Transcript - AMA President, A/Prof Brian Owler, Sky News, 2 June 2014

HELEN DALLEY: Welcome back to the program. The Medicare co-payment is also one of the budget measures that's causing a fair bit of angst in the community. Groups lining up against it are both social welfare groups and doctors. The new Federal President of the Australian Medical Association, representing doctors, is Associate Professor Brian Owler, who's a paediatric neurosurgeon, but probably better known as the Don't Rush ad campaign doctor; and he joins me now. Professor Owler, thanks very much for joining us.

BRIAN OWLER: It's a pleasure.

HELEN DALLEY: Now, can we just talk about - because you are a supporter of co-payments, so if you support co-payments what are you saying is wrong with this one?

BRIAN OWLER: Well, the AMA has always said that doctors should charge the fee that they feel their service is worth, and so many doctors already charge a co-payment. Our problem, of course, is that this proposal has a number of other elements and there are inadequate protections for those that are most vulnerable in our society, particularly those with chronic diseases and those that can't afford to pay the co-payment. And there are also very significant implications for some of our doctors - particularly in pathology and diagnostic imaging, for which the co-payment will also apply.

HELEN DALLEY: Alright. Well - can we start with just some basic sums? Who is going to be charged the $7 co-payment? People who already pay to go to the doctor, or only those who are bulk billed?

BRIAN OWLER: So there is the $7 co-payment and that should apply to every single patient. Now, there is also a cut of $5 to the Medicare rebate. So if you're paying a co-payment now, you will be paying an extra $5 because your Medicare rebate will be cut by $5. Now, every other patient that's currently being bulk billed is supposed to pay a co-payment of $7 as well, including those that are on concessions for which there have been bulk billing incentives.

Now, there is a cap of 10 co-payments, which applies not only to the GP visit but also to their pathology and diagnostic imaging, and after that the co-payment won't apply.

HELEN DALLEY: All right. Well, can I, sort of, put the opposite view I guess, and part of this is the Government view, what's wrong with - I mean $70 a year, $7 for 10 visits, is not that much in the scheme of things to go to visit the doctor 10 times if you need to.

BRIAN OWLER: Well, it wouldn't seem that way but these are the people that on concessions. So these are the people that are on age pensions, also those that are under 16, and if you've got a family with a number of children, you're on a single income, then that can really add up and that does bite into people's budgets, particularly those that are earning smaller incomes and those that may also be burdened by chronic disease.

HELEN DALLEY: So the $7 is going to be broken up. $2 goes to the doctor.

BRIAN OWLER: Yes.

HELEN DALLEY: So that's an increased fee for the doctor. And $5 of that co-payment will go to the medical research fund.

BRIAN OWLER: That's right.

HELEN DALLEY: But with the Government reducing the $5 rebate the patient is effectively paying that?

BRIAN OWLER: That's right. So the patient will pay $7, $2 of which the GP will essentially get to keep. But the savings in the Medicare rebate will essentially go to fund the medical research future funds. But those patients that we know have to visit the doctor a lot, those are the real issue, because there's a lot of pressure going to be put onto GPs not to charge the co-payment. And when that happens, particularly those that are on concessions, not only does the GP lose the $7 in co-payment, but also would lose the low gap incentive, the bulk billing incentive essentially, that applies now. So the doctor ends up being $13 worse off…

HELEN DALLEY: Sorry, wouldn't the doctor only lose the $6, plus the $2 fee that the gets out of the $7?

BRIAN OWLER: So for the concession patients there is actually a bulk billing incentive that's there at the moment.

HELEN DALLEY: So that's the $6?

BRIAN OWLER: That's right. So it's now called the low gap incentive, but you have to charge the $7 in order to access the $6. So that means that if you don't charge the co-payment you lose the $7, but you also lose the low gap incentive. Now, that means that the GP would end up being $13 worse off. And that's…

HELEN DALLEY: Per visit.

BRIAN OWLER: Per visit.

HELEN DALLEY: Per consultation.

BRIAN OWLER: If they decide to bulk bull that patient. So it's alright saying that GP’s are getting a bit more money but if they're - a lot of pressure, particularly if you're practicing in an area of low socio-economic status, and you've got a lot of patients with chronic disease, then it really raises questions as to the viability of those practices.

HELEN DALLEY: Well, the Government says that the doctor does not have to bulk bill - sorry, can bulk bill, does not have to charge the co-payment.

BRIAN OWLER: Correct.

HELEN DALLEY: But are you saying that would lead to, what, a reduction in quality of service if they lose $13 per consultation?

BRIAN OWLER: Well, if you're losing that amount per consultation, then you have to change the way that you see patients, and you would have to see more patients in a shorter period of time.

HELEN DALLEY: So how short a period of time?

BRIAN OWLER: Well, it would be up to the doctor, obviously, but there's a limit as to how far that can go. But that is the essential problem that the AMA has with this proposal, is that if we are going to drive and expect people to bulk bill, and accept a much lower rebate, then it will impact on the quality of care for patients.

HELEN DALLEY: On the other hand - I mean there was an interesting thing that came up in senate estimates today, and I want to let viewers have a listen to this, where the senior health officials actually admitted that they did no economic modelling on what would happen - the impact of the co-payment on visits to emergency wards and hospitals. Let's have a listen to Kerry Flanagan, a senior health official, in senate estimates today.

HELEN DALLEY: Apologies, that volume was a little bit low. But what is your view of the Government not having done economic modelling on whether - what the impact would be on hospitals, for instance? Because, I mean, your group, for one, has been warning the Government for months that it might push people to delay their visits to the GP and eventually push them to emergency wards.

BRIAN OWLER: Well, that's one of the disappointing parts about this whole co-payment discussion, is that the proposal was announced in the Budget and essentially it's a financial policy, not a health policy. And the AMA’s always willing to work with the Government to come up with solutions, but a lot of the proposal actually goes against the grain of health policy, preventative health care, GPs managing people out of hospital, keeping them well, preventing expensive hospital care. And so a financial solution for a complex health policy is always a recipe for disaster.

HELEN DALLEY: What is your evidence, I guess, that it would lead to - or could lead to, a spike in emergency visits to hospital?

BRIAN OWLER: Well, we already know that patients don't access health care because of financial barriers. So in New South Wales the Bureau of Health Information did put out a figure of 15 per cent of patients that don't fill a script, or don't go to the doctor, or don't access some form of health care because they're worried about the financial cost.

So imposing this will actually have an impact on those patients that are least able to - the ones that should least be not going to the doctor, those that really should be going there and having their chronic diseases managed.

HELEN DALLEY: Do you think it's also - there's an impact, a kind of a ripple effect, with these other costs that people are going to have to pay for increased costs for their scripts, visits to pathology, tests, all those sorts of things?

BRIAN OWLER: Well, it adds up. And this is the point, it's not just for seeing the GP, it's for the pathology tests and it's for the diagnostic imaging. And if you've got a chronic disease, and many people do - once they get above 40, about a third of the population have a chronic disease - that often means –

HELEN DALLEY: But they're supposed to be exempt, aren't they?

BRIAN OWLER: No, they're not. The Treasurer suggested recently that they were exempt. The chronic disease management item numbers are exempt, and that is basically a planning item number that can be charged about twice a year for actually planning the treatment. But the actual treatment of the chronic disease is not covered by any concession unless you're on an age pension or have a concession card.

HELEN DALLEY: So if you have a chronic illness the Government said that you would be exempt from these co-payments, but you're saying only the planning session for your chronic disease treatment is exempt?

BRIAN OWLER: Correct.

HELEN DALLEY: And then to come back and get the treatments you'll have to pay the $7 each time.

BRIAN OWLER: And for the pathology tests and for the diagnostic imaging.

HELEN DALLEY: So what is your view of that? Because on the other side, of course, there is the question can the Budget keep affording never ending medical funding costs?

BRIAN OWLER: Well, I'd also question that. I mean, the percentage that the Federal Government is spending on health is about 16.1 per cent. In '06/'07 it was 18 per cent. So it has actually remained a very steady figure over these years. The GP visits have actually been only growing at about 2.9 per cent per annum over the last decade.

HELEN DALLEY: Did the commission of audit say it was a hugely big jump in number of GP visits?

BRIAN OWLER: What they were actually talking about was episodes of care. And that included not just GP visits, pathology, diagnostic imaging, optometry, allied health and a whole bunch of other things that were thrown in there together. But when you break it down and you look at general practice, for instance, it's only been growing by 2.9 per cent per annum in terms of GP visits. Now, the proportion that are bulk billed has risen from about 67 to about 80 per cent, and that has some implications. But to suggest that the primary health care system that we have is unsustainable, I think, is not backed up by the evidence when you look at the numbers in the Federal Budget.

HELEN DALLEY: So - sorry - you're saying it is - it represents 16 per cent of the Federal Budget?

BRIAN OWLER: Currently.

HELEN DALLEY: And it's only growing at how much a year?

BRIAN OWLER: Well, it's been stable; in fact it's fallen. If you look at '06/'07 it was 18 per cent of Federal Government expenditure; this year it's about 16 per cent. So as a proportion of the Federal Budget and as a proportion of GDP, we have not seen a rise in health expenditure.

HELEN DALLEY: Just back to the emergency wards, will people be charged if they start going to emergency wards for things that they perhaps should go to the GP and pay the $7 for?

BRIAN OWLER: Well, the Federal Government has opened the way for states to be able to make that charge. But most states have already ruled that out. Firstly, it's impossible to administer. It's impossible, also, to determine whether or not it's a GP type problem or whether it's a serious problem. You don't want a patient with chest pain at home trying to work out whether it's a GP type problem or whether they really are having a heart attack. It's essentially imposing a much more significant problem to solve a, you know, a very small one.

HELEN DALLEY: Are you having ongoing discussions with the Minister, because last week in his National Press Club address and various forums he has seemed fairly determined to push through with what the Budget initially presented? Are you seeing any signs of perhaps compromise from what you're saying to the Government?

BRIAN OWLER: Well, I spoke with the Minister last week and they are very determined to push ahead with the co-payment proposal that's on the table. We did hear from the Prime Minister over the weekend that there's room for refinement of the proposal.

HELEN DALLEY: And what did you take that to mean?

BRIAN OWLER: Well, obviously there is some room for negotiation but obviously to get this proposal through, not only for the approval of the AMA but the approval of the Senate, there's going to have to be a lot more significant change, a lot more safety nets built in to protect those with chronic diseases and protect the sick and the elderly.

HELEN DALLEY: Alright. We'll have to leave it there. Associate Professor Brian Owler, thanks so much for joining us.

3 June 2014

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