Dr Mukesh Haikerwal - Sky2 TV, 4 Oct 2006 - Medicare Rebate Psychologist Consultations

It's part of the Government's review of mental health services, and will be the highest rebate for a non-medical service since Medicare began 22 years ago. The $1.8 billion plan will be officially announced next week. Dr Mukesh Haikerwal is the President of the Australian Medical Association and he joins us now on the line.

Dr Haikerwal, how important is this in the push to do better in the whole realm of mental health.

DR MUKESH HAIKERWAL: Yeah, good morning. This is a very important part of the COAG reforms around mental health. The provision of mental health services in the community, and across the nation in general is pretty poor.

And the role of psychologists and psychiatric nurses is to enhance the role of the doctors working in the system to leverage the amount of consultation time that's there and therefore, to use the services and skills wisely and widely.

This is something that we've been very supportive of, not just the COAG package, but also the roles of psychologists and, indeed, psychiatric nurses.

NEWSREADER: But it does cross that line and extend Medicare to a non-medical service, as I said before.

DR MUKESH HAIKERWAL: Yeah, there are two issues, really, about the Medicare benefit. One is that it's still important, but it's a referred service, so it's working as part of that general practice of psychiatry team. And we think that's very important, to make sure that there is some reference back to the doctor looking after the patient, taking total responsibility for the care; and also for some reference to be made by the psychologist or psychiatric nurse towards the doctor to say if they need any sort of particular guidance, in terms of the ongoing care.

But the other thing, really, is the rates of rebate that have been provided. What we're seeing is the rates of rebate provided to a psychologist of over $100 or so, whereas the same patient going to see the GP for the same length of time gets a much lower rebate. So they're actually rebated less for seeing the GP.

It really throws into question the whole of that Medicare schedule feebook, and the fact that it's over 20 years old and out of date. It doesn't really reflect the way practice is done today in terms of general practice, and indeed other practice. But what it does show is that there is an important need for other team members in care of the psychiatrically unwell patients.

NEWSREADER: Although there still will be a fair gap between the rebate for a psychologist and what you actually pay on the day.

DR MUKESH HAIKERWAL: There certainly is a likelihood of some sort of out of pocket fee or a gap. Those things I would expect, if it follows previous changes, would actually access the Medicare safety net.

So if enough gaps for all sorts of services to the schedule are charged, as they accrue and reach the threshold they'll be able to access the safety net, which is accessing a rebate of 80 per cent of the full cost of the fee. And that's really quite an important part of the whole process.

NEWSREADER: Dr Haikerwal, from your work, more broadly, what is the extent of mental health issues that are coming across your desk and your practice these days. Is it continuing to escalate as we keep hearing?

DR MUKESH HAIKERWAL: Yeah, mental health illnesses are significant in the community. They're a major part of the role and work of every general practitioner. They're things that you know, 80 per cent of mental illness is dealt with in the community by the GP and I think that general practice plays a very important role. But that role can be enhanced with the addition of people like psychologists and psychiatric nurses into the care team. That's really very important to make sure we use the skills that are out there, to leverage the time the doctor has available to provide these services.

So mental illness is a huge problem. Some of it's continuing to be poorly catered for by our public health system. This is one part of a jigsaw puzzle to try and improve that overall care and we'd expect the state governments to come in with funding alongside the $1.4 billion the government's committed federally.

NEWSREADER: Dr Mukesh Haikerwal, appreciate your time, thanks very much for joining us.

DR MUKESH HAIKERWAL: Thanks, good morning.

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