Medicare too complex - Sky News

Transcript: AMA Queensland President, Dr Maria Boulton, Sky News, AM Agenda with Laura Jayes, Tuesday 4 April 2023

Subjects:  Medicare reform, vaping

LAURA JAYES:   According to this government-commissioned review, the scheme isn't fit for purpose and is bleeding up to 3 billion a year thanks to billing errors. Joining me now is Brisbane GP and Australian Medical Association Queensland President, Maria Boulton. Maria, thanks so much for your time. This is a pretty concerning report. There hasn't been a report to my knowledge like this commissioned by a federal government in quite some time. Has it confirmed your suspicions?

DR MARIA BOULTON:   We've been calling for the simplification of Medicare items for some time now. There's over 6,000 Medicare item numbers. They're the rebates that patients access when they see a health practitioner, an allied health practitioner, or when they go into hospital.

I'm a GP and I can tell you that the Medicare MBS item numbers sometimes can be quite difficult to navigate. They change a lot. Particularly during COVID, we were seeing MBS item numbers being put in and taken out. And the difficulty is that when you ring the MBS to seek clarification, sometimes when you speak to two different people, you'll get two different answers. So it can be quite grey and opaque and difficult to navigate. And it's not news to us. We know that that was an issue and we've been calling for those item numbers to be simplified for some time now.

LAURA JAYES:   Okay, so give us an idea. You're at the backend, most people aren't. So how complicated is it? And if we're talking about $3 billion a year being bled out of the system, what do they mean by that? Where's that money actually going? Are people getting rebates they're not entitled to?

DR MARIA BOULTON:   Dr Phillip's report basically says that that was an estimate and the estimate starts at $1.2 billion. He said that there is need for reform of the actual item number descriptors.

When you run a busy practice and you have a new item number, it needs to be crystal clear as to whether or not a patient is eligible for that.

There was also a study done by the University of Sydney on medical practitioners, and it actually showed that medical practitioners are actually more likely to underbill because they are afraid of falling foul of the law and not interpreting those item numbers properly.

So as a GP, when a patient comes and sees you at a consultation, for example, that patient is billed a fee and then that patient receives a Medicare rebate from the government. For example, if it's a standard consultation for a GP appointment, it's $39.75 that patient receives from the government. We've been arguing for some time that that's not enough to provide the actual service for that patient to receive that service. And that's why patients now have to pay increase out-of-pocket costs.

LAURA JAYES:   Okay. So in your view, does Medicare need a massive overhaul? Does it need more funding or does it need to be more efficient with the current pool of funding?

DR MARIA BOULTON:   It's both. It needs to be easier to navigate, but at the end of the day, what we need is for patients to have increased access to GP services. We're seeing a lot of GP clinics fold because they're not financially viable. We're seeing GP clinics move away from bulk billing because the bulk billing rates are not viable to operator practice. And those practices face two options, one is to close their door or charge a gap. And what we're seeing with time is that that gap goes up and up and up and those patients are facing an increased gap fee. And it's really important for the Federal Government to realise that patients are finding it really tough at the moment with the cost of living pressures. Patients are deciding between what script can I afford this month? And it's important for the government to look at those free rebates and subsidise them appropriately because really in the last 20 years, they haven't moved very far.

LAURA JAYES:   Okay. I wanted to ask you about vaping as well because the way I see this, this is a crisis. If it's not already, it is quickly becoming a public health crisis. Young people vaping, older people vaping as well. It's right across the board. And even anecdotally, hearing people returning to cigarettes to get off the addiction of vapes, why are state and federal jurisdictions moving so slowly here?

DR MARIA BOULTON:   What we don't want is we don't want a new generation of people who are addicted to vapes and cigarettes.

LAURA JAYES:   It's too late isn't it? What are you seeing?

DR MARIA BOULTON:   Oh, we're seeing vaping in schools. I was at a sporting event with my children a few months ago, and there were two, they couldn't have been more than 13 year old kids talking about vapes and what flavours of vapes they had in their bag, which was really shocking. And what we're seeing is people don't realise the dangers of vapes. There is emerging evidence that vaping is the cause of chronic lung disease, such as asthma.

We know too, that it can cause seizures, burn to the lungs, headaches, and if ingested, it can be quite toxic. If ingested by someone who's young enough or a baby or a toddler, it can be lethal. We're also seeing vapes. They're marketed in these really colourful packages with flavours such as tutti frutti, watermelon, bubble gum. So they're clearly marketed at children and adolescents. We know that people who vape are three times more likely to pick up cigarette smoking and become addicted to that. So something really must be done. I think we do such a great job with smoking cessation, but it seems that we're behind the eight-ball when it comes to vaping.

LAURA JAYES:   Is this too hard? Why so slowly? 'Cause it doesn't look like... I mean, there was a committee formed in Queensland at a Federal Government level, can't see what they're doing to get on the front foot here. Is it just simply too hard?

DR MARIA BOULTON:   I don't think it's too hard. I think our smoking efforts have shown that we can do better. I think it's just a matter of ensuring that the laws fit for purpose, that it's also enforced, but that education piece also cuts across to the next generation of people before they start vaping.

LAURA JAYES:   Well, Maria, it was a pleasure to talk to you this morning. Thanks so much for your time.