Proposed Simplification of the Medicare Benefits Schedule

But as it stands doctors get paid $33 by Medicare whether they spend six minutes or 20 minutes with the patient. Now, it doesn't matter if the patient is there for a simple check-up or if they're trying to help them with some complications with a chronic diabetes disease or anything similar.

Now, the newly appointed Health Minister Nicola Roxon wants to simplify that system so that patients with complex medical conditions, like diabetes, spend a longer time with their GP and a higher rebate as well. After all, it seems pretty silly, doesn't it, with the current system that there's no difference between writing a repeat prescription for a patient and carrying out a pretty complex diagnosis? Now, there should not be financial disincentive to treat patients with more complicated illness surely.

So joining me on the line I have the national president of the AMA, the Australian Medical Association, Doctor Rosanna Capolingua. Good morning.

DR CAPOLINGUA: Good morning.

TIM WEBSTER: Hi. How are you?

DR CAPOLINGUA: Very well, thank you.

TIM WEBSTER: I read this and on the surface it seems a good idea. What's your initial reaction?

DR CAPOLINGUA: The AMA has been calling for some time for a simplification and streamlining of the Medicare rebate system. There are a lot of item numbers - what you described around complexity of a consultation and whether or not the rebate is appropriate for that complexity. All of those things need some attention and we'd be very keen to work with Ms Roxon to look at streamlining, simplifying and ensuring that patients get a rebate that's appropriate for the episode of care.

TIM WEBSTER: She's suggesting that maybe we bump up the rebate for a longer visit to the doctor to about, I think, just under $70. Is that far enough?

DR CAPOLINGUA: Again, we would need to have the conversation about what we mean by the length of that longer visit.

But certainly that's coming much more towards the sorts of figures we have looked at in the past. We also have to remember that Medicare rebate needs to be indexed properly because we had a top up in 2004 I think it was. But then they fall behind again so the patients that aren't bulk billed end up with increasing out of pocket costs because governments haven't been indexing properly. So we need to combine both issues in looking at how we streamline and improve the Medicare system.

TIM WEBSTER: It occurs to me, shouldn't it be based on the time you spend with the GP rather than money?

DR CAPOLINGUA: Time and complexity exactly, that's right. And to some degree, what we call the descriptors, how the items are described now are meant to be around time and complexity but we don't believe that the structure of those is necessarily correct. So we're very happy indeed to work together to look at this so that it's actually easier, simpler for general practice to generate those items and the rebates will make more sense and be more appropriate for the patients as well.

TIM WEBSTER: What about if a doctor is working overtime or if they're performing an emergency procedure, that should be even higher, shouldn't it?

DR CAPOLINGUA: Yes. That is something that we would be keen to look at. There is already a small after hours loading on items but certainly not an after hours procedural item loading where if you need to see your GP on a Sunday or after hours because your kids jumped off a wall and hurt themselves or you've got a cut or a laceration or a burn, then it would be good to see a loading on that to encourage GPs to be able to provide those services after hours.

TIM WEBSTER: Sure. Yeah, look it's complex, isn't it? I mean, the Australian General Practice Network, they're calling for funding of these complex cases - just so the listeners understand, instead of paying a doctor every time the patient goes, they would have an annual budget for say something like diabetes, for want of an argument.

DR CAPOLINGUA: Yeah, now this is really important that the Australian public understands what AGPN are proposing here. This is the General Practice Network, which is a funded arm of government run by a board. They're proposing a UK NHS fundholding system, okay? They're proposing that general practice networks or GPs are given an allocation of money that you, as a patient, will be conscripted to that practice or that doctor so you have your patient choice to pick a GP removed. You can't go to the doctor that you want to go to; you're allocated to a doctor.

TIM WEBSTER: Not fond of that, no.

DR CAPOLINGUA: Not fond of that concept - and then the doctor has to hold the funds to be able to purchase or pay for your episodes of care. When you run out of money, that's it, there is no more there. If anyone has experienced the UK system of primary care they will know that it's very difficult to get in to see a doctor, that at times there are restrictions on the services that you can access.

So I'm sorry, I support Nicola Roxon in her promotion and concept of reviewing and simplifying Medicare, but fundholding is not the answer for Australia. We don't need to go down that path. It would actually compromise patient care. It's an important issue.

TIM WEBSTER: Well, this is probably a silly question, she's only got there, but have you met with the Minister since she's been elected?

DR CAPOLINGUA: Not since she's been elected. I understand that things have been very hectic for them, appropriately so. So I've been respecting her space and time but am very keen to talk to her and I'm sure what AGPN are proposing for Australians is not exactly what Ms Roxon had in mind. They're completely different methods of providing health care and one I think that compromises Australians.

TIM WEBSTER: Yeah, just so our listeners are sure we know what we're talking about here. Under that system that you're talking about, you would have absolutely no choice whatsoever what doctor you go to? None?

DR CAPOLINGUA: The only way to make a fundholding system work, in other words, is if you give someone a budget right?

TIM WEBSTER: Yeah.

DR CAPOLINGUA: If you give a doctor or a practice or a division of general practice a budget, the only way to make it work is for you to be conscripted to that allocation of money. That allocation of money would be to pay a doctor or certain doctors and, in fact, what they're suggesting is that the patient enrolled, which is conscription, with that particularly doctor for the management of that care over time which means that that's it. Do you understand?

TIM WEBSTER: Yeah, people move. They change doctors all the time, I mean, that wouldn't work surely?

DR CAPOLINGUA: If you have that experience in the UK, you'd know how difficult it is to actually move from one doctor to the other. We really seriously do not have to go down these sorts of paths to improve what we have already in primary care in Australia. We can make things a lot better without having to throw out the current model that we have, which is equitable for the patient in many ways. In other words, they do have choice. If you don't like a GP you are able to move on and also where we are, as doctors, able to make decisions about what you need for treatment on your clinical needs, not on a budget. You know, not being mindful of I've only got this much money left, I can't give this person an MRI or a CAT scan.

TIM WEBSTER: All right. Well, the Prime Minister has said - the new Prime Minister - that he'd like his Ministers to visit their local public and private schools for homework. I think it would be a pretty good idea if one of them turned up at St Vincent's at 2am on a Sunday morning.

DR CAPOLINGUA: I think that that would be a very worthwhile experience.

TIM WEBSTER: It would be an eye opener, wouldn't it?

DR CAPOLINGUA: Be an eye opener and also at the general practice.

TIM WEBSTER: Yeah. Look, while I've got you, just quickly, I mean, you've got a new Minister, what other primary health issues would you like to see her tackle?

DR CAPOLINGUA: We still have great concerns about the - obviously nothing has changed for the AMA - the public hospital bed numbers in Australia. Again, we need to get Ms Roxon to understand that there are Australians waiting right now in elective surgery waiting lists, and there will continue to be Australians who will need admission to hospitals and in increasing number over time. And the belief that we're going to be able to manage all of this in primary care and that preventative medicine, which takes a long time to deliver results anyway, is going to stop us from needing more beds, we need to talk about that. There are patients who need treatment now. Patient's who'll need treatment in two years time, five years times, and 10 years time, they're going to need hospital beds and preventative care and primary care is not going to alleviate that need for those extra beds that we called for and we'll continue to call for them.

TIM WEBSTER: Let me put this one to you because I go every year to a professor who is a friend of mine. I've known him for a long time, for preventative medicine, I have all the over 50 tests because I like to know that I'm healthy. Now, I don't get a single cent back for that and it makes no sense to me.

DR CAPOLINGUA: Yes.

TIM WEBSTER: You know what I mean?

DR CAPOLINGUA: Yes.

TIM WEBSTER: I mean, that's the sort of thing that you should say to people, well obviously if we keep you healthy, we're going to keep you out of the hospital and that's going to cost us less money. It just makes perfect sense to me that you say to people, look, if you invest your time to go and make sure that you're fit and well and you get your medication to make sure that you are into your 60s and 70s, then you won't be in the public hospital and won't be clogging up the system.

DR CAPOLINGUA: We have a lot of work to do in that area and will get some runs on the board there. In the meantime, however, if you break a leg or develop a cancer heaven forbid or you need any other...

TIM WEBSTER: Yeah, good luck.

DR CAPOLINGUA: …surgery or you get acutely ill with septicaemia; you'll still need a hospital bed.

TIM WEBSTER: That's right.

DR CAPOLINGUA: So we have to remember that there's still going to be very much needs that we have to deal with. And, you know, with the current obesity epidemic that we have, which we can't seem to be turning around at all as yet, we're going to have an increased need for chronic disease management and for hospital admissions. So I think we have to do both. We have to invest in public hospital beds and very much have to do, as you've described, as we as GPs have been doing for a long time, encourage patients to look after their lifestyle and that means seriously look after your lifestyle, diet, exercise, relaxation, balance...

TIM WEBSTER: The whole lot, yeah.

DR CAPOLINGUA: …of work and everything else and indeed comply with annual checkups, follow-ups as required, analysing your family history, genetic risk, and comply with medications if they are necessary.

TIM WEBSTER: Yeah absolutely, thanks for your time.

DR CAPOLINGUA: Thank you very much.

TIM WEBSTER: Dr Rosanna Capolingua from the AMA, the national president.

Ends