Transcript: AMA President, A/Prof Brian Owler, Parliament House Doorstop, 29 July 2014
Subject: Out-of-pocket costs for healthcare
BRIAN OWLER: Well, thank you everyone, as you know, I’ve just been addressing the Senate inquiry in relation to out-of-pocket expenses. There was a lot of interest, obviously, in the co-payment issue, particularly around the GP co-payments and the AMA was happy to provide a discussion around its submission.
As people will be aware, the AMA cannot support the Government’s current co-payment proposal because of several issues mainly to do with the issues for vulnerable patients, those that really can’t afford to pay the co-payment, the issues to do with the viability of some medical practices, not just in general practice, but also in radiology or diagnostic imaging and because it goes against the grain of health policy, which should be to encourage people to see their GP for preventative healthcare and chronic disease management.
QUESTION: Can you give an update exactly where things are at with the progress on the proposal you’re going to put to the Government?
BRIAN OWLER: So we’re not, obviously, ready to release the proposal, but we have been working on the alternative model. We’ve been talking to our members, our AMA Council of General Practice, who make sure that they are happy with an alternative model that we’ve been discussing. I think what I can say is that the AMA’s alternative model will do what the Government has said it wants to achieve, which is to send, in its words, a price signal.
But I think in our words, the better description would be to put a greater value on general practice. But it will also have protections for those that are most vulnerable in our community, those that truly can’t afford to pay a co-payment, and encourage people to see their doctor for preventative healthcare.
QUESTION: Is it fair to say the amount to be earned would be massively less?
BRIAN OWLER: I’ve said to the Government that our alternative proposal is not about a proposal that will fund the Medical Research Future Fund. Now we know that the proportion of funding for the Medical Research Future Fund, only a fraction of it actually comes from the GP co-payment proposal, so there are other sources of funding for the Medical Research Future Fund.
And look, while we think the Medical Research Future Fund is a very important thing for the future of Australian research and the health of Australians going forward, but we’re not going to advocate to take the money out of primary healthcare to put it into a tertiary level research fund.
QUESTION: But, by necessity, will the amount raised be less because you’re protecting more vulnerable [indistinct]?
BRIAN OWLER: Well, it will be up to the Government to come up with how they plan to fund the Medical Research Future Fund and our alternative model will not be one in which the same sorts of savings and funds that are currently being budgeted for for the research fund are going forward.
QUESTION: What do you believe is the future of Medicare under this government?
BRIAN OWLER: Look, I think Medicare does have a future and I think Australia actually does have a health system that is serving the Australian population well. It’s imperfect, but I think what we need to do is value the health system that we have, its universality, the access to affordable healthcare that we do actually have in this country, and the very high standard of training and practice that people are enjoying.
We’ve seen a very substantial increase in life expectancy. The death rate’s going down by 8.5 – 8.4 per cent over the past five years. I mean, Australia is doing well at healthcare. So I think we need to value this system that we have. There are always ways that we can improve it to make sure that we get the best value for the money that we’re spending, but we’ve got to make sure that our health system continues to look after those that are most vulnerable, that those that really need healthcare can access it without an excessive financial barrier.
QUESTION: As the nation gets older and as there’s a bigger load on the health system, is there any merit at all to having a price signal on a visit to the doctor?
BRIAN OWLER: Look, I think for those patients that can afford to contribute to the costs of their healthcare, yes, there may well be a role. But I think that is the key issue, that Australia’s biggest challenge in terms of healthcare is going to be an ageing population and the burden of chronic disease. As we get older, we often have more chronic diseases. It doesn’t mean people are sick, but it means their disease needs to be managed and the right person to do that is going to be the person’s GP.
And so we need to value general practice and primary care to make sure that we manage people in our communities, keep them well, and keep them out of expensive hospital care.
QUESTION: In your alternative proposal to this GP co-payment, would those Seniors Cards – those on the pension, would they be exempt from paying this co-payment?
BRIAN OWLER: Look, I am not ready to talk about those sorts of details just at the present time, but as I said before, those that can’t afford to contribute to the costs of their healthcare need protections and a mechanism to support them.
QUESTION: So some form of means testing more than what [indistinct]…
BRIAN OWLER: [Interrupts] As I said, I’m not ready to talk about those sorts of issues just at the moment. We’ll get to that once we’ve actually had a chance to talk to the Government.
QUESTION: Well, what do you think about the idea that, harsh though it sounds, that older people are visiting the doctor a fair bit, some of them may not need to visit the doctor, and therefore that there’s a small fee for them to pay, it’ll discourage visits to the doctor that are unnecessary? So – and, you know, attached to that is the idea that if you are to exempt old age pensioners from having to pay the $7 co-payment, that might defeat the purpose, because they’re some of the people who are visiting the doctor most.
BRIAN OWLER: Look, I think the issue is about the fact that those people are more likely to have a chronic disease. About 50 per cent between the ages of 65 and 74 have five or more chronic diseases that need to be managed. I don’t think there’s any evidence to say at the moment that we have a widespread problem with unnecessary visits to the GP from elderly folk that are going to simply have a chat.
I mean, that’s the sort of stuff that often gets talked about in the media, but I’ve yet to see any evidence that that’s the case. And while there might be isolated examples, I think the vast majority of patients visiting their GP, whether they be elderly or otherwise, are doing so for very valid medical reasons.
QUESTION: When do you expect to be able to put that proposal to the Government?
BRIAN OWLER: Look, I’ve got a meeting scheduled later this week with the Minister. And obviously, they will need time to digest the proposal that we put to them and I imagine there will be more discussions that will follow after that.
QUESTION: So you’re going to put it to him – put it to the Minister at that meeting?
BRIAN OWLER: We’ll have a discussion this week about where the AMA thinks that the proposal should head and then it’s a matter of working through detail and seeing if we can come up with something the AMA and the government can agree to.
QUESTION: And in terms of the – you’ve stated a blanket opposition to reducing the Medicare rebate…
BRIAN OWLER: Mmm.
QUESTION: But that’s the mechanism by which the whole co-payment is structured, as in the reduction in the rebate is how it’s, sort of, takes a practical effect. Is there an alternate way to collect the money from the co-payment you can resist that would be practical?
BRIAN OWLER: Yeah. Look, I mean, many of our GPs already charge co-payments without a reduction in their Medicare rebate, so the AMA cannot support a proposal that takes money out of primary healthcare. And I think general practice for far too long has been undervalued.
We’ve seen this competitive drive towards six minute medicine and what we need to do is actually reward GPs for spending the time with their patients, for managing their chronic diseases, and keeping them well and out of hospital. As I’ve said many times, GPs are the answer to the sustainability of the healthcare system; they are not the problem.
QUESTION: Do you get the sense the Government is open to alternatives and willing to compromise?
BRIAN OWLER: Well, the Prime Minister asked us to work with the Minister and his Department to come up with an alternative model and to come back to them with that and that’s exactly what we’ve been doing.
QUESTION: Has there been ideas for other potential areas of savings as part of this proposal?
BRIAN OWLER: Well, no, that’s not part of the remit. The AMA does have – has talked about ways in which the health system can become more sustainable and one of the other aspects of this Budget is to move away from activity-based funding on behalf of the Commonwealth.
And the fact that the National Health Reform Agreement has ended that the fact that, the growth funding – the 50 per cent – commitment to 50 per cent growth funding of public hospitals that was going to be contributed to by the Commonwealth, that ends from 2017, and what we’re going to have is the Government funding our public hospitals on the basis of CPI and population growth.
Now, that’s going to mean our public hospitals are underfunded, but it also means that we’ve shifted away from activity-based funding. Now, activity-based funding has its own flaws and it was never meant to be an open-ended funding process, but it provided transparency and it also dealt with inefficiencies in the public hospital system and asked people to look at things like unwanted clinical variation.
And we know that our public hospital system is one of the more expensive areas of the Budget. So what we should be doing is embracing those structural reforms that actually do address things like inefficiencies in the public hospital system and I think that’s the sort of process that we need to spend more time in. It takes a long time to get the results from that. It’s not something that’s immediate like a quick budget cut, but I think for the sustainability in the long term, that’s the sort of reform and process that we should be looking at.
QUESTION: You’re meeting up with the Abbott Government later on this week. What about the crossbenchers and the Palmer United Party? Will you be talking to them about your proposal?
BRIAN OWLER: Look, we’re happy to talk to all sides of government and the crossbenchers, obviously. I think it’s fair that we talk to the Government first and share with them the ideas that we have and we’ll see where the Government decides to head from there.
QUESTION: But is it a worry that the crossbenchers, including Palmer United, are adamantly not supporting this?
BRIAN OWLER: Well, it’s pleasing that they’re not supporting the current proposal, but we’ll have to see what they think about an alternative model.
QUESTION: But you might be staying in quite an active role in promoting the alternative model to the crossbench?
BRIAN OWLER: If it’s something that the AMA and the Government can agree on then I’m happy to go out and support that model. It would not be fair of me to develop a model and propose it and then not support it. And…
QUESTION: Rather than deal with the – if you come up with an agreement with the Government, then part of that would be that you’d be able to sell that alternative plan to the crossbench?
BRIAN OWLER: Well, if I’m satisfied that we can come up with a deal that values general practice but protects vulnerable patients and then still does achieve some of the Government objectives, I’m happy to support that and it will then be up to the other parties to decide whether or not they support such a proposal themselves.
QUESTION: Do you think the Government would be willing to accept any alternatives that would mean that they get less budgetary savings?
BRIAN OWLER: Well, I think it’s the matter of looking at an alternative model. And as I’ve outlined to them already, they’re not going to come up with the sort of savings that they’ve currently got. And I can’t support a model that takes money out of primary healthcare, that reduces the Medicare rebate. I mean, that’s essentially not a negotiable option. And so if the Government does want to achieve some of its objectives in terms of sending a price signal, in its words, then we’ll have to come up with an alternative model. But they will have to accept that there are less savings to be had.
QUESTION: And do you think they have accepted that, that any workable model will mean that they will get less [indistinct]?
BRIAN OWLER: Well, I think it’s a matter to come back and see what they say with the alternative that the AMA puts to them and we’ll decide, you know, if we can support it from there.
QUESTION: Do you have any problem with the $5 PBS co-payment?
BRIAN OWLER: Look, the PBS co-payments have been around for a long time and I think they are quite different to the co-payment for seeing a GP, for instance. I mean, a co-payment for a PBS – for a prescription, obviously – involves a direction by a doctor. They know that they have to have it. But, I mean, accessing a GP – well, you don’t actually know if it’s a serious problem or not. That’s not the sort of barrier that you want to put up.
But I think, look, there are issues no matter where you put out of pocket expenses in the health system for people in terms of accessing healthcare. We already know under the current system of 81 per cent bulk billing that about five to six per cent of people defer accessing a GP or don’t access a GP because of financial costs. So we know that wherever you put the cost in the system it can deter people from actually accessing healthcare. And so it’s an issue, but I think another co-payment on top of that is going to be much more of an issue.
QUESTION: So are you willing to let the PBS [indistinct] as a kind of trade-off for [indistinct]?
BRIAN OWLER: Look, we’re not looking at it as a trade-off. We’re very much focused on the issues surrounding the GP, pathology, and diagnostic imaging co-payments, because that’s a very substantial and new change and I think that’s where our efforts are focused. Thank you.
29 July 2014
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