Dr Kerryn Phelps, AMA President, Old Parliament House, Canberra,
15 February 2001

PHELPS: Kim Beazley has said that they will be looking to discussions with the profession towards implementation of the RVS. One of the problems that we've seen over recent years is that the Medical Benefits Schedule (MBS) is so out of date that it is responsible for patients paying larger and larger gaps. And until the MBS is reviewed in the way the RVS suggests, patients gaps are going to increase and Medicare will be at risk.

JOURNALIST: But the Minister for Health has said that he doesn't have that kind of money and he won't give doctors a pay rise unless they give something back in return.

PHELPS: This is not about a pay rise for doctors - this is about patients getting rebates which are realistic and relevant to the true value of medical services. The MBS is grossly outdated and that's why patients are paying bigger gaps. So what we're talking about here is patients having a right to have rebates that are actually commensurate with the services being provided. The Government often says there's no money for something and then, suddenly, miraculously, the money becomes available. And certainly with the GST we know that there is going to be more money coming to Government for high priority issues. We believe that the health of Australians is the highest priority issue that this Government faces.

JOURNALIST: The Schedule now goes up twice a year, automatically. So are you saying that there should be a special increase on July 1 to the Schedule.

PHELPS: The Schedule goes up on an inadequate base, twice a year. And until that base is reviewed, according to the RVS, then we're really just seeing nibbling around the edges.

JOURNALIST: But are you prepared to wait until November or whenever the next increase is?

PHELPS: No. We can't wait till November. In May, we've got a budget. Now, unless there is a commitment in this upcoming Budget, the MBS is just going to fall further and further behind.

JOURNALIST: But when do you want the adjustment?

PHELPS: The adjustment has to be announced in May. And we would like to see it come in within the next financial year.

JOURNALIST: You must be disappointed, though, by the Minister's imparity of intransigence? He doesn't seem to be prepared, at all, to give doctors much…

PHELPS: We're quite accustomed to the Minister's intransigence. It's of no surprise to us. But the medical profession is really dedicated at this point to making sure that the RVS is implemented for the sake of the health of Australians - the patients that we care for.

JOURNALIST: But most patients get bulk billed, anyway. They don't pay these out-of-pocket charges. They don't feel the pain that you're talking about. The Minister doesn't feel any political imperative to do anything.

PHELPS: Oh, I think the Minister's starting to feel the pinch. There've been two successive quarterly declines in bulk billing. That will continue to decline, and I believe that the pace of that decline will build with time as the MBS is shown to be the farce that it is. We're also not only talking about consultation items for GPs here; we're talking about every single medical benefit item in the Schedule. That's what the RVS was looking at - not just about GPs. It's about operations that people have going into hospitals - private and public. Because the private health insurance funds are tied also to a percentage of the MBS, everything gets back to that Schedule. And until we revise that, and, believe me, the medical profession has never felt more strongly about an issue than they do about the RVS and the value of the work that we do…

JOURNALIST: …Have you got health funds' support for this push?

PHELPS: This is really coming out of the medical profession, but there's no question that the private health insurance funds will be facing major questions from their members if there isn't a change according to the RVS. The reason being that doctors are not going to be able to be involved in any of these no gap or known gap arrangements until the MBS is reviewed, and I think there is quite a sticking point with those types of arrangements at the moment.

JOURNALIST: Will you campaign against Dr Wooldridge in his electorate of Casey if he doesn't come to the party?

PHELPS: I think it would be unwise for the Government to underestimate the electoral power of the medical profession. We are seeing thousands and thousands of people every single day in our offices around the country and, believe me, the whole issue of the health system comes to us constantly. It's the doctors who bear the brunt of the questions and the complaints that patients have. And, you know, just by the nature of the discussions that we have with our patients, it becomes a political exercise.

JOURNALIST: But if he's stubborn how far are you prepared to go?

PHELPS: The medical profession is prepared to do what it takes to raise awareness, not only amongst the public, but also within the two parties that will be vying for Government at the next election.

JOURNALIST: So what's it going to mean for patients? What sort of out-of-pocket expenses are they facing?

PHELPS: Well, at the moment they're already facing out of pocket expenses and they're facing a major decline in bulk billing rates. And the longer we leave this going - and the writing's on the wall - and the longer we leave this as a problem, then the more likely it is that it's going to be a far bigger problem and a far more difficult one to address in the future.

JOURNALIST: Are you still talking about a doubling of the rebate in terms of what you're after in financial terms?

PHELPS: The RVS looks at every single medical item number. It's not just about GPs, although there's no question that there are certain groups that have been much more disadvantaged over the last thirty years than others. General practice is one, anaesthetics is one, consultant physicians and psychiatrists - these are the groups that I think will be looking to major improvements in the way they're dealt with under the MBS.

JOURNALIST: You say that it's going to impact on out-of-pocket expenses for patients but Medibank Private, for instance, is claiming they now have 65 or 70 per cent of their coverage is gap-free…

PHELPS: I think the simple, straightforward procedures where, at the moment, the health funds are offering a percentage higher than the MBS is keeping people reasonably happy. Where you've got more complicated procedures that's clearly a problem and, as time goes by, I don't think doctors are going to be able to continue to be involved in these no-gap and known-gap arrangements unless the MBS comes up to par and is a reflection of the real value of services. But I think the real hot spots are in general practice, anaesthetics, obstetrics, and amongst the consultant physicians and psychiatrists.

JOURNALIST: It's obviously clear that you want the Schedule to go up. But do you want the rebate to go down?

PHELPS: The Schedule overall will have to go up if it's to reflect reality. There are some procedures which will be coming down because of an increase in technology and an increase in efficiency in those particular areas. But, overall, we're seeing that the MBS is undercooked by a fairly large extent of $1.5 billion per year. What we'll be looking for is a commitment by the Government and the Opposition leading up to next election and, particularly by the Government leading up to this Budget, that they will be prepared to accept reality and implement the RVS. I mean, this has been a six year, multi-million dollar study which has been involving the AMA's representatives and the Government's representatives over both types of government and to ignore the results of this or to down play the results of this, I think, will be very politically risky.

JOURNALIST: But on the other side of the coin, do you support a reduction in the percentage of the Schedule, which is the rebate paid back to patients?

PHELPS: I think that the notion of the rebate and its level should be the subject of a community debate. I don't think that any one group in the community owns the Schedule or can say what happens with the level of the rebate. As I said in my speech to the National Press Club last year, there are a number of choices that can be faced here. And one is that the rebate might have to be differential depending upon whether the person is disadvantaged or not. And that in order to preserve Medicare for the most disadvantaged people in our community we may well have to increase the rebate for those people, and look at what happens to the rebate for others.

JOURNALIST: So you're saying it should be less than 85 per cent for ordinary salary and wage earners?

PHELPS: What I'm saying is that the Government has a number of options before it. One is to make the rebate, the percentage of MBS, different for people who are disadvantaged compared to people who have adequate means.

JOURNALIST: Does that mean you'd means test the rebate?

PHELPS: Well, I think we already means test people by giving them health care cards and about a third of the Australian population currently carry health care cards because they are seen by the Government to be disadvantaged. That is, they are either unemployed, they're on pensions, there are low income earners, and I think that that would be a place to start.

JOURNALIST: So this would leave patients further out of pocket than they are at present. How is that a good thing for them?

PHELPS: Well, unless that's fully implemented, then that is the outcome. But you know, the gaps will increase. Whether the MBS stays where it is or is increased is a matter for the Government to decide. The outcome for patients is that if the MBS doesn't increase, doctors' fees will have to increase to reflect the reality of running their practices, anyway. So the gap from where the rebate is now to where the cost of the service is now will continue to increase. What the Government does about patients' rebates is largely a matter between the patient and the Government, and the medical profession is advocating on behalf of patients to make sure that those gaps don't get out of line so much that Medicare is unsustainable. I have to say that the survival of Medicare depends on the implementation of the RVS.

JOURNALIST: So what are you saying a doctor should be paid for a typical GP visit?

PHELPS: If you're just picking up one item out of thousands, and that is a standard GP consultation, the RVS is coming in at around $44.00 for an average 15 minute consultation. At the moment, that is $22.95. One of the problems is the time range that is allowed for that standard consultation and that may need to be reviewed, but it has to be reviewed in a context of the whole RVS and not just isolating one item number from the rest.

JOURNALIST: The Minister has been under attack over appointments and some suggestion now that Kate Carnell might be in charge of the GP Training Board. Do you have any comment to make on that?

PHELPS: If Kate Carnell - and I haven't actually heard any confirmation of this at this stage, just rumour I understand - but if Kate Carnell is appointed by the Minister to head up GP training, the AMA would see that as yet another grossly inappropriate appointment. Not only is Ms Carnell a pharmacist, we were told that if training was taken out of the hands of the general practice community then it would be put in the hands of a chair who was an independent business person. Now, Ms Carnell is neither independent of this Government nor is she a businessperson and she is a pharmacist. And the medical profession would have serious concerns about a pharmacist running GP training, about a person who we did not see to be independent who is a long-term friend and, I understand, flatmate of Dr Wooldridge in Canberra. We don't see this as an independent appointment.

JOURNALIST: Does the matter with the pharmaceutical industry concern you at all? There's lots of concern about the PBAC and now a pharmacist in charge of a committee?

PHELPS: We would have serious concerns about a pharmacist being in charge of a committee that ran GP education. I just don't see the relevance, and neither would the medical profession. I think this would be a most unwise appointment and would meet with significant resistance from the medical profession.

JOURNALIST: Has the AMA agreed, though, in principle to the GP training scheme?

PHELPS: The AMA is very unhappy with the principle of the GP Training Board. We believe that general practice training should be in the hands of the learned colleges, and not in the hands of the Government body. We think it really sets a very dangerous precedent. Thank you all very much.

Ends