Transcript: AMA President, A/Prof Brian Owler, 774 ABC Melbourne, 2 June 2014
Subject: GP co-payments
JON FAINE: Tony Abbott and Joe Hockey’s Budget is still enduring a somewhat painful birth. This morning the AMA, the doctors’ association, are prepared to lay on the line their concerns and objections as the dust settles, in particular, in relation to the $7 co-payment. Associate Professor Brian Owler is a paediatric neurosurgeon, he’s the newly elected President of the AMA, the doctor’s association.
Brian, good morning to you.
BRIAN OWLER: Good morning.
JON FAINE: We’ve only got four minutes for this. [Pause]. That was an attempt at me being funny, it didn’t work did it? [Laughs].
BRIAN OWLER: [Laughs] Yes, it’s a complex problem to discuss in four minutes.
JON FAINE: And indeed complex problems with doctors are difficult to discuss in four minutes, but that’s the concern arising from the co-payment. What’s the link between a $7 co-payment and a four minute consultation? Why does the one lead to the other?
BRIAN OWLER: Well, the problem that we have is that under this scheme there is a cut to the Medicare rebate of $5. So not only is there a co-payment of $7 but the rebate goes down by five. Now, for patients on concessions and those patients that are under 16 there is a low gap incentive, but if the doctor decides to bulk bill – that is, not charge the co-payment, they forgo the low gap incentive and in fact they end up being $13 worse off. Now, doctors’ practices cannot survive by bulk billing under this sort of scheme, unless they reduce the amount of time that they spend with patients quite drastically, and that’s where you see six minute medicine going to four minute medicine, and that has significant implications for the quality of the care that’s able to be provided.
JON FAINE: Forgive me, but even within our four minutes, I’m confused. We’ve been told that the $7 co-payment is going to a medical research fund, and that’s why the $7 is being built in to our consultations with a GP. So, what’s the – the arithmetic you’ve given us here suggests that, in fact, it’s going to make up for a $5 cut in the rebate?
BRIAN OWLER: Well, that’s right. So, when the Government gives the patients back less – $5 less in terms of their Medicare rebate for their consultation, it’ll mean that that saving by the Government of $5 will actually go then to the medical research future fund. So, what we’re doing is taking money out of primary health care and keeping people well and keeping them out of hospital, and putting that into a tertiary level research fund.
Now, that – research is obviously very important and as someone that’s been involved with research throughout my career I, you know, support a research fund, but we shouldn’t be making sick people that are going to the GP pay for that.
JON FAINE: Aren’t we robbing Peter to pay Paul?
BRIAN OWLER: Yes we are, and the problem is that, you know, GPs are really the solution. They’re not the problem. They – the number of GP consultations has only been increasing by about 2.9 per cent per annum over the decade. So that’s actually not a very – the GPs are not the problem in terms of sustainability. So, yes we are taking money from patients that are sick, those people that are going to see their GP and, you know, taking it and putting it somewhere else. It’s actually not solving the Budget bottom line.
JON FAINE: But the Prime Minister, the Treasurer and Mr Peter Dutton, the Health Minister, is saying that the $7 will more than make up for the changes for GPs and that they will be – well, the arrangements are sustainable.
BRIAN OWLER: Well, no and this is part of the problem is that an extra $2 going into the practice from the co-payment, so instead of the $5 obviously, patient pays $7, GP gets an extra two. But, that’s going to be costly, collecting the co-payment, administering the scheme and then of course there are going to be those…
JON FAINE: Sorry Brian, that’s four minutes, we have to stop now.
BRIAN OWLER: [Laughs] Yeah well, that’s right. So, this is going to be exactly the problem. So, you know, what we’re going to see is that those patients that we know can’t afford to pay the co-payment are going to be bulk billed, and doctors are not going to be able to sustain their practices and forgo $13 per consultation in order to be able to absorb those sorts of costs and that means…
JON FAINE: This is going to impact in particular in poor communities in quite a – well, difficult way. I mean basically doctors will withdraw if they can’t make a living in a poor suburb, they’ll just presumably, pack up and move somewhere else. And it’s a bit like the premise upon which university funding seems to be changing which is well, people are going to have to dig deeper but there are people in the community and sadly many of them who just have no capacity to dig deeper, even if they want to.
BRIAN OWLER: Exactly, and that is the problem. So, we assume that all practices are exactly the same, seeing the same sorts of patients, but we know that they are servicing groups that are poorer, that have higher burdens of chronic disease are those that you generally use bulk billing for a very large proportion of their patients. Those practices and their viability is under threat by this system, and it’s not just about the doctors and their practices. It’s about the actual provision of health care to those groups that are least able to afford a reduction in their access to healthcare services.
JON FAINE: Are you a screaming leftie, is that what’s motivating you and your colleagues? Is this coming from a bleeding heart Labor Party front group? Is the AMA suddenly now transformed into a bunch of chardonnay sipping, socialist tosspots?
BRIAN OWLER: No, absolutely not. So – and what I’ve said all along is GP – the AMA supports a co-payment system but it’s got to have the protections for those most vulnerable in our society. I think one thing that distinguishes the AMA’s professional organisation is that not only do we look after our members, our doctors, and we need to make sure that we’re able to practice and be rewarded for doing that, but we have an altruism and a social conscience to make sure that our patients are put first and that their heath care is maintained and we get the best outcome for them.
JON FAINE: Well, that was nearly seven minutes, so that’s an extended consultation. Brian, we will see if the Government’s listening and if they’re prepared to negotiate or adjust or change the policy settings, or if not then what it might mean for the nation. We shall watch and see. Thank you for your time this morning.
BRIAN OWLER: It’s a pleasure Jon. Thank you.
JON FAINE: I’ll let you get back to your patients. Associate Professor Brian Owler. He’s a neurosurgeon but he’s the newly elected President of the AMA.
2 June 2014
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
Odette Visser 02 6270 5464 / 0427 209 753