Transcript: AMA President, A/Prof Brian Owler, Doorstop, Senate Courtyard Parliament House, 4 December 2014
Subject: Co-payments/ Bulk-billing incentives
BRIAN OWLER: Well, thank you for coming everyone. What I want to talk to you about today was some speculation that has been in the media and around Parliament for the past week or so. We saw last week the discussions around the co-payment. Is it dead? Is it alive? Is it just resting? What I’m very concerned about, though, is reports that there was a deal done between the Government and Clive Palmer to actually scrap bulk billing incentives. Now, bulk billing incentives in general practice mean $6.25 for people on concessions and those under 16, when they’re bulk billed seeing a GP, and $9.25 when they’re going to see their GP in rural or remote communities. Scrapping bulk billing incentives would be a direct attack on the most vulnerable people in our communities. It would be a direct attack on children, on the poorest people in our communities, and it would be a direct attack on Indigenous health.
That sort of proposal must be ruled out. And I’d like to ask that the Minister for Health and the Government and Clive Palmer rule out any deal that scraps bulk billing incentives. And we need to have a much clearer discussion about health policy in this country. We need to stop talking about co-payments and go back to the table, the drawing board, and start from scratch, and have a proper discussion about how we’re actually going to engage in prevention, chronic disease management, and how we’re going to keep the Australian community healthy.
QUESTION: You said – you were speaking there about if bulk billing incentives are scrapped, it could impact upon the most vulnerable. So under a co-payment or if this deal goes ahead, what happens to things like Indigenous health in Australia?
BRIAN OWLER: Well, look – for Indigenous health, the co-payment proposal is essentially defunding Indigenous health. Now, I’ve toured the Northern Territory, I’ve spoken to the Aboriginal Community Controlled Health Organisations, the AMSs that are involved in providing healthcare. They tell me that they will not charge a co-payment. They know that their patients are not able to afford the seven dollars. Not only do they lose the seven dollars, but they would lose the $9.25 bulk billing incentive for not charging the seven dollars in the first place. It would mean a loss of $14.25 per patient. And, apart from that, they have said that they would have to pay on behalf of the patient, the seven dollar co-payment every time they ordered a pathology test or diagnostic imaging. For us close the gap in Indigenous people enjoying the same life expectancy as non-Indigenous people in this country, that means investing in health care, and where we’ve done that, we’ve actually got results to show. But these sorts of proposals that are short-sighted, and have not considered closing the gap in Indigenous health, need to be taken off the table, and we need to get back to discussing actually how we tackle these problems, how we close the gap, how we actually make our health care system sustainable, and how we actually do chronic disease management in the future.
QUESTION: Mr Palmer has said twice this week that the GP co-payment is dead. Are you still concerned, though, that it will go ahead in another way?
BRIAN OWLER: Well, we’ve always been concerned that there would be some other solution put up. And that’s what we’ve been hearing reports about – there’s a report in The Australian today. There was a report last week that, instead of actually legislating a co-payment, that through regulations they would essentially just scrap the bulk billing incentive, for not only those on concessions and under 16, but in rural and regional areas. Now, that means no co-payment. But it would be a disastrous thing for those most vulnerable in our community. It would make an unfair health budget even more unfair. And I think it’s something that the Government needs to declare is off the table, so that we can get on and have a proper discussion about health care.
QUESTION: The point of the GP co-payment is to have funds towards the Medical Research Fund – to help, you know, further research projects in health. I know that a number of doctors that are backing it are concerned where the funding will come from, then [rest of question inaudible]…
BRIAN OWLER: Well, look. The co-payment does not actually fund the Medical Research Future Fund. What funds the Medical Research Future Fund is actually a cut to the Medicare rebate of five dollars. That is the cut that actually provides $3.5 billion over four years, about five billion or so over the six years.
Now, it was always a very cynical move to try and link the Medical Research Future Fund to the co-payment proposal, to take money out of the pockets of patients going to the doctor in primary health care and putting it into tertiary level research.
Now, the AMA supports having a Medical Research Future Fund. As someone that has written NHMRC grants, who’s run a lab, knows the difficulties in obtaining funding for research, I support a Medical Research Future Fund. But what we – sorry – what we don’t support is funding a Medical Research Future Fund through the co-payment. Now, the Medical Research Future Fund, the $20 billion, is actually funded by a number of sources; it’s actually funded through changes to funding public hospitals, it’s funded through cuts to government agencies, through government programs, that were all in the Budget. And many of those proposals have already gone through an appropriation, so the savings have already been made for a large proportion of the Medical Research Future Fund.
So what we need to do is either have a Medical Research Future Fund that has a lower quantum, maybe $15 billion without the co-payment, is collected over two extra years, which could see it still get to $20 billion, or the Government needs to look at other sources of funding. If it’s that important, why is the money from the Medibank Private sale going onto roads? Why isn’t it actually going to the Medical Research Future Fund?
QUESTION: Your alternative co-payment model advocates for exemptions and concessions, and to my knowledge the Government’s does not. So, if the Government put forward blanket exemptions for Indigenous people, or people from poorer backgrounds, would it then get your support?
BRIAN OWLER: Well, that’s what the AMA essentially put forward to the Government. We put forward a proposal that protected vulnerable patients. That was always our objection to the Government’s proposal. Let me say again, the AMA is not against co-payments per se; what the AMA objects to is a proposal – it’s not a policy, it’s a proposal – that actually attacks the most vulnerable in our community, discourages them from accessing health care, either their general practitioners, from having blood tests through pathology, from having their diagnostic imaging. That is the sort of proposal that actually goes against all of the health policies that exist. Every country in the world knows that prevention and chronic disease management is the key to a sustainable health care system. Keeping people well, keeping them in the community, keeping them out of expensive hospital care requires investment in general practice, and it requires protection of vulnerable patients.
So, yes, we would look at proposals that did actually have those protections in them.
4 December 2014
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