Medicare Smartcard

It's been 20 years since Bob Hawke's Australia Card concept was dumped after a fair amount of public disquiet. But the government says this card idea's different and it's much needed.

The Australian Medical Association recognised that the health system could be improved by the new card, but is still concerned about the combination with personal identification details. Dr Mukesh Haikerwal is the National President of the AMA and he joins us now. Good morning.

DR HAIKERWAL: Good morning, how are you?

COMPERE: I'm very well, thank you. Doctor, why are you concerned?

HAIKERWAL: Well, I think that this whole debate I suppose around electronic health information around Smartcard technology and around simplified billings has all got muddled up and it's got muddled up with this national identity card. And I think if you don't pull the three concepts apart, we run into trouble of not understanding what's being proposed and then losing the benefits of what could be a good electronic Smartcard technology enabled system.

What could be bad is a national identity card which people have much more concerns over and needs to be much more carefully thought through. So currently there's problems with claiming of Medicare rebates and certainly some of the Centrelink stuff is attached.

And you can improve that pretty much straight away by tweaking current provisions and the way things currently work with electronic systems that currently exist. You can make that system better by actually using the Smartcard enabled or a smart bit of technology by having a new credit card type of thing that you can flick through a machine and just like putting your card through a hole in the wall to get money or the supermarket to get money. You can then get your Medicare rebates that way or using this new card.

That new card can be a key to a database which has your medical information. But for that to work you've got to be sure the information is correct, robust, up to date and keeps up with your changing health. Also that it's safe, secure and only available to who you want it to be available to.

COMPERE: Easy to say though, safe and secure though. Wouldn't there be a concern that people's, you know, very private health details could be accessed?

HAIKERWAL: Well, that's exactly right and that's why it's so important we get it right and we get it right in that new health environment. And I think that if you then sort of start getting people to doubt going about security - and I think we could probably allay those because we see electronic means being used for bank accounts, we see them used to pay for things across the internet and buy products. And people are much more secure I suppose with that now than they used to be five or ten years ago. And they're getting more secure with the health information that way.

But if you then bring into the discussion an argument around national identity cards and so on, a lot of that good work that's been done and the foundation and the sense of acceptance, and they will be blown out of the water and that would be a real shame.

COMPERE: I suppose though that if you introduce something like a health card, it has all those details, it's not really completely beyond the pale to make - it's not a big jump to just attach some extra information on to it and then you've got a ID card. It would make it certainly easier for the government to do so, so isn't that a legitimate concern?

HAIKERWAL: It's a legitimate concern and I think that it's not a discussion we've come to a conclusion with as a community just now whether we need to have that identity card or not. But I think we've got a reasonable amount of acceptance that we need to have a better way of managing our health information.

And if we can do that with a Smartcard enabled key to a data bank that is secure about our information, that people that we want to have access to, only can have access to it and that we can update if we need to. Then that is something that is tangible, that it is of benefit and we want to pursue.

But we really don't want to cloud that debate with a debate about - that we haven't concluded, about the need for a national identity card and other people looking at your information that you want to be your own private secure information.

COMPERE: What do you think? Would you like to see an electronic card introduced? Do you think it would improve the delivery of government health provision or do you think it's the thin edge of the wedge and just a matter of time before we get an ID card? You can call us on 1300 222 720.

Dr Haikerwal, the AMA has IT specialists and a big interest in IT research, do you know who'd manage a proposed card? Have you got that far?

HAIKERWAL: Well, I mean, the - if we're talking about government agencies, the government agency is the Department of Human Services. And certainly we've had very constructive discussion with them and with the Health Department who have the running as far as health concerns. We have an environment now where there is a National E-Health Transition Authority which, for the first time, brings together the Commonwealth departments- and each of the state departments in government to make sure there is a standard 'rail gauge', if you like, for all these sorts of electronic health initiatives. And that's very, very important and because we have that, we'll have some standards for developing and some consistency. It means when we're ready for that electronic health environment which is robust, we'll actually be able to roll that out across the country in a uniform manner. And that's really very important too and I think that the government's to be commended for doing a really good job as far as that is concerned.

Obviously people are disappointed at the slow pace, but, you know, we've got to go carefully here. We don't want to be tripping up and making a big blunder which will then remove anybody's willingness to participate because they're so concerned about the downside. So we've got to make sure that what we do, we do well. What we do is actually, you know, is robust and what we do is something - comfortable with using.

COMPERE: Yes, I guess the idea of a big combined database with everybody's health information somewhere in a government department in Canberra doesn't always instil confidence. How do you get over that?

HAIKERWAL: Well, I mean that's right - the database need not be held in a government department and people have said in surveys that we've done - surveys that we've been done overseas, that really they're very comfortable with their doctor having their information, to some degree they're comfortable handling their own information. But when that information is handed onto other people, especially governmental, the more closer to bureaucracy and government you get the less comfortable, the less satisfied, the less willing they are to participate in any such schemes.

COMPERE: And how long are we looking at? Have you got any idea about if such a thing was to be introduced how long it might be until it was?

HAIKERWAL: Well, there are three sorts of phases to this. The first is using current technology we can already get Medicare claiming to be much more efficient. And that's something that needs a bit of tweaking of legislation and so on and again that something that's working with - as far as the Medicare card's concerned, that's e-enabled, the one that has a Smartcard chip. That's been trialled a little bit in South Australia and a little bit in Tasmania. And I suppose it's not too far that you could actually then make the jump to issuing it across the board.

I suppose the problem is that if you do that, you then need to have the card readers and the card writers which starts - which means more technology. So that when that happens and there's no reason why it couldn't happen, it would be able to do a few more things as well, like being the key to the door for your information. But only you would be able to put your PIN number in with that Smartcard to hand to enable people to get information about you. And that's not that far away either, but again it requires information. It requires funding to get the readers and writers happening. And also for the card to be out there.

COMPERE: Not just for the readers and writers either, I would imagine. How much would that sort of system cost to introduce?

HAIKERWAL: It's very hard to say, it depends on the technology that's been used at the time. But, you know, it is a significant amount of money. Bu it's probably a good investment if we get the systems right and if we have everybody participating because they're confident.

If we breach that confidence, if we make people wobbly about it, obviously it's not going to happen. And then it'll be a system that will be a white elephant which we really don't want because it's a very expensive, a very significant investment we'll be making.

COMPERE: Well, certainly and I mean whatever the benefits for health might be, a government might still have a separate agenda with an ID card so that might happen, that might happen regardless.

HAIKERWAL: Our constant plea is to separate the issues because what is a potentially beneficial things for the community, a potentially life saving set of investments, and certainly a streamlining and a cost saving method of looking after our health information, could be blown out of the water because people really get quite concerned about the linkage with a national identity card which we haven't come to the conclusion with that we actually want.

COMPERE: Mr Haikerwal, what age would you be looking at where you would need a card? Your baby goes on the Medicare list almost immediately. Would you be looking at a similar system?

HAIKERWAL: Well, look obviously the health information would be about each individual problem at the time you start needing health care which would be obviously from birth because at birth and you start immunisations through early childhood, that continues. And then medications and other sorts of interventions as you get older and preventive work is much easier if you've got a database that follows you around so people can check whether you've had your tetanus, whether you've had your flu jab, whether you've had your injections for going overseas.

COMPERE: All right, thank you very much for joining us with that, Doctor.

HAIKERWAL: You're welcome - good morning.

COMPERE: Thank you. Dr Mukesh Haikerwal, the President of the Australian Medical Association.