Doorstop - Dr Kerryn Phelps, AMA President, Canberra. Discussion: The future of Medicare and the future of the medical profession

PHELPS: I'm joined by Matthew Holman and Nick Brown, who are both medical students - young men who represent the future of our profession.

This morning I've delivered a very strong message to a large group of parliamentarians, at a parliamentarian breakfast here in Parliament House, about the future of Medicare, the future of the medical profession and how we can go about ensuring that we have a workforce that can meet the needs of the Australian population now and into the future.

We looked at a number of problems in the health system, particularly medical indemnity, general practice workforce, and the future of Medicare. And there was a tremendous amount of interest, a lot of questions and a lot of people who have clearly been briefed by their constituents who understand the concerns of the public and the community and are prepared to listen to the AMA in formulating solutions.

QUESTION: But given the state of the budget, how confident are you that any of the things that you want will be able to be delivered?

PHELPS: Despite the Treasurer's recent announcement that there will be no new money for health in the May budget, I would be very surprised, given the Prime Minister's interests in this health policy issue, if there wasn't new money for health coming up in the May budget.

So, I think we'll be certainly keeping the pressure on to make sure that health remains a very high priority issue for government. It is certainly a high priority issue in the minds of the Australian public and the medical profession.

QUESTION: What is the highest priority for patients?

PHELPS: The highest priority for the patients is access to health care when they need it and at an affordable rate. So, I think that rather than us continuing to focus on bulk billing rates, that is just a symptom of the malaise of Medicare. What we need to do is to say, 'Can somebody access a doctor when they need it when they're sick? And can they afford that care whatever their means?'

QUESTION: And how much money is needed to fix that problem?

PHELPS: Well, I think it really depends on what you want to achieve. Certainly, I think that there's no question that more money will come from household budgets in the future. But the really important issue that we're now facing, as an Australian community, is how we provide a safety net for people who are disadvantaged. So that people who have chronic illness, who have low incomes, fixed incomes, pensioners, are able to access health care at an affordable rate.

QUESTION: Incentives for GPs to bulk bill those less well off, would that be one way of helping solve this problem?

PHELPS: I think we need to move away from the notion of bulk billing and look at minimising gaps. Now, whether that gap is zero or whether that gap is a nominal fee is something that I think is part of the debate with the community.

Certainly, making it easier for doctors and patients to be able to claim from Medicare is one thing that should be on the table. And by that I mean expanding the notion of doctors being able to electronically claim on behalf of the patient so that the payment goes to the GP, with a co-payment that is paid by the patient upfront. Now, I think that would be easier and more affordable for families and for pensioners, for example, if they were just paying a few dollars, even if their practice didn't bulk bill, but they didn't have to come up with the whole fee upfront.

QUESTION: And what about ...... 30% private health insurance rebate?

PHELPS: Well, I have been supportive of the 30% private health insurance rebate because even though we haven't seen its full effect yet, we do believe that it is taking some pressure off the public hospital. There's been a 40% increase in private hospital separation since its inception. And, in the same time period, there's been only a 10% increase in public hospital separations.

What we need to do bear in mind is that there can't be any reduction in hospital funding at the public hospitals at either State or Commonwealth level. And that we need to make sure that our public hospitals continue to provide services free of charge to public patients. And that private patients, clearly who choose to, make a contribution to the public hospitals in that way.

Now, that is taking pressure off the public hospitals, but it is also identifying that there is still un-met need in the public sector.

QUESTION: You mentioned the government's considering trying to turn around bulk billing - the decline in bulk billing. How effective will they be, in your opinion?

PHELPS: I don't think we should be focusing on turning around the decline in bulk billing. I think that debate is over and we have entered a new phase. That new phase is about access to a doctor and affordability, so we need to address the workforce issues and we need to address affordability.

Now, as I said, if that means no gap to see a doctor, or if it means a few dollars to see a doctor, for people who are disadvantaged, then I think that we need to look at plans around that. But not necessarily focusing on how the doctor is paid.

At the moment bulk billing means that the patient doesn't pay out of their pocket, but the doctor bills the government on the patient's behalf.

Now, should the doctor, in running their small business, choose to bill the patient, what we then have to say is what is the gap between what this doctor charges and what the patient gets back from Medicare. Because increasingly we are seeing general practices move over to this private billing system rather than billing the government. They feel as if it is more of a relationship between the doctor and the patient than between the patient and the government - the doctor and the government.

QUESTION: So, low income earners should be expected to pay at least a nominal fee to see their doctors?

PHELPS: Well, I think that would depend on what the doctor's practice needs and practice costs are. I mean if you have a practice in an area where there are, say, 90% of people with Healthcare Cards, then it is going to be impossible for the doctor to operate their practice on no gap. Because where they are going to be able to discount some patients, given that the Medicare rebate is so deficient, then they are not going to be able to operate on a no gap system.

So we need to have that facility of an uncapped co-payment depending on the practice's particular needs.

QUESTION: So an uncapped co-payment, who would set the figure that the co-payment would be?

PHELPS: Yeah, sure, the government currently sets the Medicare Benefits Schedule. And no doubt that schedule will continue to be set by the government. And 85% of that is the Medicare rebate. We know that the Medicare Benefit Schedule is grossly inadequate for general practice, so I think that scheduled fee does have to be addressed and therefore the rebate needs to be addressed.

Now, it's the gap between what the rebate is and what the doctor needs to charge that is the upfront fee from the patient. That is where I think the debate needs to progress. That is up to the Government and the Opposition to work out what is affordable to the Australian public.

QUESTION: But surely it's also up to the AMA to work out what doctors should be charging. I mean you can't compel, obviously, doctors to charge a certain amount, so how can the Government and Opposition control that?

PHELPS: Well, as you would know, under the Trade Practices Act the AMA is not able to tell doctors what they should be charging. What we can say is, 'These are reasonable practice costs.' And then we work it out from there. And that will obviously vary from area to area, from practice to practice. And it will depend on whether it's a doctor in a small town in a solo practice or a doctor in a ten doctor practice in the middle of the city, the cost structure is very different. So we can't say this is what it must cost and yet Medicare sets a scheduled fee that covers everybody.

So, given that that is likely to continue as at least an average guideline, then what we need to do is to address that gap issue.

Thank you all. Thank you.

Ends