Dr Kerryn Phelps, AMA President - Radio ABC 666 2CN

So the government may be as interested as journalists today when Dr Phelps steps up to address to the National Press Club, and she's dropped in to chat with us first. Good morning, and thank you for coming in.

PHELPS: Good morning.

UHLMANN: Now, look, would it be fair to say that you're more confrontational than the former President, David Brand?

PHELPS: I think that confrontational is a difficult word. I think I have certainly been prepared to take the issues right up to government. And where we haven't been getting the hearing that I think we deserved, then I've been prepared to take it to the public, and to also speak to whoever I need to speak to in Government and Opposition, to make sure that the views of doctors and patients are heard.

UHLMANN: Confrontation may be a difficult word, but difficult perhaps is a word that they're using about you in government at the moment?

PHELPS: Well, I think that if you don't sort of roll over and play dead, you seem to be difficult. And if that's the case, then I don't mind being a little bit difficult.

UHLMANN: Was there a reason why you thought that things had to change after David Brand? Did you feel that doctors weren't getting the deal that you thought they should get from the government?

PHELPS: Well it was certainly, a lot of AMA members felt that things were not travelling well and that there were a lot of agendas operating within governments that were seeking to take control of the way doctors practice medicine and not necessarily they felt in the best interest of patients. And so we felt that a somewhat different approach was needed and that was certainly vindicated by the vote to install my team at the election before last.

UHLMANN: What would you say their key concerns were?

PHELPS: A number of concerns. I suppose one of the key issues at the time was the Memorandum of Understanding in general practice. Which was basically a plan to cap general practice outlays without actually really addressing the fundamental issues for general practitioners. Which was that their practices were becoming unviable, that there was increasing red tape and administration in running their practices and that the Medicare benefit rebate was grossly inadequate. And that we also had a relative value study on the go, which was due for completion in about 18 months from when the MOU was first mooted. Which was certainly going to look for a very different solution to the problems in general practice.

The other sorts of issues that were happening at the time were related to private health insurance and what was happening in that particular area. And I think a general sense that the views of the medical profession were being stifled.

UHLMANN: It's interesting, though, isn't it, there are some alliances that appear to be dissolving if you like. Once upon a time the private health insurance companies and doctors seemed to line up - and they lined up fairly well with the Liberal Party, too - and all three of those old standing alliances seem to be falling apart?

PHELPS: There's really been a marked change in the landscape over the last twelve months and I think that's particularly been the case with the private health insurance incentives. And I think that the medical profession felt that there might have been a somewhat different environment once that health insurance came in.

But, in fact, what happened was that the health insurance companies became quite aggressive in their contracting with the private hospitals and they became also rather aggressive in their dealings with doctors as well, and started putting out things like the preferred provider lists. Which were based on costs rather than based on any particular expertise or area of skill of that doctor or how suitable they were for a particular patient. And they really didn't want to listen to what we had to say about our concerns.

UHLMANN: They would argue, though, that what they were trying to do was to cut the cost so that there was no gap for patients. So that they could actually put out a contract that said, you know, if you've got private health insurance then you won't have to pay a gap if you come into a private hospital.

PHELPS: That was a very naughty argument. And the reason for that is the whole fundamental reason for the gap is that the Medicare benefits schedule is inadequate. It's been around for 30 years, it hasn't kept up with the cost of running practices, it certainly hasn't kept up with the cost of providing medical indemnity insurance for doctors who are working in procedural areas like obstetrics.

And so doctors have had to charge a reasonable amount to cover their practice costs and make a decent living. And if the Medicare benefits schedule ties, as it does, private health insurance rebates to its schedule and the schedule's inadequate, then the reason for the gaps is not doctors fees, it's because the Medicare benefits schedule's inadequate.

And what's naughty about the argument that they've been putting around is that they've been saying that doctors are overcharging and that's the reason you've got the gap and we have to rein them in. Whereas, in fact, it's the fact that we're dealing with the Medicare benefits schedule that's out of date and inadequate. That's the fundamental problem that we need to address.

UHLMANN: I guess one of the things that it's done for government though, and perhaps one of the reasons that the Liberal Party has come on board with it over time, is that it has capped the cost of health cover in Australia to around eight per cent of GDP from the time that it was brought in. So that's got to be a good thing from governments point of view?

PHELPS: I don't think we need to necessarily celebrate the fact that we can cap health expenditure at eight per cent. I think we need to look at what the long term gains are from that eight per cent and say, well, would we get better long term health outcomes if we spent nine per cent or nine point five per cent.

Certainly in the UK they've found that the amount that they were spending on health was inadequate in terms of the health outcomes they were getting. In the United States, they're spending a great deal more than that and not necessarily getting better health outcomes. So, being somewhere in the middle, looks like we're at about the right level. We've got, I think, the fundamentals for one of the best systems in the world. We just need to fix the problems that are in this system.

UHLMANN: I guess the thing you say, though, is that if you look at the United States it's gone up towards 15 per cent of GDP and many people would say that that's much too much to be spending on health.

PHELPS: Well, indeed. And they have a system of managed care which is trying to cap and contain costs but at the cost, quite often, of quality of care. And we don't want to see those elements of managed care where you have an enormous administration telling doctors how to practice medicine and telling patients what they can and can't receive in terms of care.

I think, in Australia, the level of autonomy that we have for clinicians to make responsible decisions with their patients is a very good system to have. And, in fact, it is, I think, very effective and efficient not only cost containment, but providing very efficient and very effective health outcomes. And we need to look at both the cost and the outcomes and ask ourselves, are we in fact spending enough money when we consider the increase in technology for example for the Australian population in 2001. And I don't think that's a fundamental question that we've yet answered.

UHLMANN: Years ago, I asked the President of the AMA, Dr Bruce Shepherd, what he liked about the office in Canberra and he said, 'Well it was just a mortar shot from Parliament House'. If you could fire a mortar up there in this election year, what would you like to explode over both parties? What message would you like to send?

PHELPS: Well, one of the themes I'll be looking at in my National Press Club speech today will be how we can take a non-partisan view of health policy for the good of Australians …

UHLMANN: Is that possible?

PHELPS: … well, I'd like to think that a large part of health policy could be beyond the argy-bargy of party politics. And I think the Australian people would like to see that, too. That we take a very practical approach to health policy and not be constantly having a war of ideologies. I think that one of the shots that I'd like to fire is to challenge the parties to see if they can rise above party politics.

UHLMANN: Does the AMA support Medicare?

PHELPS: Yes, the AMA does support Medicare. I think it is a system that is socially just and I think, if it's renovated, it will take us into the future. If it's not renovated, if it continues to be neglected, then I think that there are serious questions about whether the system can take us into the next generation.

UHLMANN: Now, just quickly, we've got a couple of minutes before we have to let you go and move on. But can you tell us, that it's Doctors Week, is it?

PHELPS: Family Doctor Week.

UHLMANN: Family Doctors Week, what's that?

PHELPS: Well somebody earlier in the week said to me that they felt that the Family Doctor was quite possibly an endangered species.

UHLMANN: I was going to say, should be sitting next to the do-do somewhere?

PHELPS: Yeah, well, it's not. And the family doctors around the country are the backbone of the health system. And I think it's a good reminder this week of the important role that family doctors actually play in the Australian community. And some of the issues that we're going to be addressing this week, and already have done are childhood obesity - which is our main theme for childhood health - bowel cancer screening, and cancer screening generally, which is, of course, core business for general practitioners, family doctors around the country.

And looking at some of the attitudes that the community have towards their GPs, their family doctors and where the GP fits in to communities. And I think that the importance of highlighting Family Doctor Week and the role of GPs is to say 'Well what can we do' obviously within the political process to ensure the long term survival of general practice. Which I think is a very valued institution in Australia, particularly in view of the tremendous onslaught of corporatisation of general practice and the changes that that is likely to bring to primary care.

UHLMANN: Well, Dr Phelps, we look forward to be your speech today at the Press Club and I should mention, too, that you'll be on line on the public record site on the ABC and that's abc.net.au/public if you got all that, just go to the ABC website from 1 to 2pm today after the Press Club address. Thank you.

PHELPS: Thank you.

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

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