Dr Kerryn Phelps, AMA President, and Dermott Casey, Federal Health and Ageing Department, with 'Radio National Breakfast'

SCHENKER: Confidentiality is one of the most significant factors in any doctor-patient relationship. Perhaps never more so than when it comes to the issue of mental health.

But concerns are being raised that confidentiality could be compromised by a new program being set up by the Federal Government. The Department of Health is introducing a specific item number to be recorded in the files of patients suffering from a number of conditions ranging from grief to substance abuse, eating disorders and anxiety. That number will even be used, too, on the files of sufferers of certain phobias and sleeping problems. And there are fears that the use of these numbers could lead to patients' privacy being compromised when records complete with the itemised record are accessed for insurance purposes or even used in court proceedings.

Obviously once the number is revealed patients might have to endure the stigma of being labelled as a sufferer of a mental illness.

The Australian Medical Association has voiced its concerns, claiming that as well as issues of privacy, the new system doesn't adequately take into account the needs of individual patients. And AMA president, Dr Kerryn Phelps, is with us now to take this further.

Kerryn, welcome to Radio National Breakfast.

PHELPS: Good morning, Vivian.

SCHENKER: We're also joined by Dermott Casey, Assistant Secretary for Mental Health and Special programs with the Federal Department of Health and Ageing. Dermott, welcome to you.

CASEY: Thank you.

SCHENKER: Now Kerryn, you recently met with the Health Minister, Kay Patterson, to discuss this very issue. What were the key concerns you expressed?

PHELPS: The key concerns that we have are that the mental health item numbers label with the HIC a patient who goes to their general practitioner as having a particular, no particular mental illness, but non-specifically labelled as having a mental illness. Now as you said in your introduction, it could be anything from an adjustment disorder, someone perhaps moving from one country to another; someone suffering from post-natal depression; a child with bed wetting or behavioural problems.

And if that GP decides that the patient requires counselling for three sessions, then the patient will get that extra time spent with them but it also means that there will be, if you like on the third visit, a flag fall where an incentive payment is made to the general practitioner but a number goes to the HIC and that patient is labelled as having had counselling for a mental illness.

SCHENKER: I'm intrigued by this idea of a flag fall payment. I mean what's the rationale behind that?

PHELPS: Well the rationale is that the Government has been wanting to introduce these specific, disease-specific item numbers. And the AMA has expressed concern about it because it goes counter to the way general practice operates, and that is that patients need to be treated holistically. They need to be treated as a whole patient. They quite often have a number of different diagnoses and, to actually split off a diagnosis of having a mental illness and that patient having had counselling really runs counter to that holistic view of general practice.

SCHENKER: And doesn't that seem a bit insulting, too, to pay you extra money to do what you would presumably do if you thought it was necessary anyway?

PHELPS: Well that's certainly what's happening. And the point that general practitioners have been making time and again and the point the AMA has been bringing to the Government time and again is that, if there is appropriate patient rebate applied to longer consultations, then GPs will be able to spend the extra time with the patient and have that be financially viable to them, particularly in cases where the patient may not be able to afford to pay the full value of that service as it currently stands. It's the rebate which is insufficient, not the fact that the GPs don't want to spend time with the patients or indeed don't actually spend that time.

The other issue is with confidentiality of this, is that there is the potential and this is one of the problems that GPs are really resisting this whole move because of this particular issue is confidentiality and that is that a life insurance company could potentially, if the patient gives consent for their records to be accessed by the life insurance company for the purposes of assessment, that life insurance companies have been excluding people from life insurance if they have a history of mental illness, particularly depression.

SCHENKER: Okay, well let's hear what Dermott's got to say about that. Dermott, let's start at the beginning. What's the rationale behind the whole program? Why do you need item numbers and why do you need to pay doctors $150 bonus for using those numbers.

CASEY: I think quite simply Vivian, that the Government wants to give some special attention to mental illness. Mental illness has never been treated very well as a priority in health and it is one of the national health priority areas so the Government wants to give special emphasis to this.

GPs have often said they don't have time to spend with their patients. This scheme allows them to have that time and rewards that time by giving the GP a bonus after they've engaged in the three-step plan with their patients.

SCHENKER: But what about what Kerryn just argued, that in fact the Government would be better off paying doctors more money for those longer consultations so that they've got the time to do what they would want to do otherwise, rather than paying the money for identifying a specific condition.

CASEY: Well look, the issue for, the matter for the Government in terms of what the rebate is, I guess my job is to implement a system the Government brought in two budgets ago to give a much better emphasis and a much better push to the treatment of people with mental illness.

SCHENKER: And are you satisfied that paying doctors a $150 bonus will do that?

CASEY: We believe this scheme has been developed in conjunction with general practitioners, mental health consumers and other interested parties and we believe that the scheme as set out has been something that has been shared with a number of organisations and is there to give much better quality mental health care to Australians.

SCHENKER: Okay, now what about the confidentiality problems that Kerryn raised as well. How can you guarantee that a patient's privacy won't be compromised through the use of the number?

CASEY: Well privacy is a right that is assigned to an individual in relation to their medical records. And the Health Insurance Commission is bound by the Privacy Act and the Health Insurance Act in handling and divulging that information. So people's medical records are private.

SCHENKER: Okay, well thank you both very much for speaking with us this morning. Dermott Casey, Assistant Secretary for Mental Health and Special programs for the Commonwealth Department of Health and Ageing. And before him we spoke with Kerryn Phelps, President of the AMA.

Ends