Doorstop AMA Vice President, Dr Mukesh Haikerwal - AMA response to the ALP and Democrat statements on Medicare

HAIKERWAL:      Ladies and gentlemen, thank you for coming along.  Obviously the debate around Medicare and the key pillar of our primary health care system is hotting up with the release in a couple of days of the Senate Select Committee's report.

We've seen some talk from Minister Abbott on Sunday, which I think is much ado about nothing, when you see some details from the Federal Government about what they're doing.

We're seeing seen Labor launch their Medicare Hot Spot initiative. And we're seeing some stuff from Democrats, too.

What has not been addressed is the fundamental under-funding of the primary health care sector over 10 or so years, which is seeing the level of rebate that we as patients get for seeing our doctors drop substantially to around 50 per cent of what it costs to provide a service.

So the fundamental change has not been made. The fundamental acceptance that more money needs to be put in towards primary  health care to ensure we continue to get high quality, timely, affordable, accessible care has not been addressed yet.

QUESTION:         So, Doctor, what do you think about the ALP and the Democrats' proposals?

HAIKERWAL:      Regarding the ALP proposal, we can see that the level of provision in our emergency departments is increasing. They're having to see more and more patients. The hospitals are telling us a lot of those patients are the sorts of patients that normally would be managed in general practice.

This underlines the need for workforce to be addressed and underlines the need for the Medicare Schedule to be revised substantially.

However, if there is a way of reducing the load by having GPs looking after general practice type patients, that would be preferable to emergency physicians doing that work, because emergency physicians should be doing emergency work.

QUESTION:         How would you advocate that more money is put into the system?

HAIKERWAL:      What we've seen is a diminishing level of payment into the Medicare pool and because of that we're seeing people moving away from the provision of services at no cost to the patient.  That's known as bulk billing, which is a method only of billing.

In order for service to be free, in other words for service to be bulk billed, you have to see that rebate actually addressing the fact that it doesn't cover the cost of providing a service.   The closer the Medicare rebate goes towards the cost of providing a service, the smaller the gaps will be and the more people will have more accessible affordable services.

QUESTION:         So you're saying that both these policies, or these ideas are pretty much useless they inject more money into the system?

HAIKERWAL:      There is a huge shortfall in the system and if that system is not addressed, we won't see any fundamental change, we'll just see fiddling around the edges.

I think that the Labor platform is showing one hot spot and that's what it is, a spot, not the whole picture that needs to be fixed.

Regarding the Democrats' proposal, it's a real ... the Democrats' proposal brings together many ideas, but to me, as a doctor, it's an administrative nightmare and something that I would have very little time for because of the number of different levels and tiers that are being proposed.  I'm not sure that the patients can understand it and we would have great difficulty, the profession, of understanding it.

QUESTION:         Where does the AMA stand on the level of the levy, should it be raised?

HAIKERWAL:      The Medicare levy does not reflect the true cost of providing health care services and it's only a fraction of the health care budget.

If there is to be increased expenditure on health, it needs to be from general taxation, not from the Medicare levy. The Medicare levy and raising that would simply reinforce the false assumption that when we pay our Medicare levy, we pay for our health services.  When we pay for the Medicare levy, we do not pay for our health services, we only pay for a very small fraction of our health services through that levy.

QUESTION:         So ideally then what would you like to see happen, from the AMA's perspective?

HAIKERWAL:      Well, we've put in, regarding the submission, we've put in about 60 recommendations around workforce, around the medical students. You know, they're saying we're going to have 234 medical students who will be forced to go and work in an area of need when they become specialist, so deciding at 17, 18, for when they're 35.  No incentive, no ... no grant, no HECS payment, nothing. So we think that's a very unfair system.  So we'd like that addressing.

We believe that we can solve some of the workforce by getting some of our junior doctors who currently are not staying in the medical workforce at all into the medical workforce.

And we're seeing ... you know, there's no point tipping a whole lot of money in for Medicare Benefits Schedule as it currently stands. But we've seen two reports into how you can make the Medicare Benefits Schedule work better and we want to see that addressed and properly funded.

By doing that, we move away from six-minute medicine, which is where we currently stand, towards 10-minute medicine, being supported by the Schedule. We actually see the qualities there.  Most people are doing 10, 15 medicine.

QUESTION:        You said before that the junior doctors aren't continuing in the workforce.  Where are they going?

HAIKERWAL:      They're leaving medicine.

QUESTION:        Leaving Australia?

HAIKERWAL:      Get out and going.

QUESTION:        And go to a different profession?

HAIKERWAL:      Absolutely.

QUESTION:        How about running the talking between ... in terms of a short fall though?  What sort of money do we need injected back into the system?

HAIKERWAL:      Look, in terms of just the Medicare Benefits Schedule, you're looking at about four to six hundred million and that's what's been diminished over the years, because when Medicare came in, you were looking at about 15 per cent discount on the cost of providing a service. And what we see now is that it's gone up to 50 per cent. Because the fees and expenses and everything have all increased but the actual individual costs have not.

So there's a graph up there. That's how the costs have changed with ... and what we've been doing is saying, oh, we'll bulk bill you, we'll bulk bill you, we'll cut back, we'll take in the slack.  But there's ... beyond a limit, you just can't do it.

So that's what's happened for the last 10 years, so there's a fair amount of catch up there. 

But we're not saying use  ... the current schedule means that if you go from nought ... not nought, one minute to five minutes is one consult fee and then it goes six minutes to 19 minutes. And that means that, you know, you get the same as a patient for a rebate for a six minute as a nine-minute ... as a 19-minute.  So everybody says ... you know, the one ... you can get a lot of a false incentive to do it at the six-minute mark.

We're trying to move it across to the 10-minute mark, which means you rejig the schedule and that's not going to be as costly as doing what the Relative Value Study was, but it means that you actually get a more useful way of working the system.

QUESTION:         And I mean, does that ... just that extra four minutes, does that give the doctor more insight into the patient so you can do more in preventative care?

HAIKERWAL:      The quality studies show that the ideal consult is between 10 and 15 minutes. And by doing 10 to 15 minutes, we actually do very well.  And BEACH, which is the Australian Institute of Health and Welfare Study, shows that most quality consults are around that level.

So, in fact, by going to 10 to 15 minutes, we're actually duding ourselves if you like. We don't care, we're about quality. But in order to maintain that, we actually have to increase up what we can get  ... out of pocket. So that's why the gaps have happened, to maintain the quality and to maintain a viable practice.

QUESTION:         The suggestion of Labor of what appears to be like flying squads of doctors and nurses going to low bulk billing areas, that doesn't make sense, because it could be quite a wealthy area and not have a high degree of bulk billing.

HAIKERWAL:      Absolutely.  It's a very quick fix sort of solution.  You need to look at a long-term sustainable solution. So we're told that there's more coming. We need to see the whole package to see what's coming, so that we can actually say 'this is what we need to do and this is how we need to ... who we're going to do it'.

QUESTION:         Is likely to come out on Thursday, or...?

HAIKERWAL:      No. Thursday is the Senate Selection Committee, which you'll probably see bagging the Government even further.

QUESTION:         Are you around on Thursday as well?

HAIKERWAL:      I'll be in Canberra, I won't be here, but I'll be around.  Bill and I will be in Sydney, then we're going to Canberra, so at lunchtime we'll be in Canberra.

QUESTION:         It's insane, isn't it?  It's only rich countries that have these medical problems.

HAIKERWAL:      Thanks, everyone, that's great.

Ends