Dr Kerryn Phelps, AMA President, 'ABC66 2CN'

Now, you may think that's okay because I've got a Health Care Card. Well, it does appear that's not going to help you much in the future either.

To tell us a little of that, we are joined by Dr Kerryn Phelps, who is the President of the Australian Medical Association. Good morning.

PHELPS: Good morning.

UHLMANN: Why are doctors becoming more reticent to accept Health Care Cards?

PHELPS: Health Care Cards have really lost their credibility amongst doctors, and that's because there are so many of them that have been issued. At latest estimates there are about eight million Australians who have access to a Health Care Card. That's not just the Health Care Card holder, but they're also dependents such as children. And it just defies belief that so many people in Australia could be disadvantaged to the level that their doctors would need to discount their fees by up to 50%.

UHLMANN: So you'd like to see some means testing applied, perhaps?

PHELPS: Well, there's a sort of form of means testing being applied now but it's reasonably haphazard. And nobody seems to know what are the recommendations for somebody to get onto a Health Care Card, how long they're able to keep it, when it can be removed, and frankly doctors are pretty sick of seeing these Health Care Cards and being expected to discount their fees heavily when somebody produces one.

UHLMANN: So you think that the government is actually handing over a subsidy but using the doctors to do it?

PHELPS: Yes, they're expecting doctors to subsidise an inadequate Medicare. The Medicare rebate, let's just say for general practice, is way below what it ought to be for patients. And so patients' gaps are increasing. But a lot of people have traditionally expected - and it's not something that doctors are obliged to do but have done so as a goodwill gesture - but people have expected doctors to provide a heavy discount, or, indeed, to bulk bill Health Care Card holders. And doctors are really at the point now where they're saying they can't maintain viable practices and subsidise Medicare to the extent that they have been.

UHLMANN: Are there certain groups that you think should be means tested further or that are causing particular worry?

PHELPS: I think it's time that the whole system of Health Care Card holders is reassessed, not only from the point of view of medical practice but also from the point of view of the Pharmaceutical Benefits Scheme. Because we just can't believe that there's eight million people who require such heavy subsidies, either by government or by the private medical practitioners.

So if they have a look at the entire system and say, well, who ought to qualify, who shouldn't be qualifying, and I think they should tighten up the fences around those Health Care Cards.

UHLMANN: And finally are we likely to see a widespread rejection of these by doctors? Or is it likely to vary from practice to practice?

PHELPS: Well, it's obviously going to vary from practice to practice, but it's certainly becoming more widespread.

The other system that is becoming increasingly less credible is the Gold Card Department of Veterans Affairs card, and particularly with procedural specialists and with general practitioners. The amount that is provided through the Department of Veterans Affairs and not through Medicare is increasingly unrealistic, and that system is also going to need to be reviewed as well.

UHLMANN: Dr Phelps, thank you.

PHELPS: Thank you.

UHLMANN: That's Dr Kerryn Phelps, who is President of the Australian Medical Association.

Ends