Transcript of Report- Medicare System in Crises - Dr Mukesh Haikerwal, with reporter Heather Ewart - The 7.30 Report - ABC - Monday 21 July 2003

KERRY O'BRIEN: A Senate inquiry into Medicare that began today didn't have to look very far for evidence that all is not well in the health system.

It came in the form of reports about a Melbourne general practice that has set a new standard in the user-pays principle for those seeking medical attention.

In this surgery, for an extra $15 you get to see the doctor at the actual appointment time or, for an extra $30, you jump right to the head of the queue, and you're next.

Critics argue this is just one example of how the collapse of bulk-billing is driving up the cost of medical treatment.

And, at the same time, they say those who can't afford to pay more than the Medicare rebate are adding an extra burden on the public hospital system.

Heather Ewart reports.

HEATHER EWART: If you're in a nursing home for the elderly and fall sick, don't expect a GP to come to the rescue in a hurry anymore, if at all.

LEANNE MACKEY, DIRECTOR OF NURSING, WYNDHAM LODGE: Especially the last 12 months it's become increasingly difficult to get doctors to take on new residents that are admitted.

HEATHER EWART: Across the country, depending on where you live, doctors surgeries are either too full of patients already to allow time for home visits or there's not enough money in it to make it worth their while.

So high-care nursing homes, like this one, Wyndham Lodge, in Melbourne's west, are often left with no alternative but to call an ambulance and send the sick resident off to the overburdened local hospital.

LEANNE MACKEY: Often we can get a doctor from the hospital ringing us sort of saying, "Why have you sent this person here? We're busy."

So they're definitely under pressure and stress as well.

HEATHER EWART: Do you feel annoyed that this is the way the system seems to be working?

LEANNE MACKEY: Yes, I do, because I think elderly people deserve to be treated a lot better than this, and it's very frustrating.

HEATHER EWART: It comes as no surprise to Leanne Mackey and other nursing home directors like her that doctors would be starting to charge extra if patients want priority treatment.

The first clinic to publicly admit to this practice is in Melbourne's northern suburb of Fawkner.

Here, for an extra $15, you're guaranteed of your appointment time ahead of bulk-billing patients.

For an extra $30, you can jump to the front of the queue.

RAY BOYAPATI, MANAGER: From our perspective, we're being given money from the government that is just -- it's totally inadequate to run a medical service.

And the only option that we had was to charge everyone, OR to do this -- something else.

And we thought it's totally unfair and discriminatory, even more so, to charge everyone and let everyone else to find another doctor.

HEATHER EWART: This amounts to a 3-tiered system, and the clinic argues it needs this to survive because the government's bulk-billing rebate isn't enough.

But despite the clinic's claims that the patients are happy with its approach, that's not the picture you get out in the street.

YOUNG WOMAN: The rich can afford it, the poor, where do they go?

YOUNG MAN: No, I don't agree with it.

I reckon if you've got Medicare, you should just give your Medicare card and that's it.

WOMAN: I wouldn't go.

I don't go to that surgery and I wouldn't pay the $15.

I'd go elsewhere.

HEATHER EWART: But what's happening in Fawkner could be the sign of things to come if the Government remodels Medicare, say some industry representatives.

MUKESH HAIKERWAL, VICE-PRESIDENT, AUSTRALIAN MEDICAL ASSOCIATION: People are free to do what they like.

I don't think it hangs well for the practice, because people will start resenting the way in which they're being treated.

That's a shame.

As far as I'm concerned, it's important that people are treated fairly.

ROD WILSON, VICTORIAN MEDICARE ACTION GROUP: I think the Fawkner case is the most obvious case, if you like, but we have many stories from consumers across Victoria of the way that they have been progressively excluded from GP services.

HEATHER EWART: Is it worse in some areas than others?

ROD WILSON: Absolutely.

Bulk-billing rates in some parts of country Victoria are down to 30 per cent and declining.

We know, for instance, that in some parts of Victoria people are excluded from GP practices when they owe them money, and in fact having to go to welfare agencies to get a referral to actually be seen by a GP.

HEATHER EWART: Rod Wilson monitors complaints about medical treatment in Victoria, but says this is a nation-wide trend.

It's a problem the Federal Government is aware of, though freedom of choice appears to be its driving philosophy.

KAY PATTERSON, HEALTH MINISTER: People can make a choice -- they can vote with their feet and go somewhere else, particularly in metropolitan Melbourne.

What I'm concerned about is in rural areas, we've got billing practices where people don't have that choice, we inherited a maldistribution of GPs -- far too many in the city, far too few in the country areas.

And what we're doing is putting incentives particularly into country areas to ensure that at least people on a healthcare card are bulk-billed.

I can't tell doctors how to bill.

Nobody ever has been able to tell doctors how to bill.

Of course there are different practices, and people make a choice and go to a doctor that bills the way they want them to bill.

HEATHER EWART: Or they don't bother going to the doctor at all.

Liz Gill is a member of the medical profession, but when she came down a with a bout of tonsillitis last night, she baulked at paying the increased charges at her local clinic that would have left her $45 out of pocket.

Do you think a lot of people do that?

LIZ GILL, AUDIOLOGIST: They do.

And my experience now, having mentioning this to colleagues and friends, they now recount similar experiences, particularly the families that I work with.

A lot of them will put it off until it's an issue of extreme pain and risk to their children before they go to a GP.

HEATHER EWART: Is that wise for your health?

LIZ GILL: No, it's not.

A lot of this pain and suffering and need for further medication, or repeat medication could be avoided if people on the frontline were getting on to it as soon as possible.

HEATHER EWART: Then there are those who don't want to pay extra charges but don't want to suffer it out either.

ROD WILSON: These people, by and large, are turning up in the emergency departments of hospitals.

The figures for emergency departments of hospitals in Victoria is just spiralling, and they are being flooded with people.

The State Government this year is spending over $100 million trying to stop people turning up to emergency departments of hospitals inappropriately.

HEATHER EWART: State governments accuse the Commonwealth of shifts costs and warn that the pressure on State hospitals is burgeoning.

And these are just some of the issues the Senate inquiry will confront in the weeks ahead.

To come up with solutions that satisfy all sides, or even most of them, is a very tall order.