Far from Lismore, where Assistant Minister for Health, Senator Fiona Nash, fronted the media on Wednesday 23 July to promote a health-funding component in the Federal Coalition’s 2014/15 Budget, AMA President, Assoc Prof Brian Owler, was voicing his organisation’s concerns about key aspects of the package at the National Press Club in Canberra.
While the specifics differed – Nash spoke on infrastructure support for GP practices, Owler on health fund involvement in primary care and GP co-payment fees - the timing highlighted the continuing gulf between the Abbott government and key organisations over both proposed and rumoured changes to public health funding.
However, a whiff of compromise is in the air: while certain aspects of the Budget, including the $7.00 co-payment, are yet to be debated in the potentially hostile Senate, they are already under review by the government.
The AMA, according to Dr Owler has submitted a proposal for an amended payment plan, and believes that “those meetings have been constructive… the Prime Minister asked that we work with the Department and the Minister for Health to come up with alternatives, and that's what we're in the process of doing.”
Whatever storm clouds hovered in Canberra, the weather was portrayed as clear in the Northern Rivers, with Sen. Nash joining Kevin Hogan, the Federal Member for Page, to confirm a $52.5 million allocation to Australia’s regional and rural areas for GP practices to build the facilities they need to take on more trainees.
“The Government will provide 175 infrastructure grants of up to $300 000 to successful applicants and require a matched contribution from the practice,” Mr Hogan said.
“This will this improve GP infrastructure, as well as encourage investment in our regional communities. Additional funding of $35.4 million will also be made available through the General Practice Rural Incentives Programme over two years, providing financial incentives to around 13,000 doctors working in regional, rural and remote areas of Australia.”
Mr Hogan added that the 2014-15 Budget delivered funding for an extra 300 GPs to be trained each year Australia-wide, boosting GP training places from 1200 to 1500 in 2015.
“GP training places will continue to rise in number, as we work to reduce the costs of GP training, improve frontline services and cut red tape.
“This Government is delivering on its commitment to double the Practice Incentive Payment for general practitioners who teach medical students from $100 to $200 per session.”
Down at the Press Club, Dr Owler, the face of a government safe driving campaign, said the AMA “obviously do have concerns” about the possibility of a US-style managed care system, which “interferes with the doctor-patient relationship and interferes with the autonomy of being able to prescribe and dictate the sort of treatment that the patient should have, that is what managed care is.”
He added, “Clearly, the Government is looking for other contributions to the costs of health care, and private health insurers are one potential. But, at the end of the day, it's actually the patient that's still paying their private health insurance premiums, so it's just another way of asking the patients to fund their health care.”
Regarding the proposed $7.00 co-payment, he said, “The AMA is not fighting against co-payments per se… many of our doctors already charge well above $7. It is the problem with this proposal in the Federal Budget that doesn't have the protection there for vulnerable patients.”
Stressing this aspect, he said, “We need to make sure that we encourage health prevention and chronic disease management, but we also need to have a value for general practice.
“Obviously, public opinion is against the co-payment and I think if the worst thing for the Government would actually be, by some miracle, they got the co-payment proposal through the Senate. Because every time someone went to the doctor, they would be reminded about the co-payment and what the problem was.
“So look, I think there is an opportunity, though, for the AMA to work with the Government that satisfies the Government's desire to - in their words - send a price signal. I would not use that term. I think a better term is actually to value general practice, because we know that people can contribute to the costs of their health care and seeing a general practitioner.
“We want to actually have people spend more time with their general practitioner, so that they can do all of those prevention measures and chronic disease management, so that we don't encourage, you know, the six minute medicine and bulk-billing centres. We actually want to encourage quality general practice and there, I think, there is an opportunity to do so with this current proposal.”
Regarding the co-payment proposal’s impact on Indigenous patients, Dr Owler said, “Because there are clinics that are basically funded through MBS; they use bulk-billing for their patients, and I think it is going to be very difficult for a lot of those patients to be able to come up with a co-payment.
“Now, if that's the case, it would mean that the health care centres would actually end up accepting a much lower rebate, and so, you know, the ability to fund those health care centres, and the doctors and health care workers working within those centres, would be jeopardised…
“… having targeted policies that we invest in areas such as the early intervention, making sure that the mothers do actually get good antenatal care - because if you can invest in that stage, you can set people up for the rest of their life; you can get people engaged with their health clinics, more likely to be engaged in education in school, and there's lots of evidence in that arena to say that that's what follows.
“So, I think we need to make sure that we are strategic with the investments that we make, it's not just about throwing more money at it. But, we have to recognise that you do have to invest in the area to actually get the results as well.”