've been discussing this morning Health Minister Peter Dutton is building a case for major changes to health funding in Medicare. He's been building this case by pointing out how costs have risen over the last decade. He says that in the past ten years the cost of Medicare's gone up 120 per cent, the Pharmaceutical Benefit Scheme 90 per cent, hospital care 80 per cent. This he says is unsustainable and in fact he's gone so far as to say yes he does think those who can afford to pay more should pay more. That includes considering a $6 co-payment to visit the GP.

With us now is the President of the Australian Medical Association Dr Steve Hambleton. Thanks for your time. Does the Minister have a point here that the rising costs over the last decade are unsustainable if they continue?

STEVE HAMBLETON: Well, it's certainly the right time to have a conversation about rising costs and we do see lots of rises. There is some good news hidden in those figures as well and we need to think about that as well. We've actually seen costs per visit to GPs for individual Australians flatlined for the last five years and that's a piece of good news. Our PBS spend has actually come back a little bit because of the coming off patent of some of our very expensive drugs. But the Minister is right, we do need to have a conversation about costs in the future and unless we turn around some of the drivers of those health care costs it is going to make it very difficult for Australia to afford those expenses.

DAVID SPEERS: And when he does say that he thinks those who can pay more should pay more, what's your reaction of that?

STEVE HAMBLETON: Well, already Australia is placed about fifth in the world for out of pocket expenses when it comes to their own health, so we're already up there. People do think about the decisions they make when they actually enter the health system. I guess what we're saying is we've got to think about what the drivers of health care costs are. We've got to step back a little bit before that and make sure that we deal with things like tobacco, alcohol, over nutrition and under exercise. It's not just the health portfolio that needs to focus on health care costs, it's the other portfolios as well. We can increase exercise, increase our health literacy and make sure that we don't get to hospital because that's where the most expensive part of the health system is.

DAVID SPEERS: Now the AMA of course represents doctors so you can understand arguing a case against increasing the cost of seeing the doctor but the Minister makes the point that patients already pay a co-payment of sorts for pharmaceuticals, they pay a co-payment for all their private health insurance, many Australians he says pay a co-payment to see the doctor already.

What about everybody though, should there be at least some nominal payment to go to the GP?

STEVE HAMBLETON: I think it's one of the levers the Government can pull. We've got to be very careful if you use a blunt instrument like payments and in particular in primary health care that we don't get perverse outcomes. There are think tanks internationally. The Lancet think tank is actually saying if you want to increase the efficiency of your health system, you lower the barriers to primary health care, you don't lift them. Now people that defer visits to the GP - that might be discretionary but also might be important - and the evidence shows that they don't go for both, and if they end up in hospital that's going to be a downside because it's going to make the health system more expensive. So we do need to spend each dollar efficiently but any changes we make we need to examine all the possible outcomes and some of the.

DAVID SPEERS: What about this idea of allowing private health insurance to cover a visit to the GP?

STEVE HAMBLETON: Well, that's something that all governments have resisted over many years. Now there's no doubt we need to join up our health system. Our public hospitals need to interface with GPs. The same with private hospitals. They need to interface with GPs as well. Private health insurers are there but we don't want to unbalance the good things about our system. One of the very good things is that relationship, that longitudinal relationship with the GP. So the AMA is very interested in exploring opportunities for private health insurers to join up the health system, to support the GP to do their work, not compete with the GP or divert the patient somewhere else. There are opportunities there. We need to have one health system whether it's public, whether it's private, make sure we connect with primary care.

DAVID SPEERS: Because at the moment private health insurance cannot cover something that Medicare does - that's basically the rule isn't it, that Medicare does cover a visit to the GP technically if you bulk bill, but if you had private health insurance covering a GP visit, certainly for those who can afford to have private health insurance that would be an attractive option.

STEVE HAMBLETON: It certainly would be but we've got to make sure we have equity of access - that people do get access to care. Now the private health insurers have got a lot of disease management programs that we could engage for our patients to make sure that their diabetes is well managed. I think we could minimise the risk of obesity and overweight because that drives things like diabetes, heart disease and stroke. We need to join those things up. We need to make sure we don't distort the market though so we can carefully manage these things. We're very happy to work with them to make sure that every single health dollar is spent efficiently.

DAVID SPEERS: Is he looking in the right areas? I mean you pointed out the need for a unified system here. Is he at the moment from what you've heard looking at the right area of the health budget?

STEVE HAMBLETON: Well I would say that focusing on primary health care and putting barriers there is not the right approach. Helping GPs to look after chronic disease, that's the major burden in our community, is. Medicare's 30 years old. We've seen some change in Medicare over the last few years that we need to support. Putting barriers up is probably not the best solution. Our public hospitals are the most rapidly growing area in the system and that means we've got to make sure we run them efficiently.

But more broadly we've got to step back from all that and say, well, what are the drivers of costs. End of life care is something we should talk to the Minister about to make sure that we're actually making appropriate choices. That the palliative care option is supported, because we've actually looked at the final stages of life and the difference between choosing another drug and actually providing good support for palliative care quality of life, emotional, physical and spiritual, actually people live longer and it is less expensive.

But it does mean spending money in the primary care area. And if we can reorient our spend, we can make our system more sustainable.

DAVID SPEERS: Just a final question on a separate matter. The food label consumers’ health website that the Government pulled down amid some controversy over the role of the Assistant Minister's Chief of Staff. On the website itself, would it have made a big difference do you think?

STEVE HAMBLETON: Well yes, I think the answer's a resounding yes. Look, people wouldn't necessarily have accessed the website but the website was very smart. In behind it was a whole lot of calculations enabling industry to put those stars on their product. And we may have seen earlier products put those stars on to get a market advantage. Look it's all about helping consumers make the right decisions. And it's the very people who don't understand those complicated labels on the back of the food products that would have benefited from the stars on the front. You don't need a degree in nutrition to be able to work out which product is better for you but you do if you're looking at the back of a product. So this is a really important assistance for keeping health care costs down. Equally we want to see a national summit on alcohol, because that's another big cost driver.

DAVID SPEARS: Yeah, and there's a whole lot of conversation in that one. AMA President Dr Steve Hambleton, good to talk to you this morning. Thanks for that.

STEVE HAMBLETON: Thank you very much.

20 February 2014

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