Dr Kerryn Phelps, AMA President, with Nicole Haack, 'Radio 5AA'

Dr Phelps is, of course, the Federal President of the Australian Medical Association. She joins me now. Dr Phelps, thanks for being with us.

PHELPS: Good morning.

HAACK: Is bulk billing going to become a thing of the past?

PHELPS: Bulk billing is fast becoming a thing of the past. I have to say that many practices are reluctant to abandon bulk billing, particularly for their patients who are on pensions or low fixed incomes. But they're finding that even though they're reluctant to do it, they have to, in order to continue to maintain their services and to keep their practice doors open.

HAACK: Can you walk us through the reasons behind that?

PHELPS: Well, the first thing is that the bulk billing rate is fixed by the Government at a rate which is called the Medicare Benefits Schedule. Now this schedule sets what the Government says it can afford to pay for patients, in terms of the rebate they get back for seeing the doctor.

If a practice bulk bills, they're accepting 85 per cent of that fee which, let's say for a standard GP consultation, is in the order of about $24 dollars. A lot of practices are finding that their costs have now increased to over 60 per cent of their gross billing. So, that means that the doctors themselves are finding it very difficult to even make a living and pay for all of their staff and their premises and everything else, because that Medicare Benefit Schedule rate hasn't increased in line with the cost of providing that service for the last couple of decades.

HAACK: Now, I mentioned earlier that one of our oldest general practices is the latest to be hit by this, that's the Beulah Park Medical Centre, isn't it?

PHELPS: I visited that practice this morning and I spoke to the doctors working there, and it is a real wrench for them, they are finding it actually quite difficult to come to that decision. But it's one that they've had to make in order to keep on working and providing the practice that they've been able to provide, for three generations in some cases. But they have to be able to charge their patients a small fee, in order to continue to be able to be their GPs.

HAACK: What does it mean for ordinary, and I guess in particular for those people - ordinary Australians - those that are from lower socio-economic areas?

PHELPS: Well, people who are on low fixed incomes who are disadvantaged are going to find that it will be a little more difficult for them, because they're going to have to pay something on top of the Medicare rebate to see their doctor. And that will have to be fitted into their household budgets.

What will happen in a number of cases, it's going to be a little bit of going back to the old days I suppose, where doctors will have a private conversation with their patients who are in this situation and perhaps come to an agreement to discount their fees, so that their patients are able to afford to come and see them without having to think too much about that.

HAACK: Are we going to get to a situation where some people might choose not to go to the doctor, because they simply can't afford it?

PHELPS: I really hope that doesn't happen. I think that we'll find that some patients will be going through emergency departments in hospitals, which would be a great shame, because one of the mainstays of general practice, and good primary health care, is having continuity of care with the one doctor or the one practice, who knows you, knows your family, knows your circumstances.

Some people, if they're in that circumstance, will be having the discussion that I mentioned with their doctors. But really, I think it is up to Government to have a discussion with the medical profession about how best to protect the people who are in that circumstance, and perhaps increase the rebates for those people so that they're not facing large gaps.

HAACK: Has the Government been open to your thoughts so far?

PHELPS: Not as yet, not in the slightest.

HAACK: Surprise, surprise.

PHELPS: They keep talking about the incentive payments. Now, as far as I can see, the incentive payments are very unpopular with GPs, they take a lot of administration, there's an enormous amount of red tape with them and they're more about providing statistics to Government than about care to patients. We haven't really seen any accountability for any of these so-called practice incentive payments. I don't think that there's been any proof that they've improved the care that patients get, and what it's done, is to drive more and more practices like the Beulah Park practice away from bulk billing.

HAACK: One of the concerns as well, as you said, is that if people do start fronting up at the emergency centres of hospitals, those emergency facilities are already stretched to the absolute limit, our hospitals simply can't cope with that.

PHELPS: No, the hospitals can't cope with that, and it's not reasonable to expect that the hospitals should have to cope with that, because they should be seeing the patients that need acute hospital care and it's not appropriate for patients who should be seen in general practice to be going to those sorts of facilities.

They're not going to be able to get the continuity of care for a start. If someone's got a chronic or long-term disease, they need to go to a practice that understands their condition, that has their records, that understands them, their family, and their background. And there is so much more to general practice than simply looking at the condition or the problem that the patient's presented with on that particular day.

HAACK: Mmm. In percentage terms, how many practices have already ceased bulk billing?

PHELPS: Well, if you just look at the South Australian figures, just over the last 12 months, we've seen it go down from a figure of over 70 per cent. The figure for South Australia - I'm just looking that up for you - has gone from 74.9 per cent 12 months ago to 69.6 per cent now, and that's just in South Australia.

Some other States, the smaller States, have lower levels of bulk billing like the Northern Territory, Tasmania and the ACT, but South Australia's the next lowest. And I think that we are really seeing the beginning of a precipitous slide in the numbers of patients being bulk billed.

HAACK: So the tip of the iceberg, really.

PHELPS: It is the tip of the iceberg and that's not a bad thing in itself because, you know, I'm well and truly on the record as not being a great supporter of bulk billing for all sorts of reasons. But my concern is the gap that patients will have to pay if they are disadvantaged or on low and fixed incomes, and people who might have to think twice before they see a doctor when perhaps they need to, in order to keep themselves well.

HAACK: Mmm. It's a big issue. Where are you going to take it from here, Dr Phelps?

PHELPS: Well, I think that patients really need to be talking to their Members of Parliament because this is really now between patients and their insurer, that's Medicare and Medicare governed by the Government of the day. And that's where any action, if there's going to be any action at all, needs to be taken.

So if people let their MPs know their concerns. Obviously, talk to your doctor if you have problems being able to pay for your doctor's care and, as I said, doctors will more than likely be open to some discussion about discounting their fees, but that won't always be possible and, it's going to be a bit of a difficult judgement call for a lot of practices. And it really shouldn't be up to GPs to be subsidising Medicare, it's supposed to be a universal health insurance scheme.

HAACK: Mmm. Very good point indeed. All right, I know you've had a busy schedule this morning so I appreciate your making time for us, Dr Phelps.

PHELPS: My pleasure.

HAACK: Thank you, great to talk to you. Dr Phelps there, who is of course the Federal President of the Australian Medical Association.

Ends