Doorstop Transcript - AMA Vice President, Dr Mukesh Haikerwal, on Medicare Gold

                            The current situation is one that's not sustainable and what's been suggested may have some legs.  And it's important that we work through and make sure that what happens actually comes through long term as a successful process for looking after older people.

QUESTION:                           It sounds like you're not giving it a wholehearted endorsement. Where do you see the pitfalls potentially coming in the future?

HAIKERWAL: Like with all new schemes when they come through we have to see how they develop in time.  We saw when Medicare first came out it was a scheme that was excellent and valued by lots of people. But it was not kept... it did not keep pace with the true cost of providing the services and we found that the value of Medicare actually fell in time. We've seen the same thing with the Gold Card scheme for Veterans' Affairs.

                            So what we're saying is we've got to make sure that nothing comes in the way of the doctor-patient relationship. We have to make sure that the doctor remains the advocate for the patient and that throughout the whole of this process the people who care for older folk are actually the ones that make the decisions in their best interests.

                            What's important is that when private doctors are engaged in this process that the manner in which they look after the older folk is one which is the best way that that can happen for older folk and for their needs. What the problem could be is that the schedules which look after these people do not keep pace with time, and with time the value of these services may actually diminish.

                            What's important, too, is that we've got an awful lot of people out there over 75 on waiting lists waiting to get into the system. We need to be able to manage those people and although there is a guarantee that they'll get access to services there is going to be some delay. That has to be accepted.

                            This is an innovative use of the private system to look after people in the public sector and that's also very important too. So there are many plusses here, many new innovative ways of looking after older folk, but there are also some concerns about the longevity of the system, the way in which it's going to pan out in due course, and we've got to make sure that nothing interferes with individuals' rights to look after... to be looked after by the doctor of their choice and that the manner in which they're looked after is not interfered with by any third party, be that third party the insurer, the government or indeed the private hospital.

QUESTION:                           Ten or 15 years from now the baby boomers will be in this over-75 age group. Is it fanciful to think that a government could pay for this sort of system long-term?

HAIKERWAL: Look, I think that the demands on the system today are huge. Obviously when the baby boomer generation hits the retired age group that bulge in the number of older people will increase, therefore demands on the system will increase. Obviously this policy has an eye to that.

                            It's important we work through this process to make sure that when older folk today hit the hospital scene and then need to leave the hospital scene, that there's a proper provision for their transitional care out of the system, so they're not dumped from an acute hospital bed back into the community, but are properly rehabilitated so that they can do all their activities of daily living if they go home; or that

they're well prepared to go into an aged care facility.

And those transitional arrangements are just as important as acute beds but it's important that we do have the acute beds too. These need to be provided, and provided with good quality personnel and we need to make sure that they're properly trained and that there are enough of them in the system.    

QUESTION:                           What is this cost ballooning out, given that we do have this ageing population?

HAIKERWAL: The costs are going to increase, there is no doubt. We can minimise our costs now by making sure that we do things like preventive health work, by making sure we do proper things like smoking cessation programmes, by making sure we've got tobacco control happening. All those big picture public health policy things we need to do now. Keeping people's blood pressure right, keeping people's cholesterols right. That's where we're going to make the savings longer-term, if we keep people well now so when they enter the old aged group they're actually fitter and more able to cope.

QUESTION:                           Mark Latham said the policy will reduce private health coverage and even the cost of private health insurance. Is that a good thing, or will it stress out the public system?

HAIKERWAL: Well, it remains to be seen just how much strain will be put on the public system as more 75-year-olds decide they want to get off the waiting list and come in now. And also the private system is reasonably well full currently, so, you know, if you've got a large number of people coming out needing to be seen now with a guarantee of easy early access, that's going to put a lot of strain on the system. Nonetheless we can increase capacity, that's good...

QUESTION:                           What's the effect of the... well, Mark Latham says reduction... it will reduce private health cover, cost and level.

HAIKERWAL: By reducing the need or removing the need for older folk to be in the private healthcare pool, it means those people left in the healthcare pool won't be having to pay for that large number of people with a

large number of problems. So the actual costs to the people left in the pool may well be less. However, the actual cost to us as a taxpayer for looking after the larger pool will increase and I think that that's where the balance has to be met, and that's being met from the public purse.

QUESTION:                           You've given some qualifications on your opinions; bottom line, does this get a tick or a cross?

HAIKERWAL: It's more difficult than a tick and a cross - it's a tick for thought process and good innovation; it's a cross for details and the sting in the tail. We need to wait and see the details but I think there's a lot of positives here and we've got to work through the details to make sure the whole thing can fly.

QUESTION:                           And government...  who's the better policy, Government or Labor?

HAIKERWAL: At this stage too early to call.  There's still another week of election promises to come. We believe there's more to come.

            What we're seeing is a lot of talk around mental health, dementia, the care of older people; all of these policies will require more care in the community. That care in the community is watched over and looked after by general practitioners. We've seen a lot of money being thrown in through the Medicare benefits schedule toward general practitioners but we've not seen the real agenda being addressed and that's the agenda of making sure that the general practice quality agenda, the quality agenda that makes sure the patients are not out of pocket for a proper consult of 15 minutes because they've got chronic and complex care needs. That needs to be addressed and nobody's done that yet. So a big cross for government and a big cross for Labor for that.