Dr David Rivett, Chairman of the AMA's Council of General Practice, with John Stanley, 'Radio 2UE'

The AMA, representing doctors, is saying this scuttles claims that doctors are practising six-minute medicine and that one of the reasons doctors are having trouble in coping with the present situation - where the money they get back from Medicare, the Medicare rebate simply isn't good enough - is that in putting together all of the consultations they get in the day if the average is 14.8 minutes they simply can't cope that's why they have to put up their costs and why they have to abandon bulk billing. There's pressure on the Federal Government to do something about this.

Doctor David Rivett is the Chairman of the AMA's National Council of General Practice and he's on the line. Doctor, good afternoon to you.

RIVETT: Good afternoon.

STANLEY: How can we be sure that that's the average visit, 15 minutes?

RIVETT: This is a huge survey of over 30,000 consultations and nearly 1,000 GPs. They're the largest stats that have been collected in Australia.

STANLEY: All right. I haven't got the figures in front of me, I assume you have a broad idea. If it's an average of 15 minutes does that then suggest the Medicare rebate would not cover a doctor's costs, if he's seeing or she's seeing someone, what, four patients an hour?

RIVETT: I certainly don't in my practice. You can't see four patients an hour on those figures. All the data shows is that 25 per cent of GP time is spent non face-to- face and the Medicare rebates only embrace the face-to-face times spent with the patient, not all the things you do when you're not actually with the patient on behalf of the patient.

STANLEY: So is this the major argument, you'd say, as to why GPs are abandoning bulk billing?

RIVETT: This reinforces what the true facts are again to the Government. On these sort of consultation benefits there's no way you can stay in business and bulk bill unless you've got a very wealthy spouse or partner.

STANLEY: Okay. So what is the rebate at the moment?

RIVETT: For a non-vocationally registered GP a little bit over $17 - $17.25 for up to 25 minutes. For a vocationally registered GP it's $24.45. So, if you factor in three of those in an hour, they're the common type of GP, that's a bit over $73 dollars an hour.

STANLEY: And out of that has got to come the cost of running your practice, insurance, all the rest of it?

RIVETT: Practice costs run at roughly $80 dollars an hour, so it just doesn't add up in any way, shape or form.

STANLEY: The advantages of bulk billing, as I understand it, are that you can then bulk bill, you don't have the administrative costs, you don't have as much paperwork, but the size of the rebate being what it is those advantages have been long outstripped. Is that what you're saying?

RIVETT: I think the 15 per cent discount for bulk billing has always been a bit of a furphy. I mean I'm no longer a bulk billing practice and bad debts run at 3 to 4 per cent I'd say, looking at my figures, and the administration time involved with issuing an account rather than bulk billing is fairly minimal. If they want to be realistic about it, instead of a 15 per cent discount I suppose there'd be a 5 per cent discount.

STANLEY: So, what would you then say needs to be done by the Government to try to change the situation, to try to get more GPs bulk billing and also to get more GPs setting realistic charges?

RIVETT: Well, they need to get more GPs back into the workforce at the moment. There's a GP shortage around Australia, outer urban Australia and rural Australia certainly and in quite a few inner urban areas also. If they want to get GPs meeting the need, they've got to encourage them back into the workforce with higher rebates and better work conditions, with less time wasted on red tape.

STANLEY: Such as?

RIVETT: When you see the GP they often have to get on the phone and ring up for an authority prescription. Things like this waste enormous amounts of time every day. Just jumping through the hoops of the accreditation process to chase PIP payments and other government incentives are enormously time consuming.

STANLEY: Sorry, what are those PIP payments?

RIVETT: PIP payments are Practice Incentive Payments, whereas if you collate a certain amount of data and use information technology in your practice to enhance patient care, you're rewarded by a payment on a quarterly basis by the Government.

STANLEY: Okay. So where would you like to see that rebate? At what level would you like to see it set?

RIVETT: The Relative Value Study, which was an independent study funded by the Government at a cost of $10 million dollars in taxpayers' dollars, came out with a figure of over $48 dollars. This was a study concluded in 1999 after three years of study. It's an enormous study with data comparing GPs training and expertise to other like professions.

STANLEY: Talking about doubling the rebate then?

RIVETT: That's what the Relative Value Study came down with basically, roughly doubling the rebate. If you want to have quality rooms for your patients with parking facilities, a practice nurse, all those sort of things, it just can't be done on a shoestring, as it's being done at the moment.

STANLEY: So where does the Medicare levy come in then?

RIVETT: The Medicare levy doesn't fund health care in Australia, that's a common myth.

STANLEY: Well, I think that's been pretty well dispensed and everyone knows that, but it generates an amount of money and a contribution. Should it be lifted?

RIVETT: It's really lifting taxes, I think. I'd like to see the Medicare levy abolished, and if the Government wants to raise tax be honest about it, and raise tax and have an open debate with the community whether they want to pay more tax and have a higher standard of health care or less tax and a lower standard of health care.

STANLEY: So basically abolish the Medicare levy, lift everyone's taxes by that percentage, which is what you'd have to do, and then argue for a further increase in taxes.

RIVETT: If people are going to pay a Medicare levy they often get a false expectation from it that they've paid all their medical expenses by paying a Medicare levy, which is in no way related to it.

STANLEY: Sure. So you'd actually get rid of it and increase other taxes.

RIVETT: I think that's the only way forward. I think we need more spending on health and education.

STANLEY: Yes, because the only way we can have more spending on health and education is if we actually pay for it.

RIVETT: Absolutely.

STANLEY: So they should go out there and argue with a tax increase and for once, actually argue that a tax increase actually represents paying for something that you're getting.

RIVETT: It's good value down the line to spend more dollars now on primary health care. It will save tertiary health care dollars 10, 20, 30 years down the line, which our kids will be paying for. The less people in hospital getting expensive procedures, if we keep them out of trouble now, preventative care is dollars well spent …

STANLEY: Absolutely.

RIVETT: … and GPs are in the best position to do this in a community. But if they're in a rush and they're not financed properly it all goes out the window.

STANLEY: Just finally, private health funds. It doesn't affect you because they can't actually cover - well, they can't cover the gap certainly, but the Government said yesterday, private health funds can raise their premiums in line with the inflation rate without Government approval. What did you make of that?

RIVETT: I didn't think it was really a realistic outcome, I thought it was politically tainted and being something they could sell to the populace without thinking about it much.

STANLEY: The clue really was when they announced it, wasn't it? Late on September 11.

RIVETT: Health fund rises generally have been greater than the CPI year after year, and health care costs have been greater than the CPI year after year with new technologies coming in and the population ageing, so to try and link it, that means something has got to give and break, and the funds will be applying each year for above CPI benefits which will get nowhere. The whole purpose of the review was to attract new health care funds to set up and this will have the direct opposite effect, I should imagine.

STANLEY: Doctor Rivett, I thank you for your time.

RIVETT: Thank you.

Ends