AMA Transcript - GP co-payment

FRAN KELLY: Laura and Michelle were just discussing the confusion that reigned yesterday around the Federal Government's Budget policy to charge a $7 co-payment for a visit to the GP. So, beyond that confusion, what is actually happening, is there a change afoot? Brian Owler is the President of the AMA. Yesterday he accused the Health Minister Peter Dutton of being petulant in his refusal to dump the policy. Brian Owler, welcome to RN Breakfast.

BRIAN OWLER: Thanks, Fran.

FRAN KELLY: The Government is not being at all clear about how it's going to impose a price signal, but it does remain committed to a price signal, that's clear, and the Health Minister said yesterday there are now different options being considered. Do you know what these options are, and are they options you would be happy with?

BRIAN OWLER: Well, I don't think he knows what the options are because yesterday we had, well during the week, we've had a number of changes. There's been this discussion that if they can't get it through the Senate that they turn to regulation to actually cut the fee schedule but that's a disallowable instrument in Parliament, so the Senate would be able to object to that and, you know, just trying to change the fee to essentially save the 3.5 billion, I mean they're losing sight of all of the issues that have been discussed over the past six months. I mean, the Prime Minister and the Minister for Health have acknowledged that there are issues to do with residential aged care, there are issues to do with Indigenous health, mental health, with looking after children and immunisation, and so just trying to ram something through and forgetting all of those issues, I think he is being petulant because they're - it's “I must get this policy through at all costs and I don't care what the consequences are.”

FRAN KELLY: I'm sure the Government would say that they are keeping sight of the issues that the whole reason they're pushing ahead with this is the Minister says it's crucial for the viability, really, the sustainability of Medicare to have a price signal to discourage overuse of the system and to get some more money back in to the system.

BRIAN OWLER: Well, again, I would disagree with that. I mean, the narrative we've been fed is that the health system is in some sort of crisis, but spending has not been going out of control, in fact...

FRAN KELLY: It is rising pretty quickly though…

BRIAN OWLER: Well, the proportion of the Federal Budget in terms of expenditure in 2006/07 was 18 per cent. It’s now down to just over 16 per cent so, in fact, the proportion of the Federal Budget going to health is actually falling. In raw terms, yes the numbers are going up but they're going up with everything and - but as a proportion they're actually being very stable. So, you know, the idea that it's all of a sudden out of control is incorrect and I can tell you that the - the expensive part of the health care system is not general practice and primary care. That's actually where we should be investing because the real key to sustainability is managing the growing burden of chronic disease. We have an ageing population, people over 65 often have three, four, even five chronic diseases, all of which need to be managed in the community. And keeping those people out of hospital and expensive hospital care is the key to the sustainable health care system, and every country in the world knows that this is the case.

FRAN KELLY: The Government - if the Government does change its plan and reduce the Medicare rebate instead, that would hit doctors. The AMA has been accused, well the Government implying in the past really that the AMA is more concerned about doctors' salaries than about the greater good of making Medicare more financially sustainable and yesterday on the program we spoke with Terry Barnes, he's considered the architect of the $7 Medicare GP copayment policy, and he was very critical of the AMA's opposition to this policy. Let's have a listen.

in many, many...

BRIAN OWLER: Well actually, again, you know, this is all about ideology and the whole, the whole of that is incorrect. I mean, actually, when you look at specialists’ fees and gaps, 89 per cent of medical services in hospital are actually charged at a no-gap rate, which means that there's no out of pocket expenses for the patient. Another 3 or 4 per cent are under known-gap arrangements and so, in actual fact, there's only 7 per cent of services that attract a gap. So, you know, what Terry Barnes is talking about is completely incorrect. Our opposition to this policy is not about self-interest. If it was a self-interest, we'd actually take it on and say yes, great, we'll charge, you know $7, we'll charge more.

But the issue here is actually about vulnerable patients in the community because we know that this is going to be a disaster for things like Indigenous health. For example, I've been up to the Northern Territory, I've spoken to the Aboriginal community controlled health services and they have all said - and not just said - that they will not charge the co-payment. That means that they not only lose $7, they lose $9.25 in the bulk billing incentive and they will also have to pay the $7 for their patients to have their pathology or diagnostic imaging. So this is effectively a defunding of Indigenous health services. So I, you know, these are real issues for people and doctors know that there are many people in our community that this will affect...

FRAN KELLY: Brian, I need to cut you - cut in there because we're heading to the news, but I'd like to thank you very much for joining us.

BRIAN OWLER: Pleasure Fran, see you.

FRAN KELLY: Dr Brian Owler as we heard he's a paediatric neurosurgeon and he's also the President of the AMA.

28 November 2014

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