AMA Transcript - Concerns about the $7 GP co-payment pushing an extra 500,000 patients into emergency departments

STEVE PRICE: Front page of the Daily Telegraph today ran details of an analysis by New South Wales health that has been backed, according to the Herald report, by doctors and health groups that says if a $7 Medicare co-payment were introduced for GP visits that an extra 500,000 people would be pushed into emergency departments at public hospitals. I found that difficult to understand how you could calculate that, and I am a sort of person who practically thinks about these things.

If you have an issue where you need to go to your GP and you're going to be charged an extra $7, are you going to not go to your GP and instead go and sit for hours in an emergency department in a public hospital. And wouldn't a simple way to sort this out if the $7 goes ahead to put the $7 payment into emergency as well for people who present for afflictions that could be catered for by a GP? But let's go to the top, talk to the Australian Medical Association. Their federal president is Associate Professor Brian Owler. Thank you for staying up to talk to us tonight, Brian.

BRIAN OWLER: It's a pleasure, Steve.

STEVE PRICE: Is this an exaggeration?

BRIAN OWLER: Well, I'm not sure how they have actually come to the calculations but this is a document that apparently has come from the Department of Health in New South Wales itself, so it's not a document that's been designed to exaggerate something. It's something that's been a piece of information that's been delivered to the New South Wales Government.

And when we look at other jurisdictions some of them have done similar modelling. The figures do vary around the country but the bottom line is we know that if you are going to introduce a $7 GP co-payment people are going to go to emergency departments instead of the general practice.

STEVE PRICE: Will they? In those numbers?

BRIAN OWLER: Well, I'm not sure about the actual numbers.

STEVE PRICE: I mean, if you've got a - I mean, the point I make and I try and deal with these things on a practical basis. If you've got flu symptoms and you feel like you need the GP to prescribe you something to sort you out or to give you a flu injection or - I mean I can give you a million examples - you're not going to go and sit for four hours at Royal North Shore and wait for a spot in the queue are you, for $7?

BRIAN OWLER: Well, for most people they won't. I mean, you or I would never dream of doing something like that. But the fact is that we already know that there are people that will defer or actually not go to a GP at all because of a financial barrier, whether it only be six or seven dollars. And so, this is most prominent, of course, in disadvantaged areas and for some people they will avoid paying the $7 because it is still a significant amount to them and they will go to an emergency department.

And they won't have to wait four hours because we know that any patients that go through emergency departments don't necessarily have to wait that amount of time. Some, of course, do and even give up waiting but many people will actually go, wait and avoid paying the money. And so this is a problem for our emergency departments.

STEVE PRICE: It seems no one but the Federal Government wants this. I mean, I've argued that, you know, if the system is so in need of help financially and if it is going - if health is going to send the budget broke then, you know, my view is $7 may be able to be argued down to six or five and maybe a co-payment would be acceptable.

But everyone else is arguing against it. Even the New South Wales Health Minister said GP co-payments were developed after the National Commission of Audit. She said she had written to the Federal Health Minister but did not detail what she said to him. She doesn't like it. John Robertson goes out and whips it around today by saying, this would smash the health system if 500,000 other people turned up at emergency. Well, of course it would. I mean, it's not going to happen, is it?

BRIAN OWLER: Well, I'm not sure about the numbers, as you said, but it's still a significant problem. I mean, the AMA has said all along that it's not against co-payments per se but it is against the Government's co-payment model because it doesn't have the protection for vulnerable patients, it doesn't encourage preventative healthcare and chronic disease management.

And if we're serious about saving money and the sustainability of the health care system then actually investing in general practice is the key. I mean, the Government has not really considered health policy in any detail in introducing these policies. It's a very blunt tool and, in fact, on the other hand they have also gone away from structural reforms like activity-based funding which is actually about saving money in the most expensive part of the health care system, and that's in our public hospitals. So if they are serious about doing these things it needs to be a much more considered policy approach rather than just saying, everyone is going to have to pay $7.

STEVE PRICE: So where are we at on the negotiation and the argy-bargy?

BRIAN OWLER: Well, the Prime Minister and the Minister asked the AMA to come up with an alternative which we did a few months ago. We had an alternative that had co-payments for people that could afford to pay but protections for many other patients and we didn't have a cut for the Medicare Rebate of $5 which is included in this proposal. And, of course, they didn't accept that.

I understand that crossbenchers are still very much resistant and it doesn't seem to be going anywhere at the moment. But I think if they want to progress this any further then they need to talk to people like the AMA and they need to consider really reconsidering their approach and making sure that they do have protections there because it is the least popular of all the budget measures that were announced in, of course, the Federal May Budget.

STEVE PRICE: Always appreciate your time. Maureen's got a quick question if it's okay with you.

BRIAN OWLER: Of course.

STEVE PRICE: Yes, Maureen, go ahead.

MAUREEN: Yes. Good evening. I understood that when this was first announced it was said that the doctors - well people with chronic diseases - illnesses and things like that - it was up to the discretion of the doctor to waive - he could waive the $7 co-payment. Unless that's changed that's what I understood.

STEVE PRICE: Is that your understanding, Brian?

BRIAN OWLER: Well, they can but of course that means that the doctor ends up coming out of their pocket, so, because there's a cut to the Medicare rebate of $5 it means that the GP ends up being $5 worse off. So they have to absorb the co-payment. And then if there's a patient that's on a concession they also lose the bulk billing incentive so they can end up being $13 or $14 worse off and that's a real problem particularly for Aboriginal Medical Services, which have said that they're not going to charge the co-payment because it will be a disaster for Indigenous health, for example.

STEVE PRICE: We'll keep following the debate. Thanks for your time as usual, Brian.

9 October 2014

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