Transcript - Dr Kerryn Phelps, AMA President, Parliament House, Canberra - Relative Value Study

PHELPS: I did raise the issue. The Prime Minister said he would certainly look at it. What we're asking for now is for a meeting of the AMA, representing the medical profession, and the ERC so that the Government is fully aware of the AMA's position prior to the May Budget.

JOURNALIST: If that happened, that would set a bit of a precedent for lobby groups. You could argue that it would set a precedent, then any lobby group in Canberra could come up and try to put their case to ERC directly?

PHELPS: I've never been frightened of setting a precedent, and I think it's important that the ERC is able to hear what the AMA has to say. I think it's a different situation - it's almost unique in that we've had a seven year study which has involved the AMA and the Government in coming up with a new Medicare Benefits Schedule (MBS), and the process for that has been the RVS. So I guess, in a way, the precedent has already been set, and I think that it's time that the ERC actually had the opportunity to hear directly from the medical profession about our findings which we came to conclusions alongside Government and that it's time, I think, that the ERC were able to make what we consider would be an informed decision.

JOURNALIST: Is this a vote of 'no confidence' in Michael Wooldridge that he's not putting the case for you? Because he's the one who should be doing it in front of ERC.

PHELPS: It's certainly an indication of frustration with our attempts to discuss the RVS with Dr Wooldridge and I think that we would certainly like to be able to discuss with other Government members the implications of the RVS for the health system, just in case Dr Wooldridge hasn't mentioned those implications.

JOURNALIST: You're unlikely to see the ERC. You said there would be other implications if you didn't. What are those? What happens?

PHELPS: Well, the implications will be, I think, a lack of informed decision-making by ERC, particularly in respect of what lack of implementation of the RVS will mean to the health system. The AMA has conducted an extensive fax poll of general practitioners recently and 95% of GPs said that they wanted to see the implementation of the RVS and they wanted to see improvements for Fee for Service under the MBS. Now, you can't ignore the country's GPs because if the GPs are not heard then they will simply have to really just take matters into their own hands, which is, I guess, what's happening now with the declining rates of bulk billing. But what we don't want to see is an expansion of patients' gaps beyond the affordability for Australian people, particularly for needy groups, and that's what will happen.

JOURNALIST: The Government argues that the Medicare schedule has gone up by more than the CPI in the last five years. What's the problem?

PHELPS: We would argue that any increases have been off an insufficient base. The foundation for the MBS is 30 years old. It was never right to start with. It was only an estimate to begin with. And there were some groups within the profession that were traditionally disadvantaged going right back to that 30 years ago and they included general practice, consultant physicians, psychiatrists, obstetricians and gynaecologists. Those groups continue to be disadvantaged under the current system and it's the patients of those doctors who will become increasingly disadvantaged as their gaps widen.

JOURNALIST: You want the scheduled fee lifted to about $45 but that's no guarantee that doctors will actually charge that. So it mightn't help patients at all, might it?

PHELPS: Well, the $44 figure that was mentioned is actually a 1999 figure. So we're in the process at the moment of upgrading that to a 2001 figure and what we will also have to do is to look at some of the other areas that were not considered by the RVS in coming out with that figure - things like the cost for accreditation, the cost of doing BASs, which we know … certainly the GST discriminates against small businesses like general practice quite significantly. So we will be looking at a modification of that figure based on 2001 data and those are the sorts of issues that we will need to bring to ERC so that they can make their decisions about the Schedule. But when you talk about that $44 figure, that's one item number amongst thousands of item numbers, and the MBS has to be reviewed with the whole MBS in mind with every one of those thousands of item numbers and not just that one.

JOURNALIST: Besides the decline in bulk billing that you think will flow from this, what other activities do you have in mind in your campaign?

PHELPS: Well, I don't think we'll actually see a change in bulk billing because of the RVS being implemented, because I think GPs have lost faith in the MBS keeping up with the real cost of running a practice over years. And so, even though doctors may change to private billing what we want to see is, we want to see a preservation of household incomes by not having that load being placed particularly on needy families. And we need to discuss with Government what the options might be, particularly for disadvantaged people.

JOURNALIST: If GPs have lost faith in bulk billing and they can charge whatever they want now, why do we need the RVS adopted?

PHELPS: We need the RVS because patients are paying the gaps between what the doctor charges and what Medicare will pay them back. And I think, particularly for families with a lot of children, GPs have been traditionally subsidising people who are disadvantaged, unemployed, people with chronic illness, and so forth. And I guess GPs are getting to the point of saying, 'Well, maybe the Government should be doing its bit now, and helping those people who are disadvantaged. If we have a universal health insurance scheme under Medicare, it is the Government's role to do that.'

JOURNALIST: Are you saying that the implementation of the RVS won't increase rates of bulk billing?

PHELPS: I think the implementation of the RVS will arrest the decline of bulk billing. I don't necessarily think it will increase it. As I said, there are a lot of factors involved in the decline in bulk billing and a lot of it has to do with a loss of faith of GPs in the fact that the MBS will keep up with their practice costs as time goes by. And so I think it's easier for them now to consider abandoning bulk billing as a way of billing their patients, but rather to have them privately bill their patients, but to lobby on behalf of patients for lower gaps.

JOURNALIST: Don't you think that might weaken your case, politically, because politicians who may be convinced by higher rates of bulk billing?

PHELPS: I think that provided that patients are able to access affordable health care and that they are getting a reasonable rebate back from Government, then I do think that solves that problem. And I have spoken to a large number of MPs, particularly in rural areas and in suburban fringe areas, where they have large numbers of disadvantaged people. And what they're concerned about is the gap that people are paying and, while bulk billing rates would reflect a zero gap, if the MBS was appropriate then the gaps would be small/minimal, perhaps even zero.

JOURNALIST: If it is adopted, though, would you write to all your members, or tell all your members 'this is the schedule' - you have to charge these fees'?

PHELPS: Well, you can't do that. I think it would be inappropriate. Although I think the other thing you need to know is the MBS is really just an average. You have some practices that are vastly more expensive to run, you have other practices that are in areas where the costs of running the practice are less. So the MBS is really an average and it's a guide only. And, similarly, any AMA list of fees would be a guide only. And so what we would be saying was that GPs and doctors generally would need to look at their practice costs for where they're working, for what their patient load is and that sort of thing, and to be able to make a decision on what they charge, based on what their costs are, which is quite individual for each practice.

JOURNALIST: Is this an issue you'd campaign against the Federal Government on if they don't accept your requests?

PHELPS: Well, I think that grassroots GPs have a very angry and frustrated mood - and I've been around the countryside, I'm talking to GPs all the time. They want the RVS implemented, they want a good deal, they want not just adequate remuneration which reflects the level of responsibility, the level of training which is ten to twelve years to train to become an independently practicing GP. They have a tremendous amount of responsibility, they work very hard, and they believe that that should be appropriately reflected in their incomes. Now, if that income is not forthcoming through Medicare then, clearly, they're going to have to charge what is appropriate for them to charge, based on their experience and their responsibility. In terms of campaigning, well, there is an election coming up, and we'll basically be just saying it as it is. And GPs will be talking to their patients - they'll be talking to them one-to-one in their practices and they'll be going to their MPs and they'll be talking to their MPs about the position of the doctors who are working in those local areas.

JOURNALIST: Are you toning down … there was a suggestion there would be a much more coordinated campaign. You seem to be saying something different now?

PHELPS: I'm not saying anything differently at all. What I am saying is there will, indeed, be a campaign in the lead-up to the next election to ensure that health is at the top of the agenda and that the AMA will be leading that charge to make sure that the MBS is appropriate to 2001. We need to also be looking to all, not only the Government, but the Opposition parties, to look at what they have proposed in the lead-up to the next election because I think the Australian people need to be able to differentiate between what each party might have to offer if they were in Government. And the AMA will certainly be having a strong, leading role in that particular debate. In terms of a coordinated campaign, well, that's happening anyway because there is a real groundswell of feeling amongst doctors, in the communities - urban and rural - and they want to see this RVS implemented and the AMA speaking on their behalf.

Ends