Media Interviews
The Federal Government's proposed changes to the Medicare System
Interview With Kerry O'Brien, The 7:30 Report, ABC National Television.
28 April 2003
Presenter:
The government has announced these changes to Medicare as a direct response to the decline in bulk billing of patients by GPs over the past three years. But will the changes arrest that decline or accelerate it? I'm joined now by the Health Minister Dr Kay Patterson in Canberra … not Dr Kay Patterson, it's Senator Kay Patterson.
Senator Kay Patterson - Federal Health Minister:
Well, it is … thank you, Laurie (laughs) … sorry, Kerry.
Presenter:
(Laughs) You're selling these … I don't know whether that's a promotion or not … you're selling these changes as a fairer Medicare. The man who wrote the original Medicare blueprint, Professor John Deeble, says you're doing the opposite. He says this attacks a fundamental principle of Medicare - that many, many more people are going to lose access to bulk billing. Now, he'd know, wouldn't he?
Patterson:
Well Dr Deeble, I don't think, would agree with anything that the Coalition put forward. But let me just say this package is about giving incentives to doctors to increase the likelihood that people on Health Care Cards are bulk billed. Kerry, the issue is that I haven't just responded to bulk billing rates. What I've been concerned about on becoming Heath Minister was that there are people, particularly in rural areas, on Health Care Cards who have never had access to a doctor who bulk bills.
You indicated that where there are a higher number of doctors, particularly in inner city areas, doctors bulk bill. Some rates are up around ninety-two per cent. But in rural areas and outer metropolitan areas, we have fewer doctors, that's not the case. These incentives will give them incentives to do that.
But also, Kerryn Phelps forgets that we've got nurses … nearly eight hundred practices will benefit from practice nurses to take the load off doctors and to help them to continue to bulk bill.
Presenter:
You've … how many people are now going to pay more to go to the doctor as a result of your changes to Medicare?
Patterson:
There's nothing in this package - nothing - that should mean doctors should charge more. The estimations I've been given is that the vast majority of doctors will be better off if they bulk bill. If they choose to charge non-concession card holders it will mean that patients, instead of having to going … you gave that example of the family. Instead of going with two children to the Medicare office when they're sick, they'll be able to assign their Medicare rebate to the doctor and pay the gap.
But there's nothing in the package that should indicate or should cause doctors to increase their charges.
Presenter:
So, are you saying that the rate of Medicare will now be … that the decline will be arrested? It's seventy per cent of GP visits are now bulk billed. Are you saying that you'll now keep that rate?
Patterson:
Well, Kerry, one of the things with any rate is that hidden behind that rate is the inequity. And the inequity has been, ever since the introduction of Medicare, that people on Health Care Cards, some have never never had access to a doctor who bulk bills, and there was no incentive for the doctor to bulk bill, particularly in rural areas.
Presenter:
But eighty per cent … until three years ago, eighty per cent of GP visits around Australia were bulk billed.
Patterson:
And a signi …
Presenter:
Now, Dr Deeble says that within two years you'll see that rate of bulk billing down to about fifty per cent or less …
Patterson:
Well, that's …
Presenter:
… that doctors will only bulk bill, in the main, for those Health Care Card holders.
Patterson:
That's Dr Deeble's prediction. What we have …
Presenter:
And others.
Patterson:
… is not only have we increased the Medicare rebate. We've given doctors incentives to actually treat people with diabetes, with mental illness, with asthma. We've actually increased payments to doctors to get our immunisation rates up. We've increased payments to doctors to ensure that women have pap smears.
There's a range of measures, including now a hundred and sixty-eight million dollars to actually give doctors in areas where there are a low number of doctors access to a practice nurse to assist them and reduce the load on them and their practices.
Presenter:
You're talking … your focus is very much on rural doctors. We've just seen one doctor in a regional medical practice who says that this does nothing for him, that he has changed from bulk billing to directly charging fees to pensioners and that this will not change that practice for him.
Patterson:
And I had a rural doctor in my office the other day who bulk bills all her patients who said this would assist her in her practice. So, I'm sure …
Presenter:
So, some will, some won't?
Patterson:
Some will and some won't. But what it does is increase the chances and give doctors who bulk bill their Health Care Card holders a payment to do so. It's the first time we've had an incentive to make Medicare fair at that level. There's no reason for doctors to increase their charges within this package.
Presenter:
Can you honestly say that GPs who now regard themselves as underpaid, struggling to stay afloat in many instances, they say, won't see this as an invitation to increase their fees for patients that they're not bulk billing?
Patterson:
We can't actually tell doctors what to charge. And Dr Blewett, when he introduced Medicare, indicated that that wasn't an issue, that was something we couldn't address. I don't think doctors will take advantage of this. Doctors will be guided by their patients. Doctors … in particular there'll be other doctors who don't put their fees up. There'll be a level of competition.
But we're actually giving doctors an incentive, a payment in which we estimate that the vast majority of doctors will be better off, to bulk bill their Health Care Card holders. Many of them will continue, and Dr Phelps has said, some of them will continue to bulk bill all their patients.
Presenter:
Well, I keep quoting Professor Deeble because he is the man who wrote the policy that has been in place for twenty years, including seven years of your government - seven years of your government. Now, he says that fees … well, doctors fees will now be uncapped, unpredictable, and only a fool would believe that they won't rise.
Patterson:
And doctors fees have been uncapped since the inception of Medicare.
Presenter:
Are you saying that Medicare … that bulk billing in Medicare has never acted as a means of controlling doctors fees from going up?
Patterson:
I'm saying that bulk billing or Medicare has never actually given doctors incentive to ensure or to attempt to ensure that as many people on low incomes as possible have access to bulk billing. In rural areas, as I indicated to you, and some outer metropolitan areas, there've been people who have never even had the potential of seeing a doctor who bulk bills.
This package - and Dr Mackey's indicated he thinks fifty per cent of doctors will take it up in rural areas, I think that there'll be more - will enable patients with Health Care Cards to at least have the potential of the opportunity to attend a doctor who bulk bills.
Presenter:
The Australian Consumers' Association agrees with Professor Deeble. It says, the message from your Medicare changes is that Medicare is no longer going to pay for this system, the patient is. The message to doctors and patients is that you're not serious about saving Medicare. It's just not Dr Deeble.
Patterson:
Let me just say that with increasing the number of general practices in training, that will actually put pressure on fees to ensure that we've got doctors in areas where we need them. We actually are increasing the number of medical students to increase access. It's about increasing access and affordability.
And where you have a reasonable number of doctors you have a higher level of bulk billing and we need to ensure that we have doctors appropriately distributed. When we came into government …
Presenter:
Well, why didn't you do this seven years ago?
Patterson:
… we had a maldistribution. When we came into government we had a maldistribution of doctors and we've been working towards addressing that maldistribution. Kerry, we have seen a turnaround in doctors in rural areas. Last year a four point seven per cent increase in estimated full time doctors in rural areas.
Since we've been in government an over eleven per cent increase in estimated full time doctors. The first time we've seen a turnaround in people being able to access doctors in rural areas. We have been working on it. You can't change these workforce issues overnight.
Presenter:
There are twenty million Australians, Senator Patterson, a significant number of them in the bush, and yes, they do face problems, but those problems are not confined to the bush.
Even the AMA is lukewarm at best about these changes. Their president, Dr Phelps, says some doctors will continue to bulk bill all their patients if they can afford it, some will move to bulk billing only Health Care Card holders and privately bill the rest, and others will move completely to private billing.
Are you saying that you're confident that no one's going to fall through the cracks there, people who now are bulk billed who will consider themselves that they will not be able at times to afford a visit to the doctor?
Patterson:
Kerry, since the introduction of Medicare, there have been some doctors who bulk bill all their patients, some doctors who bulk bill their concession card holders and some patients … some doctors who don't bulk bill anybody. Dr Phelps knows that. It's thus ever been the case.
What the package is intending to do, as designed to do, is to increase the likelihood and the availability of bulk billing doctors in areas where they've never existed before.
[ENDS]
