Interview - Dr Bill Glasson, AMA President - Radio 2SM - the decline of doctors bulk billing in regional areas is impacting on Australian healthcare

When people go to doctors in this town they have to have $44 in cash upfront and ready to go.  If they're pensioners, $36.  That might sound not that much, but we were all talking about it here, doing my office survey, and many of us find that when we get to the end of our pay weeks if we had to go to the doctor and find $44, there are many times when we wouldn't be able to do that.  The decline in the number of doctors bulk billing will have a serious impact on how we manage our health.

Many doctors in these towns are exercising their discretion to bulk bill a small number of patients they consider to be in financial hardship, but pensioners and the unemployed can't expect to be bulk billed routinely.  And many of the doctors in these towns say that the government's $1 billion reform plan to encourage them to bulk bill won't get them to do that.  They simply can't afford to keep doing that.

One of the other changes or interesting things that's happening in our health care system is what the Premier was talking about, that people because they can't go to doctors because the doctors aren't bulk billing and they can't afford it - therefore going into emergency wards for things like sore throats or splinters or ear wax.  If that's not overloading our system and putting an awful strain on what is already a system overloaded, then I don't know what is.

Well, to perhaps give us some perspective on what is another way out of this increasingly untidy mess, I'm joined now by Dr Bill Glasson, who is President of the AMA.  Good morning, doctor, thank you very much for your time this morning.

GLASSON:      Thank you, Tricia, good morning to you.

DUFFIELD:      The Premier was talking about people presenting at emergency hospitals with things that they would normally see a GP for, and he's saying can we put GPs into emergency wards.  From your perspective is that a good alternative?

GLASSON:      I think that that's an issue.  Obviously as pressures comes on to the private system and doctors find they just can't accept the bulk billing rate, there are a percentage of patients out there, for the reasons of an out-of-pocket cost for seeing the doctor, but importantly for the out-of-pocket costs of the pharmacy side of things, that they find it's too much.

So it is putting an increasing strain, I agree, but that's not the problem in the A&E departments.  The problem is that we essentially have not got enough beds in the hospital, and so the reality is that we can't get patients into hospital because we can't get them out.  So I think that's the major issue in relation to our public hospitals and our A&E departments.

Do I think putting in GP clinics next door are going to make a big difference?  I think in reality no, it will take some of the load but that's a very small load.  And I think most of the studies we've seen from the A&E departments show that maybe five at the most, sort of 10% patients you could argue could go and see a general practitioner rather than being seen in the department.

And I would agree if you've got a splinter or wax in your ears, then that's just not appropriate to be seen in the department, particularly after hours.  So I understand where they're coming from, but in reality as long as they don't understand that this is not going to solve the problems in our A&E departments.

DUFFIELD:      Right, OK, the Premier is saying that it's mainly the fault of the Commonwealth, that the states are doing their best but things like age care, the decline in bulk billing and so on, is actually what's putting the strain on the state governments in trying to run the hospitals.  Who do you think has got it right in this discussion?

GLASSON:      Look, I think as Bob Carr said previously, I think in reality is that both sides have equal responsibility and I don't think we should be putting blame on anybody.  I think we should look at the system and decide how we need to reform this in an appropriate way so that you and I can access services in the public system.

There is so much duplication in costs across the state and the Commonwealth.  There is so much shifting of costs between the state and the Commonwealth that we really do have to get smarter.  And, as Bob Carr said, if we can sit down, take our political coats off and say, "Listen, we've got this amount of money for health.  We've got to run the public system and the private system, et cetera.  How can we actually make this system much more efficient?"

And I think we can do that.  I think we've got the opportunity to do that now, and I don't want to see a lot of states blaming Commonwealth, the Commonwealth saying it's a state problem.  The public out there have had enough of that.  They really want us just to sit down as grown-up mature people and say, "Listen, we know we haven't got enough money for the system.  We never will.  But let's make sure we spend that money properly."

And I think we can do that, Tricia.  And I think out of this sort of summit meeting they're having in Canberra at the moment, if all parties can agree that we need to move ahead in this prescribed manner and in this time frame, by the way - that they put a time frame on it, for goodness sake - that we can actually get an outcome that you have a seamless system.

So that whether you're in the public system being treated or moving out to aged care, or whatever, that you actually move through that system and that there're not moving through the state and the Commonwealth responsibility, I suppose.  It's got to be seamless and you as the patient should not be held up because of some bureaucracy I suppose.

DUFFIELD:      Now, as head of the AMA, you must see from your position there, you must look across the whole range of all of this, what's happening in the hospitals, what's happening to rural doctors, what's happening in Medicare - crikey, I'd be tearing my hair out if I was in your position because it seems that there are fires springing up.  You put one out or you address one, and there's something else that's just as bad around the corner.

GLASSON:      That's true, Tricia.  The reality is that the demands on the health system - not only in Australia but around the world - are becoming greater and greater.  We're living longer, we've got more hi-tech procedures we can do on people these days.  And so we've got to try and I suppose rationalise how we're going to actually deliver these services.  We've got to get very smart.

We've got to make sure that we're as cost effective as possible.  But it's got to be a community decision.  A community has to decide what level of health care they want.  If they want the top of the range for everybody across the board, then we've got to pay for that.  And in reality we've got to pay more for health, full stop.  But we can do it, we can deliver the best system across the world, as we have done traditionally.

DUFFIELD:      I'm just throwing this in to the mix, just to mix it all up.  Do you think also that doctors expect to have too high a standard of living, too high a reward for their efforts?  Do you think you have to start encouraging doctors to perhaps lower their aim a bit in terms of their profit margins and so on?

GLASSON:      The reality in general practice, Tricia, they have been struggling out there for the last five to 10 years.  In other words, their returns basically have fallen dramatically.  Now, it doesn't affect the specialists so much, but certainly in general practice - my general practice colleagues really have been hardly in the high-income group, I can tell you for the hours of work and the responsibility they have.

And I suppose that's why they've decided that the amount of money - their returns are such that they can't deliver the quality of service they want to deliver to their patients.  And more importantly, the patients are saying, "Listen, I want time with my doctor.  I want to talk to my doctor.  I don't want to be shifted in and shifted out in six minutes."

And so the patients are putting pressure on the profession saying, "We want you to deliver us the service that we require."  And the doctors are saying to the government, "We want you to fund the patients' Medicare system so that the gaps between what we need to charge and what you get back is at least acceptable."

The trouble is with those gaps now - if you've got a young family or you're chronically ill or whatever, the gaps, you just can't handle them.  And so what I'm saying to our doctors is that you've got to charge what you need to charge.  But they're also saying to me, "Listen, I've got all these patients out there that I feel can't afford to pay.  What do I do about it?"

And so they are desperate and they get frustrated because they're trying to do the right things by the patients financially on one side, but on the other hand they're trying to give them the service that they think they deserve.  That's the difficulty.

DUFFIELD:      Well, let's hope that politics doesn't interfere with what really needs to be something that we address urgently and try and do something about our hospitals, about Medicare and whatever, and that we don't start getting too much blaming.

GLASSON:      Exactly, because at the end of the day, it's all our problem.  It's our problem, a community problem, so tell the politicians to sort of sit up and think and stop blaming each other, for goodness sake.  And let's see if we can get a system that's acceptable to everybody out there.

DUFFIELD:      Yes.  Doctor, thank you very much for your time on the program this morning.  Bye, bye.  Dr Bill Glasson, President of the AMA.

Ends