AMA Transcript – AMA President, Dr Steve Hambleton, Sky News Australia, 22 May 2014

Transcript: AMA President, Dr Steve Hambleton, Sky News Australia, 22 May 2014

Subject: GP co-payments

KIERAN GILBERT: Our top story this morning, the Australian Medical Association says its members are already reporting that people are not presenting to their GP because of the $7 co-payment which, of course, does not come in until next year. Some GP practices have had to send text messages to their patients explaining that the co-payment does not start until 1 July 2015, because the practices have already experienced less people presenting for appointments. I spoke to the president of the AMA, Dr Steve Hambleton, a short time ago.

STEVE HAMBLETON: Well, we’re hearing a number of things and there is a fair bit of confusion. We’ve actually got some patients thinking it’s already come in. We’ve got practices where there’s less presentations right now. Some of those practices have actually had to resort to actually letting the patients know it doesn’t start until July next year. Then, I guess, we’ve got to think about the details; there’s a lot of complexity in this thing.

KIERAN GILBERT: So you’re saying already less people are going to the doctor because of a scheme that’s not already even in place.

STEVE HAMBLETON: Just hearing about it in the Budget’s been sufficient for some patients to actually not attend. And I guess we know that it’s going to change behaviour and this is good evidence that it will change behaviour; even before people have had to pay there’s  reduced presentations to general practice. Now, that’s a bit of a concern because general practice is actually the efficient end of the health system. It’s the place where we do the health promotion and health prevention. It’s where we keep people out of hospitals.

KIERAN GILBERT: But do you have – are you hearing that people that should be going aren’t going? Because the Government’s approach is basically to, I suppose, provide a price signal to prevent those visits to the GP that aren’t crucial. What are you hearing about the patients that are actually not presenting?

STEVE HAMBLETON: We don’t know the detail yet about who are they, why aren’t they coming, what are the concerns and that’s exactly – you’ve identified the problem. If we have people diverting, either not going to the GP and getting sicker and then needing more expensive care that’s not a good thing; or diverting to somewhere else like calling an ambulance or ending up in emergency. Those sorts of things actually are going to cost us more money, not less, and that’s what we don’t want to see as an outcome.

KIERAN GILBERT: So how many people are we talking about already from the AMA’s soundings?

STEVE HAMBLETON: Low numbers, but now at least two states have confirmed that there are some concerns. So there is a bit of a broad concern in the community and I guess they don’t – we need to make it clear that it’s July 1 next year, not this year, that these changes will come in, if they come in.

KIERAN GILBERT: Well, if they come in. How do GPs plan for a system which there’s still a question mark over? Because there’s no guarantee. In fact, if you look at the Senate right now, the make-up both before July 1 and after it, it looks unlikely that the Government will be able to secure the passage of this.

STEVE HAMBLETON: Well, I think people have got to understand, the Senators have got to understand, the population’s got to understand, you know, what is the reason we’re doing this? If it’s simply a cost saving measure I think that people are going to be less likely to be supporting it. But if this is part of overall health reform we need to understand that process and why this is necessary. You know, we know that most of Australians can actually pay that co-payment, but there are some parts of Australia where it’s going to be very, very difficult and that’s the very low income earners.

KIERAN GILBERT: Well, in those areas where the Treasurer says GPs can exempt people where they think that they’re not able to pay the money, people can be exempted by the GP. How does that work in an area, like Western Sydney, for example, where you might have many cases, a high percentage of people, who would be in that bracket? Would the GP have to exempt all and would the GP then suffer in terms of the amount of money that they generate?

STEVE HAMBLETON: Well, there’s a strong economic driver to charge the $7 in this measure. If you don’t charge the $7 you miss out on – there’s a $5 reduction in the rebate which is a drop in income for the practice, but there’s also the bulk billing incentive which falls away so it’s about a 25 per cent reduction in revenue for that practice. And for most practices that’s not possible. So it will be highly likely they’ll need to do something; they’ll need to charge that $7. And if they do, in fact, they’ll be $2 better off but that will be consumed by extra staff and extra administration and extra costs.

KIERAN GILBERT: So you think GPs won’t exempt, that they can’t exempt?