Dr Kerryn Phelps, AMA President, with Derryn Hinch, Radio 3AK

On the line the National President of the Australian Medical Association, Dr Kerryn Phelps. Good morning.

PHELPS: Good morning, Derryn.

HINCH: Look, I know we've had plenty of hours for this to all sink in but to slug people an extra $6.20 from every prescription as of August 1, I mean that is shameful, isn't it?

PHELPS: I think it's really going to hit, as you said, families, the people who are fixed and low incomes, who are already on tight household budgets. And to find the extra money the thing that really concerns the medical profession is that people will make decisions about whether they pay for the medication or whether they just see whether they're going to get worse. And indeed we do know, from overseas studies in Canada, in the US, that if you have social security beneficiaries who have to pay more for their medications that you have a massive increase in admissions to hospital, presentations at accident and emergency departments and visits to the doctor. So it's a false economy.

HINCH: Yeah. To me it's so obvious as the nose on your face. If people suddenly find they are starting to scimp and they can't afford the medication, more people are going to end up in hospitals. The point I made earlier to this morning that, I don't know whether you agree or not, but because of the more sophisticated drugs people are being turned out of hospitals faster and to take their medication. Well, people will start to say, "Well, I can't afford all that.'

PHELPS: You're absolutely right. One of the main triumphs of medical practice over the last couple of decades is that there has been vast improvements made in the amount of time people have to spend in hospital. And, let's face it, you don't want to have to spend more time in hospital than you absolutely need to.

HINCH: True.

PHELPS: But people are getting better faster. They are being better managed in the community. We are making tremendous headway with diseases like asthma, for example. Now, if people are saying, 'Well, look, I've got blood pressure, I've got asthma but I'm actually feeling pretty well and I reckon I can go without this medication', we are going to have to pay the piper down the track.

HINCH: Well, last year one of your protagonists, the then Health Minister Michael Wooldridge, got into a bit of a kafuffle when the Government was virtually saying to people you can go on a diet for six weeks before you are allowed to have any medication. I think I said to you, I mean, take a look at Michael Wooldridge, he should take his own advice..

HINCH: But I mean, isn't the Government suddenly meddling in doctor's surgeries?

PHELPS: Yes, we are really concerned about the extent to which the Government is starting to interfere with the doctor's decision and with the doctor - patient relationship. And, for example, doctors will prescribe, based on evidence, what they feel is in the best interests of the patient.

Now, if we are provided with credible independent evidence that a certain type of medication is as good or better for our patients, then that's the way we will prescribe.

HINCH: Generic ones we are talking about here?

PHELPS: Well, generic or otherwise. But I mean, there are reasons why we don't prescribe generically as well, because you are, you know, familiar with a particular format of a medication. Some elderly people find a particular size of capsule easier to swallow than another size. And just cause the medication is the same doesn't mean that the actual presentation of the drug is the same.

People might be accustomed to a particular shape and colour of a pill, and if you go changing that - I mean I've got so many stories of people who go into hospital. They're given, to go home with, the generic equivalent of a drug that they were taking before, and they've come home and take up taking all of their usual medications plus the generic, which means that they're doubling up on medication and getting confused in that respect.

So you have to look at a whole range of the human dimension of these sorts of…

HINCH: That's a very good point, especially for older people.

PHELPS: Yes, and they can get confused. And so you can't always reasonably prescribe a generic and it's not always the best way to go.

HINCH: Yes, I know. If I'm getting say a blood pressure tablet and I've been taking this certain brand for some time, if the doctor suddenly says after a year of that saying, 'Listen, try the Black and Gold version', you might say, 'Hang on a flash, I've been doing very well with what I've got, thanks.'

PHELPS: Yes, well that's exactly the sort of thing I'm talking about. But the extra slug on pensioners, on people on low incomes, is I think really heartless and it is going to impact on a lot of people. And the shocking thing to me is that this was done without any consultation with either the medical profession or consumer group.

HINCH: Funny, that my next question was going to be, I thought as though it was a strange question - did they ever talk to you about it?

PHELPS: No, I mean we put a submission to the Government saying, you know, we recognised that they're going to have to rein in some of the PBS expenditure. We recognise that the medical profession has a role to play here and, we would like to work in a cooperative way with the Government on sensible measures to assist GPs and specialists in their prescribing decisions to assist consumers in their decisions and their discussions that they have with doctors. Completely ignored. And they just basically put through $2 billion worth of cuts to the PBS without any consultation with the profession at all.

I mean things like increasing the amount of authority information that's required. Now, do you know about these authority prescriptions?

HINCH: You have to get permission, first.

PHELPS: Yes, you have to get permission from the HIC. Now, what this means is that I'm in my surgery with you sitting across the table and or with a patient sitting across the table and I want to prescribe a particular medication that the Government says that I have to get special permission for. Now, it's not because it's a terribly dangerous drug and you really need to have a particular quality of safety reason for it, it's because it's more expensive.

Now, people don't like taking medication unless they absolutely have to.

HINCH: True.

PHELPS: But under this authority system you've got to ring up, talk to a clerk in the HIC by telephone, give the patient's name, details, the medication you want prescribed, then the reason for it. Now, it might be genital herpes or it might be schizophrenia or it might be shingles, but it's patient's personal information but you have to give that over.

Now they're saying you have to give more information. Which hospital they went in to have a diagnosis. What test they had done. What the date of those tests were. Doctors are going to spend their whole lives wrapped up in red tape.

HINCH: This is what I was saying yesterday about the government getting into doctor's surgeries. Now I know that you have to have some controls and I heard the warnings put out by Peter Costello about how out of control, but to me I'm just wonder where some of the arbitrary - $6.20 comes from?

PHELPS: I think they - who knows? I mean a lot of the things that they've announced in the PBS cuts, I mean, I can't honestly imagine how they're going to work to actually cut $2 billion out in the next four years. I mean all of the debate that I've been hearing from health economists and people really in the know about what we're spending on health in Australia have been saying, 'Well, maybe what we're spending, the 8.5% of gross domestic product isn't enough and maybe we should be looking to increase the amount spent on health to 9.5 or even 10% of GDP. Because if you invest in health you're investing in the future of your country.

And it's the same with education. If you invest in the future you are investing in health and education. And to cut a billion dollars out of the health budget over the next four years, to actually cut back on what we're spending when we have rising need, to me is counter intuitive.

HINCH: Yeah, I agree with you. Dr Phelps, thanks for your time.

PHELPS: Thanks, Derryn.

Ends