Medicare rebates need boost

Transcript: AMA Queensland President, Dr Maria Boulton, 4BC, Weekends with Spencer Howson, Sunday 22 October 2023

Subjects: GP fees, state politics

SPENCER HOWSON:   Well, as I mentioned last hour, GPs are putting up their fees again for the third time this year. From next month, you'll be charged more than $100 for a standard non-bulk billed appointment after the Australian Medical Association recommended doctors raise their fees to cope with galloping practice costs. Dr Maria Boulton is the Queensland President of the AMA. Hello, Maria.

DR MARIA BOULTON:   Good morning, Spencer.

SPENCER HOWSON:   Why are you having to do this again?

DR MARIA BOULTON:   Well the AMA recommended fees list is something that has been there for a long, long time. And why it got started was because the Medicare rebates that the government gives to the patient to access their doctor services has not kept up with the cost of providing the services. So the AMA releases recommended fees that show approximately how much it actually costs to provide the service. Then the GP, depending on where their clinic is, what their costs are, then come up with their fee that they need to keep their door open.

This is a crucial time because we've just had the fourth GP clinic closed in the Sunshine Coast. For far too long GP practices and GPs have subsidised that medical care for patients to access their GP. But it's come to the crunch. GPs are having to make the decision between charging a gap or closing their doors. And nobody wants to lose their GP in their community because we know that without their GP where would we be? We are crucial to keeping people safe, healthy and well and out of hospital and that is why we need to support GPs better. If patients are unhappy about paying a larger out-of-pocket cost, they need to ask the federal government why is it that my Medicare rebate come 1st of November is only going to go up by 20 cents? It's not enough.

SPENCER HOWSON:   The headline figure here, this $100 to see a doctor for a standard non-bulk GP appointment - do you see that as being an accurate figure?

DR MARIA BOULTON:   No. You'll find that most GPs are under that. You'll find that there are still GPs that bulk bill and most GPs do the best they can so to keep their prices affordable. But the reality is that your Medicare rebate to see your GP for a standard consultation is about 40 bucks. And it's not enough. to keep the electricity on, to employ the nurses, the receptionists, to provide the services that we need to provide. As much as we want to charge as little as possible, we do need to keep the lights on. And the question is, why is the government not doing more to ensure that Medicare rebate that the patient has access to access their GP services, why is that so low? Why hasn't it gone up? We know that inflation is 6 per cent, health inflation is more than that. And yet the Medicare rebate this year has barely gone up to above 4 four per cent and it's playing catch up too because it was frozen for many years. So that question is best posed to the government.

SPENCER HOWSON:   So just to be clear on the $100 figure, you're saying that basically if you shop around, you should be able to do better. If your doctor is trying to charge you $100, should be able to find cheaper elsewhere?

DR MARIA BOULTON:   Well, I guess people just must understand that everyone will have different costs when it comes to providing a service. And especially when you go out rural and remote, it gets more expensive. Staff is expensive and in rural and remote, there are less doctors, there are less staff available. So you have to be competitive when it comes to the wages that you pay, for example, for your nurses. You know, do you want cheap or do you want good? And do you want to keep seeing the doctor that you have been seeing, who knows you, who perhaps knows your entire family and who's doing everything possible they can to keep their doors open.

SPENCER HOWSON:   I notice in The Sunday Mail today, your colleague Dr Danielle McMullen is quoted saying that because the federal government is tripling the bulk billing incentive it pays doctors from November 1st, she's likely to start re-offering bulk billing as a result. Do you expect more GPs to do that?

DR MARIA BOULTON:   No, and the reason for that is because the tripled bulk billing incentive only applies for a small percentage of the population - kids under the age of 16, people on concession cards. And it varies whether or not you are in rural and remote area versus Brisbane for example. So in Brisbane that bulk bill incentive is not as much as if you're living in, for example, Charleville. And it's not the Medicare rebate. It's that smaller fee that doctors get if they bulk bill, but it's not that actual big amount that the patient has access to when they access their GP. There's a bit of confusion over that. It's not the Medicare rebate that's tripling, it's just that small payment that some people are eligible for when their doctor bulk bills that consultation. Bearing in mind, it's not a very big payment and it hasn't gone far enough for Brisbane doctors to make up for that out-of-pocket costs that they must charge to keep their doors open.

SPENCER HOWSON:   And just finally, Dr Maria Boulton, you might have heard me mention there the Opposition Leader David Crisafulli is currently giving a speech a year out from the state election. He's outlining the five priority areas for the LNP. And I gave the headlines before and I've got the full headline sentence now for the health one. And I might just get your response to this. The priority includes easier access to health services by driving down ambulance ramping and surgery wait lists as well as reopening maternity services in regional Queensland. It's only one sentence at this point, but your reaction to that?

DR MARIA BOULTON:   We absolutely welcome any anything that can help with those areas. Last year I travelled to Gladstone when they had the maternity bypass for 12 months and it is devastating to see the effects on families who are wanting to deliver babies who had to travel to Rockhampton to do that. So we know that health is under pressure. We know that if it wasn't for the amazing work that healthcare workers do day in, day out, who knows where we would be?

General practice - and I guess that's what we're talking about today - is particularly in a difficult spot because even though the Medicare rebates are federally funded, there is also a lot that the state government can do to help patients access GPs. For example, in Queensland, wouldn't it be great if we had incentive payments to increase our workforce in general practice similar to what Victoria has released, giving people incentives to go into GP training so that they can become GP specialists. We would welcome something like that.

Also payroll tax, this has been an ongoing issue and yes, we've had more clarity and yes, we have the amnesty, but a clear cut exemption would have been much easier so that we could spend that time, rather than on administrative tasks, we could spend it on patients. There's a lot we can do, and I look forward to working with whatever party wins in the end because there is a lot of work and we are doing that day in, day out. We have our own recommendations that AMA Queensland put together to help with ambulance ramping. Some of them have been taken up, others still need to be funded. And we're happy to collaborate with whoever is in power at the time.

SPENCER HOWSON:   That was going to be such a positive and optimistic note to end on, but I've got to share this text with you that's just come in, Maria Boulton. It's from James and, it sort of backs up what Joy's sentiment where she said GPs had better lift their act. James says ‘I'm sick and tired of hearing GPs complaining. They have tonnes of money. I have no sympathy for GPs’. What do you say to that?

DR MARIA BOULTON:   Everyone is entitled to their own opinion, but the fact of the matter is that there are GP clinics closing and without general practice, more people will end up in hospitals and hospital care is really expensive. We cannot afford to continue building hospitals endlessly. And we know that when general practice is funded appropriately, if you look at the example of Denmark, where people are very well supported to see their GP, they've had to close down hospitals because they don't need them.

I value my GP, I see my GP often and yes, I have my own GP -

SPENCER HOWSON:   I was going to say, you don't just see yourself?

DR MARIA BOULTON:   No, absolutely not. And my family have their own GP and I value them and they're having to do a lot more with less. And when you see how hard they work and when you go into a general practice and actually see the level of services that they provide. Let's bring up COVID. During COVID, we provided more than half of the vaccines. We kept our doors open despite us not getting many resources like PPE, fit testing. We weren't even considered frontline when it came to vaccines. And yet we continued to keep our doors open throughout COVID.

We are often the first port of call when people have mental health issues. They come to their GP. Why? Because they know us and they feel comfortable with us And where would we be without them?

SPENCER HOWSON:   When you go to your own GP, Maria Boulton, do you sometimes ask yourself for a second opinion afterwards?

DR MARIA BOULTON:   I trust my GP implicitly and I just ask my GP, you know I'm a doctor but please treat me like a patient because I value your care. I've just had to find a new GP because my previous GP retired and I was devastated. But I've got someone who's new, who's brilliant and, who's looking after me. So thank you to my GP.

SPENCER HOWSON:   Thank you for your time. Appreciate it as always.

See the current fees list (annual indexation released on 1 November)

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