Transcript: AMA President, A/Prof Brian Owler, Sydney Adventist Hospital Doorstop, 23 September 2014
Subject: Federal Government health funding; GP co-payment; $5 cut to Medicare rebate
BRIAN OWLER: Well, thank you for coming out. What I want to talk about today is the report that’s been released by the Australian Institute for Health and Welfare. What the report actually says, and it shows very clearly, is that Government expenditure, in particular, has actually been falling in real terms and so, we’ve seen over the past 12 months or at least the 12 months, 2012 and 2013, the lowest growth in health care expenditure for the past decade. In real terms it’s only been 1.5 per cent, and what that does is really make a mockery of the fact that the Government’s been claiming that health care expenditure is out of control.
What we’ve seen is that actually health care expenditure has actually been contracting in terms of growth, and we’ve also seen that more money’s been put – or cost has been put back towards patients, rather than the Government, so the Government is shifting costs away from themselves and back to patients in terms of out-of-pocket expenditure. Now, the Government’s used this as a narrative in terms of the lead-up to its Federal Budget, saying that health care expenditure is out of control, and it’s used that to justify the introduction of the GP co-payment. Now, there is no justification for a GP co-payment, let alone the cut, the $5 [cut], for the patient’s Medicare rebate.
What we need to do is actually see more investment in general practice because anyone in health care, particularly health care policy, knows that the answer to the sustainability of our health care system is not introducing a co-payment, it’s actually encouraging people to go and see their GP, to actually have prevention in chronic disease management, which is the biggest challenge for the Australian health care system in the future.
QUESTION: This $5 Medicare rebate, it’s obviously a Budget measure, and will it put extra pressure on doctors?
BRIAN OWLER: Yeah, so what we’re seeing is the co-payment fee announced and most people are familiar with the fact that it’s $7 but, of course, accompanying that is a $5 cut for the patient’s Medicare rebate and so that money, of course, has been shifted to the Medical Research Future Fund. So, I think the real struggle is going to be for – not doctors but for patients, because there are many people in the community that can’t afford to go and see a GP, let alone have the pathology test and diagnostic imaging. But it seems that this is already a problem, particularly in Indigenous health, where Aboriginal community controlled health care centres have all said that they’re not going to charge the co-payment, and they’re going to have to wear the cut in funding.
And, so, there is no justification for cutting the patient’s Medicare rebate, there’s no justification for introducing this co-payment proposal, because health care expenditure is not out of control in this country and, in fact, the Government’s own agency is now showing that there’s only been a 1.5 per cent increase in health care expenditure across the sector.
QUESTION: Have you had an opportunity to talk to the Health Minister about the latest figures?
BRIAN OWLER: We haven’t yet. The report’s only been released today so we haven’t yet talked to the Minister about this but no doubt the same lines will be trotted out in terms of raw numbers, saying that there’s been millions of dollars extra in terms of growth over the past few years and it sounds like a lot of money but, when we actually looked at 2012, 2013 and a 1.5 per cent growth in real terms, in terms of health care expenditure, that’s a very modest amount. What we see is the Australian health care system spending, as a nation, 9.67 per cent of GDP which is right on the OECD average and, in fact, we get much better health care results for that expenditure.
So, not only do we have a very efficient health care system but we have a very effective health care system, and what we don’t want to see is the introduction of poor policies such as the GP co-payment proposal actually impacting on the health care outcomes of our patients.
QUESTION: We’ve seen in the last 12 months, [indistinct] restrictions as well as dental health and that sort of thing [indistinct] evidence tended to come at once. Is this just possibly a blip on an overall still sustainable growth and spending or is this, do you think, the beginning of a rapid decline?
BRIAN OWLER: So – well we’ve seen over the past decade that actually health care expenditure has been relatively stable. Yes, we are spending more of – as a nation on health care and that’s a good thing. As the population ages and we get better results for our treatments, people live longer and we’re going to have to spend more on health managing their chronic disease. But what worries me in the future is that the Government is clearly – has an ideology that is about shifting the cost back to patients, shifting costs away from, particularly, the Federal Government, back towards the states who are least able to afford to pay the increase for running public hospitals and so there are cuts right across the board.
It’s not just about the GP co-payment. We know that there is – they’ve gone away from the National Health Reform Agreement which funds our public hospitals. So, all that money, all that $20 billion that’s going into the Medical Research Future Fund, is actually coming out from cuts to frontline clinical services.
QUESTION: You mentioned the states – the declining spending of State governments as well, do you think that they need to take more responsibility or is [indistinct]?
BRIAN OWLER: Well, I think the problem for our State governments – and I mean there have been states that have actually increased expenditure, such as New South Wales and Victoria – but the problem for State governments has been the fact that their revenue base has fallen. So, particularly for smaller economies such as South Australia and Tasmania, they are going to have a very difficult time in funding our public hospitals, as the Government shifts cost away from itself, shifts cost back towards State governments, and back to the patients.
So, we have seen that from 2017, that is when the problems are really going to start for our states in terms of our public hospitals, because they are only going to fund public hospitals of the states on CPI [consumer price index] and population growth. And so that is going to be not enough money to fund our public hospitals; small states, in particular, are really going to struggle. And, at the end of the day, these sorts of changes are really going to impact on frontline clinical services, the ability of doctors and patients to meet the demands of the Australian patients in terms of keeping them healthy and, of course, if we have a GP co-payment, we are just going to have more patients ending up at our public hospitals using up those resources.
QUESTION: How will the co-payment impact on regional and rural New South Wales?
BRIAN OWLER: Yeah, so the co-payment for regional and rural New South Wales … impacts right across the country, but we know that there are, particularly practices, where there are bulk-billing practices that are going to be particularly impacted, and those are practices in disadvantaged areas. So, where there is disadvantage we know that the proportion of patients and the effect of the co-payment is going to be much greater. It depends on the region, but in terms of remote areas we know it is going to be more of a problem. There are many Indigenous patients, of course, that live in rural and remote regions of Australia, and not just in terms of Aboriginal medical services, but their ability to access mainstream general practice, is going to be negatively impacted.
And so, all of the efforts that have been going into improving the health of the population in rural and regional areas, but also particularly in Indigenous health, where we have been trying to close the gap in life expectancy and health outcomes, all of those things are going to be adversely affected by poor policy in the form of the GP co-payment that was proposed in the Federal Government’s Budget.
QUESTION: [We’ve] seen a rise in spending by non-government organisations, is that [indistinct] helping to alleviate some of the strain?
BRIAN OWLER: Well, I think we need to realise that expenditure, for instance by private health insurers, at the end of the day is money that is coming out of the pockets of patients. Because they are the people that are paying the premiums, they are the people that are seeing the premium increases. And so, the biggest growth in spending as a proportion has actually been for patients, but also for health insurers, as the cost is being shifted away from the Federal Government, and being shifted towards patients. Now, if we see the introduction of the co-payment and the other plans that the Government has had, we are actually going to see a much greater growth in terms of out-of-pocket expenditure for patients, and I think that is a bad thing for the health care of Australia.
QUESTION: Do you have a time at which you think that you might be able to engage with Peter Dutton on the issue?
BRIAN OWLER: Well, we have been engaging with the Government all along, and we are continuing to talk to not only the Minister for Health, but other ministers, such as the Minister for Finance, the Treasurer, and the Prime Minister. And we have raised these concerns on a number of occasions. The Government has recognised at various – at various times, that there are real problems for various sectors of the community in actually being able to even introduce a co-payment – for instance, people in residential aged care facilities, for indigenous Australians.
So – but we have still not seen any significant shift from the Federal Government. They are determined to push ahead with the co-payment that they proposed in the Budget; while they have hinted at changes, there has been nothing that’s [been] put on the table by the Government. They continue to try and horse trade with the crossbenchers to get their changes through the Senate. They asked the AMA to come back with an alternative proposal, which we did, which protected vulnerable patients, invested in general practice, but actually asked for a co-payment – a modest co-payment – from those people that could afford to pay. But they were not interested in that compromise, it seems. So, so far, we have not seen any shift in the Government or acknowledgement of the very … significant impact that this poor proposal is going to have for the health care of Australians.
Thank you very much.
23 September 2014
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