Dr Gerard Segal, AMA Spokesman on aged care - ABC Radio 3LO, with Jill Singer

SEGAL: Good morning, Jill.

SINGER: Now, could you explain to us, yesterday we were talking about this program and the way it worked in the private sector, and there was a suggestion, certainly that the Epworth Hospital, a private hospital, was managing to get 'hospital in the home' programs into nursing homes and wanting to encourage that. Can you tell us how does the private and public sector differ in this regard?

SEGAL: There's a huge difference. Firstly, there's a Medicare agreement in the public system and that says that you will be treated by a public doctor in the public system and that any other doctor is prohibited from actually treating you in any way, shape or form and that's a vital difference. So that means that GPs cannot treat those people. If they're at home, or in the nursing home, or wherever they are, they're deemed to actually still be in hospital, so if they're in hospital then they can only be treated by a hospital doctor or hospital staff.

SINGER: How would you like to see that changed?

SEGAL: Well, to change that would be a basic change in the whole Medicare agreement, which would be a different thing. However, the hospitals could certainly put on their staff general practitioners and that would get past that problem in a big way. That could make a huge difference because then you could find that the GPs could actually go into the home, treat the people who they know well, when there's bigger problems send them back to the hospital, which I said they're still in, but actually send them back. That would actually be a very good thing. Nursing homes - a different story altogether. Remember, nursing homes, they're financed in a totally different way under what's called the Resident Classification Scale, are actually paid to do all that work. Now, if a person is technically in hospital, then the hospital actually has to provide all that nursing service. It's not going to work, really, in that situation.

SINGER: We've obviously seen problems, though, with people in nursing homes who might then need medical care and there's trouble getting them space in the hospital system. How we've seen that obviously the private system said, 'Well, we could perhaps send someone in there to help them stay in the nursing home'. Now, surely it would be preferable to see the public system following this line and being able to ease the pressure there. If we look at the pressure on public hospitals and also nursing homes, doesn't this need to change?

SEGAL: We need a very much more flexible system - you're correct about that. We need a different type of care, something that we, at the AMA, have been calling transitional care, rehabilitation care, the ability to have people funded for that type of care in nursing homes. Unfortunately, as I said, you really can't get the public hospital people in there, but if there was a different level of funding that allowed that type of care to occur, in other words, the intensive type of care, people don't need to always be in an acute hospital, but they do need care. That's a very different thing. We know that people, after they've been unwell, often need rehabilitation, or they just need someone actually to look after them. So, there needs to be a step down option and that's not there at the moment, at all.

SINGER: I understand you have been thinking of calling for a summit. Is that the case?

SEGAL: Yes. Look, we all know that aged care has huge problems, it really does. And it's about time that there was a bipartisan summit, one where all parties come along, where all people who are interested in aged care - that's the providers, the medical profession, nurses, whomever - all come together and we actually get some proper workable solutions. Because the way we're going at the moment, things are not going well. It doesn't matter what the ministers or, in fact, both parties say, there is no real solutions being offered, and I think it's about time everyone got together in a bipartisan way and offered some real solutions.

SINGER: Very briefly, do you think there should be more cooperation between Federal and State health systems in this matter?

SEGAL: Well, that would make a huge difference, because otherwise we have this cost shifting game which expends lots of energy, wastes money, wastes time. It's really a crazy thing.

SINGER: Dr Gerard Segal, thanks very much.

SEGAL: A pleasure.

Ends