Transcript: AMA President, A/Prof Brian Owler, Parliament House Doorstop, 25 June 2014
Subject: GP Co-payment
BRIAN OWLER: Alright. Thank you for coming, everyone. Obviously, I just want to talk to you today about the meeting that I had with the Prime Minister [Tony Abbott] and the Minister for Health, Peter Dutton. I’ve got to say it a very constructive meeting. The Prime Minister and the Minister listened to the concerns of the AMA. The concerns that stem from our practitioners, but also the concerns for vulnerable patients, and for the implications for health care policy.
The Prime Minister and the Minister listened to our concerns. There was a constructive atmosphere in terms of the meeting and the AMA, of course, outlined its concerns about the impacts of cutting the Medicare rebate and the fact that while the AMA can’t support this proposal, the AMA has always said that a form of co-payment would be an acceptable model.
And so, what we want to do is work with the Government to come up with a model that not only promotes health care and promotes the health of our patients, but it protects those that are most vulnerable, and also looks after the interests of our members and doctors that are serving the public. So, that’s the sort of model that we want to work with, with the Government. We must make sure that we protect those most vulnerable in our society, and we must make sure the funding is maintained for general practice, which is about keeping patients out of expensive hospital care.
QUESTION: What’s the form – can you elaborate on the actual form of the co-payment that you’d find acceptable?
BRIAN OWLER: Well, look, I think there are people in our society that can contribute to their health care. About 20 per cent of GP services attract some form of co-payment, often in the form of more than $7. There are many people that are non-concession patients that can afford to contribute to their health care, and we acknowledge that and what we’d like to see is a model that actually promotes that. So, while it’s too early to actually outline numbers or exactly how that’s going to be instituted, I think the message that was clear today was a commitment on behalf of the Prime Minister and the Minister to look at alternative models, something that we haven’t heard before or since the Budget was announced, and I think that’s a very positive mood.
QUESTION: Can I just confirm on that, are you saying that the Government gave you an indication that it’s willing to adjust the GP co-payment that he’d announced in the Budget and actually change what it’s putting forward?
BRIAN OWLER: Ah, the Prime Minister and Minister made it fairly clear in the meeting that they were willing to look at alternative models and consider those on their merits. Obviously, if there’s a model that is acceptable to the AMA, that we’re able to support, I’m hoping the Government will support that model and so I think, for the first time, an indication at last that there’s a willingness to revisit the model that they’ve put forward in the Budget and if it delivers the sort of objectives that the Government are looking at in terms of sending the price signal and having more people contribute to their health care, then that’s the positive message.
QUESTION: Did you take a new model to them that you found acceptable?
BRIAN OWLER: I think there are some elements of the model that we were able to outline, and certainly some elements that we’re not willing to accept, such as the cuts to the Medicare rebate. I mean, our GP services are certainly worth a lot more than $36, and we need to make sure that the value that is put on GP services reflect the sort of work and commitment that our GPs provide to their patients.
So, look, we’ve outlined the fact that we’re not going to support a cut to the Medicare rebate. We’ve outlined the fact that we need to make sure that we have the ability to bulk bill those people in society that are not able to contribute further to the costs of their health care, and that promotes things like prevention and allows people to look after patients with chronic diseases.
QUESTION: Specifically, who should be carved out of having to pay some co-payment?
BRIAN OWLER: Well, I think it’s too early to make a simple statement on who should or should not be carved out. Obviously, we have concerns about particular groups in society. I think the example of people in aged care, residential facilities, where it’s very impractical to actually collect a co-payment is one example. But I don’t think we necessarily want to go down the avenue of just drawing a line in the sand across people on various concession payments. I think there are probably more sophisticated ways that we can come up with of looking at the issue and so, as I said, it’s too early to come up with a model, and certainly we are not going to announce the model right now.
But I think there is a willingness at least to acknowledge the fact that there are people in our society that – for whom a co-payment will be an issue, and we need to make sure that those people are [indistinct].
QUESTION: The original proposal for these co-payments suggested a 12-visit limit for everybody. Is that one option you’d consider?
BRIAN OWLER: Well, I think we’ve moved on a long way from the original proposal. I think those sorts of simple models are – that – it’s very difficult to apply those to the complexities of health care policy. I think what we need to be doing is providing some incentives for people that are not on concessions, that clearly can afford to contribute to the cost of their health care, providing some incentives for them to make a contribution.
QUESTION: One of the concerns is that parents won’t be able to afford to take their kids to the doctor; would you like to see maybe a blanket exemption for children under 18?
BRIAN OWLER: Not sure what age it should be. Recently we’ve seen New Zealand move away from their model and actually exempt children under 13 years of age. Certainly, we have like concerns for families with multiple children, and certainly [we’ve] got concerns about the implications for immunisation. We want to make sure that we’re actually promoting it – making it easier for people to go and have your children immunised. It’s a very important public health message. So, I think those are the sorts of things that we need to look at. Certainly, children are one of the groups that we have concerns about, and certainly people with multiple children, each of which would obviously attract a co-payment under the current model, is an issue.
QUESTION: What about the chronically ill?
BRIAN OWLER: Look, the chronically ill I think are a significant issue. A lot of those patients are not necessarily on concessions and we need to make sure that people are not punished for having a chronic illness. Everyone over the age of 40 is – the vast majority of people actually [who] end up with a chronic illness [are] over that age, and as we get into our older years, people can have two or three chronic conditions, and to expect people to have to pay co-payments every time they see a doctor and every time they have a pathology test to manage those chronic conditions, I think is not acceptable. So, we need to make sure that we promote preventative health care, but also have protections for those people that’re chronically ill.
QUESTION: Have you had any discussions with the incoming crossbench Senators on these issues?
BRIAN OWLER: Ah look, we’ve sought meetings with the crossbench Senators coming in from 1 July. We haven’t had any of those meetings yet. We’re planning to provide some briefings in the very near future. I understand some of those are scheduled, and I think obviously they will have a very important role to play but I think the main thing is to work on a model with the Government that addresses our concerns and the concerns that I know that many people in the Australian public have, particularly those most vulnerable and the concerns that our doctors, our GPs have about being able to provide health care and health care prevention and many chronic diseases and keep people out of hospitals.
QUESTION: What about co-payments for emergency departments?
BRIAN OWLER: Look, the AMA does not support co-payments for emergency departments. It’s a very impractical model to impose. We don’t want people trying to decide whether their chest pain is a heart attack or simply indigestion and whether or not they should go to a hospital because they might not necessarily be able to afford a co-payment. What we need to do is make sure that we have an emergency department that is accessible for people when they have general health concerns and we certainly don’t want to be putting financial barriers up for people going for emergency [indistinct].
QUESTION: Did the PM and Health Minister agree with you on a particular timeline for reworking the model? Was there any sort of discussion about where to from here in terms of how they finesse the model if that’s the case?
BRIAN OWLER: Look, we’ve got a commitment that we‘re going to work with the Minister and come back to him with some of our preliminary suggestions and where we see a model heading in the future. There’s a commitment there to work with us. There’s no timeline that’s been set or deadline that’s been set in coming to an agreement, but clearly this is something that is best sorted out in the near future and something we would not like to see dragged on for an extended period of time.
QUESTION: So, it’s a rather – Peter Dutton’s today seized on a report from the Australian Institute of Health and Welfare which shows that health spending has increased 70 per cent in real terms over the last decade or so. He says that that shows why co-payment is necessary; do you agree with him?
BRIAN OWLER: No, look, those figures don’t actually support a model for a co-payment and certainly not a co-payment in general practice. Those health care spending figures are actually all health care spending by the Australian Government, the State governments, private health insurers and, of course, individuals. And a lot of the costs actually are contributed by individuals already. What we’ve actually seen is that the Federal Government’s expenditure on health care has actually remained fairly steady as a proportion of the total spending. You look at 2006-07, it was 18.1 per cent of the Federal Budget went on health. I think last year it was down to 16.13 per cent. So, we’re actually seeing a fall in terms of the proportion that the Federal Government is spending on health care. And I think, if you look at general practice since 2006-07, in terms of real expenditure per capita, the figure is about $301.60 per person. It’s gone up to a staggering $304.40 per person in the last financial year, according to the Productivity Commission. So that’s an increase of 0.18 per cent over that time period per annum.
I don’t think general practise is the area of the Budget that is growing at an unsustainable rate, and I think people need to remember that general practice, I think, is the answer to the sustainability of the health care system, and certainly not the problem.
QUESTION: This press conference is sort of focused on the vulnerable people who could be exempted from the GP payment. Just to flip that around, what would your comment be on those people in society who should pay it or could pay it? Do you have a few on who it should be applied to?
BRIAN OWLER: Yeah. So, as I mentioned before, already about 20 per cent of people actually contribute in terms of the co-payment, often much more than $7, and I think there are a group that are in that middle ground that are people who are working, who are not on a concession, and still end up being bulk billed, and I think what we need to do is value general practice in terms of the contribution that those patients make, make sure that we encourage quality general practice that is rewarding general practitioners for spending more time with those patients. And so, I understand that there is a group in the centre there that we can agree should contribute more to the cost of their health care. But it shouldn’t be at the expense of cutting the Medicare rebate, and we need to make sure that the investment stays in general practice.
QUESTION: If fewer people would be paying [indistinct] new co-payment, would that mean the actual amount that those other people still included would have to pay would have to go up, as in there’d need to be a higher co-payment because there are fewer people who would be paying it compared to the Government’s…?
BRIAN OWLER: You might have to repeat that one.
QUESTION: Well, if you don’t cut the Medicare rebate, that’s how the Government was going to save its money, how is the Government going to make any savings on this? Are you prepared to wear a higher co-payment for those people who you think can afford it?
BRIAN OWLER: Well, look, as I said, I don’t think the answer is to cut the Medicare rebate. Now, I know that there is money that is – the savings are actually not going to the bottom line of the Budget. The savings are actually supposedly going to the Medical Research Future Fund. Now, taking money out of primary health care and putting it into tertiary level research is not something that we support. I mean, as a researcher myself, I very much support money going into research, but I think if the Government wants to fund research, then the money needs to go – come from another source. It shouldn’t be coming out of primary health care. Primary health care is not an area, and general practice is not an area, which is getting excess funding. It’s an area that needs to be supported to sustain our health care system.
I think one of the things that the Government wants to achieve is to send a price signal in terms of having people value their health care. And we know that our GPs support the notion that people want – they want people to value the service that they provide. So, I think that is the primary aim that we need to achieve. It’s not necessarily saving money out of general practice, because, as I said, that – as an area of expenditure, in terms of the Commonwealth, that’s not one that’s been uncontrollably growing.
QUESTION: But would you support a higher co-payment for people who could afford to pay it?
BRIAN OWLER: So, I made no statements about where the co-payment should be set. Obviously, it needs to be something that is affordable and again, doesn’t discourage people from accessing health care, but sends the right signal, that they should value the service, and also supports general practice. So what the co-payment should be, it’s one of those things that we’re going to have to work on. It’s very preliminary, and I think the take-home message from today was that the Prime Minister and Minister for Health have actually shown a willingness to work with the AMA and come up with a solution that protects vulnerable people, but supports general practice, and makes sure that we support things like preventive health care and chronic disease management.
Thank you very much.
25 June 2014
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