Transcript - Dr Glasson Discusses Medicare; Private Health; Informed Financial Consent

In 2005, we've got a Medicare system that has been in place for some 20 years or more and the question we ask is: is the current Medicare the system the one that can actually address the health needs of modern Australia?

Now, modern Australia is made up of people, basically, with chronic disease, of ageing population, increasing technology, expanding services, I suppose increasing costs with the system. And as we live longer and longer - I relayed the fact the other day that in 30 years time the number of people over 80 years of age will have increased four times.

That produces huge demands on the system and our concern obviously is: is the current Medicare the system that we need to lead us into the next two or three decades? And so I've put that challenge to the politicians, the challenge in the sense of using the analogy of a car. We've had a car that we've been filling up with fuel, filling it up with oil, but we actually haven't had a major overhaul. And unless we have that major overhaul, we may find that in one or two decades that the health system that we currently have is not meeting the needs, as I said, of Australians out there.

QUESTION: So would Labor's Medicare Gold be the way to go?

DR GLASSON: The reality of the Medicare Gold - our concern there was that we really couldn't deliver on that. Deliver in the sense that giving people access to the doctor of choice, hospital of choice, procedure of choice at any time.

The reality of it was that putting … extra people into that system as well as the DVA patients that are already within such a system was not viable.

So it was not deliverable. I suppose that's what we're trying to get the message through.

QUESTION: But Tony Abbott has said that the changes that he brought in last year are the biggest reform to Medicare in 25 years, so what's happening?

DR GLASSON: Look, there has…the issue around the Safety Net, and I suppose the biggest change around the current Medicare system is that there was obviously more funding into Medicare but the addition of the Safety Net really provides a protection for the patient on both sides of the cliff face. So if you - it provides affordability at one end in the sense of the basic increase in Medicare across the board, and the Safety Net obviously is a safety valve that patients can access in terms of high out-of-pocket medical expenses.

And so that has been a big change. But the question is, is that enough in the sense of the reform that we need to handle the burden of chronic disease that we find within the Australian population today, and will get worse as we age even more over the next decade or more.

QUESTION: How long…

QUESTION: So what sort of overhaul are you talking about, Bill? Changing the balance between public and private health?

DR GLASSON: David, I think the balance we have at the moment between public and private is good. I think the public system is struggling. I think the question we ask, how can we actually make, I suppose, the public system deliver more in the way of services. The difficulty is the public system does acute medicine very well. So if you're acutely ill or you have acute injury or got a cancer, the public system works very well.

The public system is not particularly good at delivering elective surgery. The private system is very good at that. It probably delivers it more efficiently and much more cost effectively. So I think we need the mix of public and private. And I don't think we necessarily need to rejig that. But what we do need to look at is exactly, I suppose, accountability around the money that goes from the Commonwealth to the State.

Stop this cost-shifting and try and make sure that the dollars we spend are spent at the coalface - in other words spent at the doctor-patient interface - and not necessarily up the food chain around a greater range of bureaucrats.

QUESTION: Well the Government has the Podger Inquiry looking at Federal-State Relationships. Do they need more?

DR GLASSON: Look we wait with great interest what actually Podger will deliver. Obviously it's looking specifically at the jurisdictional responsibilities between the Commonwealth and the State. And I'd hope to think that that puts a blueprint for the future, I suppose, inquiries or future inroads to exactly how we can make this system more accountable.

I mean the broader debate about whether we should have one health system, in other words remove one tier out of the system, remove the State Governments out of the system or whatever, is I suppose a broader debate the community needs to have. Now whether that actually will lead to a more efficient system is debatable. You can look at the British system and essentially in that system it does not necessarily deliver improved access with a single system. In fact Britain has probably got the biggest health bureaucracy of any health system in the world.

So, we don't want to build a bigger bureaucracy. We want to have a system that actually gives patients good access, good affordability, delivers choice, and preserves the independence of the doctor/patient relationship.

QUESTION: How long has the government got to get this right before it reaches absolute crisis point?

DR GLASSON: Look, in relation to both workforce and relation to the ageing population, we are reaching, we're going to reach a crisis point very, very soon.

I cannot underestimate that the impact that workforce shortages are having across the health sphere - in doctors, nursing and allied health.

And obviously the government has put new medical school places, an extra thousand medical school places. That will have an impact in 10 years. But in the next 10 years we've got to look at some innovative ways of trying to ensure that the workforce we have stay working.

That they stay in the procedural areas, because we are not going to meet the demands of the ageing population.

And therefore we have to be innovative in the way we actually attach other allied health persons to the doctors concerned - including our nurses - because essentially unless we do that, then demand will outstrip the supply of services.

QUESTION: Bill, various people have expressed concern about rising doctors' fees, not least the Health Minister himself. Tony Abbott, as I understand it, has put more money into the health system than any Minister before him.

Do doctors now have a moral duty to exercise a bit of fee restraint for the benefit of society?

DR GLASSON: Look, we, I've looked specifically at this. In relation to the safety net, I have looked specifically at a series of item numbers to make sure - just to see what's actually happening out there. In fact doctors are not increasing their fees.

What's happening is the money that Tony Abbott's put into the system - and I congratulate him for doing it - is actually going towards meeting the gaps that you and I pay when we've seen the doctor for the last 10 years or more.

In fact patients are paying $2 billion in gaps to see their doctor or doctors, up until about a year ago. What this extra money has done is help to meet those gaps that you and I have been paying.

And the reality is the money is going to the patient's pocket, it's not going to the doctor's pocket.

QUESTION: What about the specialists in the private system though? I mean, the gap fees have risen by 19% apparently?

DR GLASSON: No. The gap fees have risen, that's because services that traditionally were not attracting any rebate - particularly around obstetrics and to some extent in relation to the infertility issue - these are gaps, this is money that patients were paying that were not being rebated in any way, and are now being picked up by the safety net.

So when you look at the safety net figures you think, oh golly, those doctors are making, charging more, higher fees. The doctors' fees in fact have not changed at all. What's happened is the system is starting to meet or pick up those out-of-pockets that weren't being picked up before.

So the reality is that the system is addressing what it should be, and that's addressing the needs of the patients, not the needs of the doctor.

QUESTION: And were you surprised that Tony Abbott's first encounter with the health system left him so shocked about its state that he went out and made a speech to about it?

DR GLASSON:. Yes, it was a bit of an unfortunate experience. But I think it's an experience that many patients in the private system go through.

The one thing that we complain about with the private system is the multitude of bills; the complexity of the system, and about gaps.

Now we don't complain about known gaps. If a doctor says to you I'm going to be, you're going to be $100 out-of-pocket for this procedure, and if you're $100 out-of-pocket you don't complain. But if you're $200 out-of-pocket when you've been told it's $100, then you get a little terse.

So people complain about unknown gaps so we do support informed financial consent as a consequence. But the reality is that doctors' fees are not rising, the reality is the system is helping the patients out there, and that's what the system's there for.

QUESTION: Should informed financial consent be mandatory on doctors?

DR GLASSON: I mean, we have looked - obviously the difficulty is in certain emergency situations it's difficult. If you come in unconscious or come in acute pain, you're given some narcotic to remove the pain, you're not in a position where you actually can be given informed financial consent.

But in most elected procedures now - where you're having a hip done or eye done or whatever - patients are given written informed consent. So that is not the issue. The issue is, like the Minister had, an acute event - had a renal stone, he had acute pain, he was filled up with dope, and it's very hard in that situation to give informed consent.

Having said that, I think we can make the system better. The profession has a responsibility to make it better. And we're going to be certainly sitting down to make sure that the system is as good as it can be, to make sure patients know what they are, if they are going to be out of pocket.

And so it's our responsibility to make sure we deliver on that.

Ends/…