Partial Transcript of Doorstop Interview AMA President, Dr Bill Glasson, Brisbane, Monday 6 September 2004

                             I'd like to say that I first of all welcome the initiative from both parties in the sense of, I suppose, acknowledging the fact that Medicare has been under-funded for the last decade or more, and that you the patients out there have been the one paying the gaps and the doctors as well offering the compassionate discount.

                            It's up to the government of the day to ensure that they fund the system properly and I think the commitment from both sides needs to be commended.

                            However, there is a difference between the two policies.   One is based on a policy of bulk billing and the other one allows some flexibility between those who want to bulk bill and those who don't.

                            I'd like to remind the people of Australia that Medicare is there for one person only - that's you, the patient.   It's not there for the doctor.   It's there to fund you the patient to allow both affordability, and important, as well to allow access.

                            Now what the Labor Party's policy around linking everything to bulk billing fails to reflect the fact there are a huge shortage of doctors out there, and the primary thing that the patients are wanting are access to their GP first and foremost, and, secondly, that they want to make sure that that service is affordable and I forewarn the Labor Party not to pursue this fever about bulk billing.  

                            Bulk Billing is not a measure of the health of the medical system in this country, bulk billing is just a means by which doctors bill the government for a service that they provide.  I would much prefer to have it such that doctors bill patients and patients in turn bill the government who are the funder of the system.

                            So I commend both for the commitment they've made but having said that I think the Labor Party's gone down the wrong line, the wrong track, and I think the Coalition's come out and played the trump card this morning in really saying that yes, we have, we will allow the funding to extend across those doctors who bulk bill, but importantly as well we'll allow funding to those patients whose doctors don't bulk bill because I feel that what the Labor Party's putting forward discriminates against patients and discriminates against those patients who can't find a doctor that bulk bills in their area.

                            Now it's particularly in rural areas and particularly in the outer metropolitan areas.    So no doubt there'll be more to be laid on the plate in the next three weeks, but I think the first play of the cards the Coalition has got the upper hand.

JOURNALIST:   Are you surprised by how generous the Prime Minister has been?

GLASSON:        Look, I've been very surprised.  Obviously there's been a huge amount of money go into the system.  There is a pipeline from Treasury to Health that Tony Abbott has put in place, and we've had a huge amount of money go into the health system, and notwithstanding the extra that the Prime Minister's come forward with this morning, I was very surprised. 

                            I congratulate him for it, because I think it's money that's still owed, that the government owes the system because as I said there's something like $2 billion in gaps that patients are paying in the system at the moment and between the increase of the Medicare rebate and the safety net at the other end I think this will give patients a huge amount of affordability, but importantly, well, a huge amount of security for those mums and dads particularly those with young children, particularly those with chronic illnesses, that there's a system there that will support them in the long term.

JOURNALIST:   Do you think this is the breakthrough that the AMA's been looking for?

GLASSON:       Very much so.   I think to unlink increased payment to bulk billing is what we're after.  We wanted both government and the opposition not to concentrate on bulk billing, not to use bulk billing as a measure of the health of the health system in this country, and a ready target the BB word with the AA word.  In other words, replace the bulk billing word with access and affordability, and that's what we've been trying to drive home to the government and the opposition in the last six months, and I think the Prime Minister has listened to that, and in his announcement today he recognises that in the sense that the increased rebate extends not only to those patients who get bulk billed but important extension to those patients who don't get bulk billed.

JOURNALIST:   Will this be the end of bulk billing?

GLASSON:       Well there certainly won't be an increase in bulk billing.  I think there's been certain initiatives in place to allow we, the doctors, to bulk bill patients who we feel have certain, you know, financial circumstances. 

                           We should not be pushing bulk billing as a measure, as I said.   If the system's affordable enough then it will allow us doctors to actually rebate or bulk bill as many patients we feel is necessary, and so it's not the end of bulk billing, but bulk billing will always continue and bulk billing will always be part of the Medicare system, but it shouldn't be the mantra which everybody keeps rolling out to say that this is how we judge the health of the system in this country, because it is not a measure of the health of the medical system, all it is is a measure of basically how many doctors are willing to charge the government for the service as opposed to charging the patient for the service.

                            And in turn the government, the patients get that rebate back from the government.   The government is the funder of the system, and from the patient's perspective the government is the insurer who provides them with the money to in turn allow them to see the doctor with some degree of affordability.

JOURNALIST:   Have you had any feed back from patients or from doctors yet?

GLASSON:       Yes, certainly, I've had a number of doctors ring me already saying that they are very pleased about the breakage of the linkage, as I said, between the increased funding and that of bulk billing.  

                            Both parties have been pushing it to date, and I'm pleased to say that the Coalition are the first ones to try and break that nexus.   

                            You can still bulk bill.  That money goes to those doctors who bulk bill so it doesn't work against those doctors, those patients who have a bulk billing doctor, but importantly it doesn't work against those patients who can't find a bulk billing doctor and there's a huge number of patients in the bush, as I said, out in rural areas, who don't have bulk billing available and therefore it's unfair on our bushie patients and I'm here to advocate very strongly for our bushie patients and also for those who live in outer metropolitan areas of the larger cities and provincial towns in this country.

JOURNALIST:   Do you think Labor's been living in a on this issue?

GLASSON:       Well I do think they have.  I think they have been fixated on bulk billing and I've spoken with Julia Gillard about this saying that for goodness sake don't try and target bulk billing.   If they want to revamp the system or re-jig the system to make it better and fairer I'm happy to go out and look at their initiatives and support them where we think it's going to lead to better patient care, better access, better affordability, better security, but I keep coming back to this acronym of QAAC - this is about quality, access, affordability, and choice, and I'd like to add one other little word to that, and that is independence.  

                            We must maintain the independence of the doctor patient relationship, such that your doctor always advocates for you, and doesn't advocate for the government or any other third party payer, whether that be an insurance company or whatever it may be, your doctor must be always in a position that he bats for you up there for what is best for you for health, whether that means the best drug, the preferred operation, or the preferred place to have your procedure done.

                            Once you get a system where doctors are being paid by government then doctors will start to sing the tune of government and not sing the tune of their patients, and so I am very, you know, strong about the fact that we must maintain the independence of the profession, we must preserve the doctor patient relationship, and we must ensure that patients have the best that's available.

                            Now if the economy or the government of the day can't afford that that's fair enough.  They can come out and say we can only fund the system to X and we're asking for 2X but that doesn't matter, we are there to advocate for the patient what's better and the profession must maintain that independence.

JOURNALIST:   So Labor's made health one of its big platforms.  Would you say they'd dropped the ball on this one?

GLASSON:        I do.  I think they have dropped the ball.  I think they underestimated I think the Coalition's I suppose willingness to put extra funds in the system, and willingness to show some flexibility in how the system is funded, and I really feel that the Labor Party has to look seriously at where they're going in health, and I suppose the other thing to say to the Labor Party I want them to be open and honest about what proposals they have for the public of Australia.  

                            I will not go to the election with what I call a black box theory where Labor says trust us with this health reform commission which I'm not quite sure what it's going to deliver.  I'd like them to come to the Australian public and say this is what we're going to do in our private arena, this is what we're going to do in our public hospitals, this is how we're going to fund it, etc, etc.

                            So I think we need a lot more laid on the table for the Labor Party's point of view, and I'm sure they will do that, but I ask for honesty in the sense of saying to the Australian public this is what we're going to deliver, and this is what it's going to give you as an outcome and this is how it will impact on quality, choice, independence, access and affordability. So get those key words and apply that to the policies of the day.

JOURNALIST:   You're asking for honesty.  Are you saying then that Labor's being dishonest at the moment?

GLASSON:        No I don't think so.  I think that the Labor Party has gone down the line of supporting bulk billing, and they have from the outset.  They've never really changed their tune on that, but I don't think that really reflects the realities of today in the sense that we've got a huge work force shortage and unless we can get more doctors into the system, particularly general practitioners, there's not going to be doctors there to see the patients of tomorrow, particularly as we age, we've got this chronic disease problem, more complex diseases, so we have to make sure we have a work force that sustainable, that is willing to go into general practice because we've got a huge shortage of GPs in the system.

                            We've got fewer doctors willing to go into general practice from the start anyway, so we've got to make general practice more attractive.  It is the cornerstone of the medical system of this country.  

                            If you do not have GPs in the system the system will collapse, and my concern is that if we don't address that issue then essentially the whole system will collapse, the primary care system will collapse and the primary care system is the most efficient and affordable way to deliver services to the public of Australia, full stop.

JOURNALIST:   So you believe the Government's policies will see savings passed on to patients?

GLASSON:        Yeah, I think what the Government's policies will do, it will allow flexibility, it will allow choice, and I think that there's a whole lot of doctors out there that aren't bulk billing.  They'll continue to charge what they feel they need to charge to provide the service they require, and those that are bulk billing, or bulk billing a part of, will continue to bulk bill, and so I think the incentive there is, you know, look at your practice, look at your demographics, you may have to bulk bill at 80 per cent in some areas, depending where you live, you may be able to bulk bill at 20 per cent in other areas.

                            So look at the needs of your patients, make sure your patients come first, and make sure both the financial needs as well as the medical needs of those patients are met but, as I said, most importantly to make sure we get a doctor to see you tomorrow if you fall ill your children or one of your grandparents, though it's access to a medical practitioner, and that was highlighted in the survey we did some weeks ago which showed that 80 per cent of people in Australia that we surveyed said that access was the most important issue and 20 per cent said that bulk billing was.

ENDS