Radio Transcript - Reported Problems With People Using Healthcare Cards

My pleasure to welcome to the program the president of the AMA, Dr Bill Glasson. Good morning.

BILL GLASSON: Leon, good morning to you and all your listeners.

DELANEY: The Pharmaceutical Benefits Scheme of course provides co-payments for people with prescriptions, and concession cards also mean that doctors are eligible for the bulk billing incentive that the government has recently introduced. But if those concession cards are not valid, then somebody's left out of pocket, aren't they?

GLASSON: That's the truth. And as you know, in relation to the pharmacy issue, that's a difference often between $28.60 one end if you're a general patient as opposed to $4.60 if you're a concession card holder. So it is a huge difference, and when you're talking about $4 billion that we spend on the pharmacy subsidies across the board, you'd only need 5% or 10% of those being inappropriate, that it represents a huge cost burden to the taxpayer.

And obviously there's a limited amount of money in the system, we've got to make sure the system looks after the poorest and sickest in the system and make sure it runs efficiently.

And on the doctors' side, as you know, we had problems, particularly prior to Christmas, when, as you said, patients that were under 16, patients that are on various health benefits, were getting a higher rebate, and for those doctors that bulk billed in good faith, they checked the healthcare card, it appeared to be appropriate and they accepted that. And of course, when they put the claim into the government, 5% to 10% of those claims were rejected on the grounds that these cards were not current and that the data that the HIC had does not correlate necessarily with the data that Centrelink has.

And so a lot of the doctors said, "Well, blow it. We're trying to do the right thing, we're trying to bulk bill but we're being penalised," and so a lot of them actually have said that they've stopped bulk billing.

And so thanks to Tony Abbott, who stepped in, they've actually decided that the system will run with the good faith, in other words, if doctors in good faith do the checking, it appears to be appropriate, then they'll receive the higher rebate up until the middle of next year when hopefully the technology, or the IT, the computer systems, actually can come on speed, or come up to speed such that we can check these in real time, Leon, so I can say to you, "Well, you've seen me today, I've checked the computer, you're entitled to a higher rebate, you know, thank you very much." But until we do that, then the system is working against those doctors who are trying to do the right things by their patients and the right thing by the system.

DELANEY: Wouldn't it have been simpler for the government just to increase the bulk billing rate for all patients?

GLASSON: That's exactly right. I mean, that was always our line. You're absolutely right, Leon. We always said that there shouldn't necessarily be differential rebates, particularly on geography. And as you know, if you live in Tasmania, live in certain rural areas, you get a higher rebate. We certainly don't believe in that.

No, obviously if there are particular patients in need, that's obviously children, those that are elderly, then you could argue that they do need a higher rebate because they afford less in the way of a co-payment. So I think you can debate that one.

But the reality is that the more complex you make it, the more difficult it is to administer. There's more loopholes, I suppose, where people can actually fall through.

DELANEY: Are people intentionally ripping off the system or are they just losing track of whether or not their card's valid? They've still got the card and they think, "Oh, I'll use this."

GLASSON: Exactly, a bit of both, Leon. I think a lot of people think they hold the card, therefore while they've got the card it's valid. Other people I think probably know that it's not valid but simply continue to use it.

The reality is that while there is a loophole, whether for intentionally or non-intentionally, people fall through it. We've got to make sure we fix it up and the reality is that the IT systems, particularly those between the Health Insurance Commission and Centrelink, which is now Joe Hockey's sort of responsibility as the minister, we've got to make sure those systems are up to speed, we've got to make sure that they are real time so that they are there to benefit those patients who need it most and that we don't end up forking out a huge amount of taxpayers' money for people who actually, you know, don't do a probity .

DELANEY: Why do we even need a separate healthcare card? Everybody has a Medicare card, which has a magnetic stripe on it, and after introducing smart Medicare cards which would be able to link to a person's database so that the doctor or the pharmacist could be able to check instantly, if the Medicare card was so organised, to determine whether or not that person was eligible.

GLASSON: That's exactly the way it's heading. There will be a one card ultimately that covers both the medical and pharmaceutical side and so that you can swipe that card and hopefully that gives you current data.

And so the government, particularly too their IT side, is currently working on that and the AMA is involved in those discussions to make sure that obviously privacy issues are addressed both first and foremost. But after having said that, we've got to make sure the system works, that it's cost effective and that, as I said, it really provides the best and most appropriate sort of both accountancy and a medical system available.

DELANEY: So for the time being we're going to continue to rely on the healthcare card, which is actually a piece of paper, and it may in fact not be valid and the doctor is going to process that in good faith and it's going to cost the taxpayers even if the person's not entitled to it?

GLASSON: After the middle of next year, the government in good faith has said if doctors in - you know, a patient comes in, the doctor checks, does the appropriate checking and says, "Yes, you're entitled to it," and then find out that later on it's not entitled, well, they'll still be paid at that appropriate - the higher rebate, that's the extra $5 or $7.50, depending on where you live. Hopefully by then we'll have a real time system.

The pharmacy system is much better, Leon. It's much more advanced, and when you go to your pharmacist now they can more or less, real time, determine whether you're eligible or not eligible. And hopefully by the middle of next year, that will apply to the medical side as well. But as you say, you get that one card that actually gives you all the information as you swipe it across.

DELANEY: Yes. In the meantime though, that continued use of the piece of paper means that people having heard this announcement might be more inclined to deliberately rip off the system?

GLASSON: Well, I hope not. I mean, at the end of the day, 99% of people do the right thing, Leon. The 1% or 2% who don't, no matter what locks you try and put in the system, it's interesting how they find their way around it. But the rally is because most people do the right system - right thing, the system works anyway.

Ends…