Transcript of Doorstop - Dr Kerryn Phelps, AMA President, Parliament House, Canberra - Medicare

PHELPS: I've just emerged from a two hour meeting with the Prime Minister and two Ministers, and we've had a very important discussion about the future of the health system in this country and about Medicare.

I have to say that in other circumstances you would be hearing today from me about what would be on the front pages and the lead stories in your news bulletins but, given international events, that's going to be another matter.

But I do have to say that health is the major domestic policy concern for Australians. It is something that I am pleased to say the government has now turned its full attention to, and there will be some changes to the way the health system works, and to Medicare policy.

The AMA is pleased with some of the things that we've heard today, they've certainly heard us on some of our issues. We are still at an early stage of assessing what these changes will mean to our patients, and to the doctors who are working out in the cities and suburbs and the rural towns of Australia. So we do have some analysis to go through but, in the early stages, there are some positives, there are some concerns.

QUESTION: What changes has the government agreed to make to Medicare and Bulk Billing?

PHELPS: There will be some geographically targeted practice incentive payments. We have expressed concern about practice incentive payments in the past, and we'll continue to express those concerns. And we'll have to see what administration is required around those, and whether it actually does anything to address the stresses particularly on general practice. In order to access those incentive payments the practice would have to agree to bulk bill its concession cardholders, and we have some concerns around that, but it would be a voluntary opt-in system.

The government has heard our concerns about the numbers of doctors, about the workforce shortage and, for the longer term, there are going to be some bonded medical student places which we will have to assess what that will mean to the students who decide to take up those extra places. But there will be more funded medical student places.

We're also pleased that the government has heard what we've said about the numbers of GPs training in Australia, and there will be an increase in those numbers if you can attract young graduates into those areas of people who want to actually work in general practice. So there's been some difficulty getting people to actually take up general practice training places as it is, and so I guess the more attractive general practice can become the more likely it will be that people will take up those training places.

And there will need to be some fundamental change to legislation to accommodate one of the other issues that the government is addressing, which is the area of the co-payment and billing arrangements, that doctors who opt into a particular scheme to bulk bill concession cardholders will be able to directly, through the HSC online system, claim the patient's rebate, and then the patients who are not bulk billed will be able to just pay the co-payment up front.

QUESTION: The government has agreed to that?

PHELPS: The government has been looking at that as an issue, yes.

QUESTION: And what's your first reaction to that?

PHELPS: Well, all of my reactions are bound to be preliminary because this is very early days, we haven't had a chance to fully analyse the government's proposals. But, at first blush, it may well - I think it will be easier for some patients in certain practices. We'll have to really get a cross-section of reactions from my colleagues about how it will affect their particular practices.

There's no question that if patients don't have to worry about claiming back their Medicare rebate and not paying the full amount up front of a co-payment that that will streamline the claiming arrangements for them. And it will mean that patients who are being privately billed - who are not concession cardholders - their life will be easier in terms of making their Medicare claim.

QUESTION: And it will be easier for doctors to charge more?

PHELPS: It will be easier for doctors who are privately billing their non-concession cardholders to be able to provide that service for their patients without them paying the full up-front fee.

QUESTION: But it's a concern that the doctors fees will increase anyway, that patients will be paying more, even though there's a co-payment system in place.

PHELPS: Well the reality is that doctors fees have to increase for doctors to stay in practice, so that is going to be happening, take that as a given. One thing that is perhaps a little disappointing is that there hasn't been a fundamental addressing of the real underlying problem in a lot of the medical system at the moment, and that is the Medicare Benefit Schedule. And, unless we address the schedule, and use the relative value study modelling, then it really is not going to address the fundamental problem in Medicare, which is an inadequate schedule.

QUESTION: One of the other fundamental problems is the decline in bulk billing. Will any of these initiatives help address the slump?

PHELPS: I think we're going to have to move away from looking at bulk billing as the measure of how healthy the health system is. And we're going to have to look at access and affordability issues. Now, if patients are paying a modest co-payment, and they have access to a doctor, then those issues are addressed.

What we need to do is to continue to look at the Medicare Benefit Schedule and whether that is addressing the needs of Australians and their healthcare. At the moment it is not, and we need to look at access to healthcare. So where are the doctors working, what incentives can be put in place so that patients, wherever they live, are able to access a doctor and, in terms of the doctor being able to provide that service, is it going to be affordable for the patient?

QUESTION: Were you given a timetable on?

PHELPS: No.

QUESTION: So, the government didn't indicate when they would announce this?

PHELPS: They indicated some time over the coming weeks they'll be announcing it, but the Prime Minister has given us an undertaking to get back to us on some of the issues of concern that we raised, and that will happen within the next couple of weeks. There'll be another meeting, they will give us a response to the concerns that we've raised about the package that was announced today.

QUESTION: What are the concerns? What are the main concerns?

PHELPS: The main concerns that we have are what happens to the veterans? And that, at this stage, has not been addressed. The other areas of concern are what happens to urban areas of need who are not targeted by these incentive payments that are currently targeted at non-urban, outer metropolitan and rural practices.

So those would be probably the major areas of interest that we need to get the government to get back to us on.

QUESTION: Did the government give an idea of what the quantum for the practice incentive payment would be, to keep bulk billing pensioners?

PHELPS: Yes, they did, but I'll leave that to the Prime Minister to announce that.

QUESTION: Does this mean bulk billing as we know it is dead?

PHELPS: Well, I think that the idea here is that doctors who are struggling to maintain bulk billing in their practices, and we can see - you can look at the graph and you see - that the graph of bulk billing is sliding. It has been particularly over the last two years. That will accelerate over the coming years and I think that bulk billing, as we have known it, is no longer going to be in place. And I think we really need to look at these issues of who pays, whether the taxpayer pays the large bulk of healthcare payments or whether individuals share that cost with the taxpayer to a greater extent than they are now.

So I think that's the fundamental, ideological difference that we're going to be seeing now but, I mean, clearly the gauntlet has been thrown down on health. It's going to be up to the other parties to come up with a solution that perhaps the Australian people will like as much, or better. And the AMA will be there to comment on behalf of the medical profession and our patients.

QUESTION: Do you think the government will have trouble selling this package to the public?

PHELPS: Well, I think the government's going to have to look at how this will affect patients. Certainly there needs to be a solution around what's happening with Medicare, we can't just see Medicare continuing to decline.

I think that the Medicare Benefit Schedule is really the central core of the problem to do with Medicare at the moment, and to do with a lot of the problems in general practice, and that hasn't been addressed yet. But there are some incentives that may well assist general practitioners particularly to continue to provide services at an affordable rate for sometime into the future.

QUESTION: How would you change the Medicare Schedule?

PHELPS: Well the Medicare Schedule needs to reflect the reality of the cost of providing a service. So you set the schedule at the realistic amount and then you say, well, can we afford as a nation to pay the 85% of that Schedule Fee amount, or do we have to set that rebate at a lower amount - at what the community can afford.

But don't pretend that the Medicare Benefit Schedule is realistic, because it's not.

QUESTION: Did you give them the figures on what would be more accurate?

PHELPS: They've had all the figures, they know all the figures, we've given it to them a million times and, you know, if the government says they do not choose to fully fund Medicare at the rate that is realistic to run a practice, then that's the political decision that they're making.

Thank you.

Ends