With talk of Medicare reform, let’s not neglect vertical equity

Equal treatment for equal need is not enough — positive discrimination for disadvantaged groups is also required

With the “reform” of Medicare on the political agenda, it is timely to reflect on the objectives of fairness and equity that are key goals of our national health scheme. These objectives include both “horizontal equity”, or equal treatment for equal need, and “vertical equity”, which involves appropriately different treatment for those with different needs.

The goal of horizontal equity was made explicit by Neal Blewett, then minister for health, in his second reading speech of the Health Legislation Amendment Bill 1983. He stated that a goal of Medicare was “to produce a simple, fair, affordable insurance system that provides basic health cover to all Australians”.1

The goal of vertical equity is implicit in the more recent government policy of Closing the Gap — improving health outcomes for Indigenous Australians relative to the general population.2 The objective of this policy is to eliminate the difference in life expectancy between the two groups within a generation (by 2031) and to halve the excess mortality for Indigenous children under 5 years of age by 2018.2

Disadvantaged populations and vertical equity in health care in Australia

Indigenous Australians are only one of the marginalised populations in Australia. Others include the chronically sick, older people, people from non-English-speaking backgrounds, refugees, those on low incomes, the mentally ill and the homeless. Several policies already exist that seek to improve vertical equity for these groups. They include the use of means-tested safety nets and health care concession cards for people on low incomes, the funding of specific workforces to treat conditions associated with disadvantage (eg, drug and alcohol workers), and the availability of services and programs for particular needy groups, such as dental care for children or case coordination for those with chronic illness. These examples illustrate policies that achieve appropriately different treatment for people with different needs.

Importantly, the Australian Government also has agreements with the states and territories to fund hospital and other health care programs that target particular needs. For example, all states and territories operate patient assisted travel schemes for geographically isolated patients. These schemes provide assistance with travel, escort and accommodation expenses when patients have to travel over 100 km to access specialised health care.3 Several of these policies and programs to improve vertical equity are under threat from the proposed 2014 Budget cutbacks.

Within Medicare, the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) both achieve horizontal equity through their universality, but there are also examples of their use to achieve vertical equity. These include the prioritisation of people with more serious diseases — the so-called “rule of rescue”4 — and a few services determined on the basis of age, such as the MBS Healthy Kids Check for the early detection of lifestyle risk factors, and several physical health services provided by general practitioners and practice nurses that are available for 4-year-olds.5

However, Medicare has not been used explicitly to prioritise those with greater need due to social characteristics such as class, disadvantage or ethnicity, as routinely occurs in the United Kingdom’s National Health Service.6 There are a few exceptions: the MBS and PBS item numbers for Indigenous health workers, and specific subsidies for the treatment of otitis media, fungal infections, alcoholism, smoking and worms — conditions that are overrepresented in Indigenous Australians and people on lower incomes.7 There are lower copayments for Indigenous Australians for several MBS and PBS services and products. For example, the Closing the Gap — PBS Co-payment Measure results in lower or no copayments for PBS-listed medicines for Indigenous Australians who are at risk of, or who have, chronic disease.8 While removing a few barriers to access, such examples are rare.

Medicare does not have an overarching evidence-based decision framework for achieving vertical equity. Doubts remain regarding the extent to which our health care system, and particularly those parts controlled by explicit regulation (the MBS and PBS), is equipped and prepared to make policy decisions to achieve vertical equity; that is, decisions requiring positive discrimination.

The reluctance to pursue vertical equity is, in part, attributable to perceived difficulties with operational methods and public acceptance. Operationally, there could be a concern that such policies would create a precedence for decisions that may lead to future difficulty in “drawing the line”, or a fear of “opening the flood gates”, or being vulnerable to litigation. There may also be a perception that the public or taxpayers would not accept policy decisions that positively discriminate on the basis of social characteristics or disadvantage.

Research into equitable allocation of the health budget

Fortunately, research is available to help with operational decision rules, and there is a strong argument for basing equity objectives on social preferences in a democracy such as Australia. Existing research shows that the general public has clear views about fairness and equity between different groups in society and is capable of articulating preferences that may be used for allocating unequal resources between those with unequal health needs.9 The research to date has focused on health and personal characteristics. For example, people indicate that they are willing for society to pay more for the health of children, those with serious illness, those who were not responsible for their own condition and those with minimal other treatment options.9–11 In the UK, one study of disadvantage by social class found that an incremental increase in life expectancy for the lowest social class was weighted about seven times higher than an equivalent gain for the highest social class by members of the general population.12

In our own research conducted in 2011, we used relative social willingness-to-pay methods13 and a postal questionnaire to survey the Australian public, randomly approached from a database of general public adults willing to participate in research (Dalziel K, Segal L. The structure of Australia’s health funding systems: who is missing out and how does it align with social preferences? 9th World Congress on Health Economics; 2013 Jul 7–10; Sydney, Australia). Ninety out of 429 people responded (21% response rate). Overall, our respondents were slightly younger, more likely to be single and more educated than the Australian population. In the survey, participants had a hypothetical $40 000 to allocate to a child with asthma to improve either the quality or length of life. Participants were then presented with scenarios in which they were asked to make similar decisions when the child with asthma also had a social disadvantage. The survey results indicated a willingness to increase the budget for children in some socially disadvantaged groups, such as Indigenous Australians, refugees, low-income earners and those in remote locations (Box). The apparent negative allocation preferences for girls and children of single parents are thought to represent an overcorrection made by respondents who did not wish to indicate preferential budget allocation on either basis.

These findings suggest that decisionmaker fears that positive discrimination would be unacceptable to the Australian population may be unfounded, and provide a starting point for quantifying the budgetary implications of seeking vertical equity in the health sector.

The need for evidence-based change

When change to health care structure and funding is being considered, it is important to ensure that new policies do not have a disproportionate effect on low-income and vulnerable Australians.14 The climate of change, however, also provides an opportunity to strengthen Medicare’s commitment to equity objectives in other ways — in particular, by targeting barriers to health care for groups identified as having special needs.15 A proactive approach to such problems should be firmly rooted in research to maximise the effectiveness and consistency of any changes.

Australia’s health system and the health of all Australians will benefit from evidence-based mechanisms to allocate unequal resources to those with unequal health. This is particularly urgent for groups such as Indigenous Australians, whose health outcomes lag well behind those of others,16 but it is also true for other groups. Their needs and the appropriate response to them require further research of the sort described here.

Survey results showing the public’s willingness to allocate additional hypothetical health care funds to Australian children with asthma if they also have a social disadvantage*

* The percentages indicate the relative increase in funds the public would be willing to allocate to a child with asthma in each disadvantaged group, relative to an average Australian child with asthma (Dalziel K, Segal L. The structure of Australia’s health funding systems: who is missing out and how does it align with social preferences? 9th World Congress on Health Economics; 2013 Jul 7–10; Sydney, Australia).

PHNs give many Medicare Locals new lease of life

Medicare Locals are involved in more than half the organisations selected by the Federal Government to succeed them, details of successful Primary Health Network applicants show.

The 28 preferred Primary Health Network operators announced by Health Minister Sussan Ley include at least 18 in which Medicare Locals are a dominant or major partner, including for PHNs in Northern and South Western Sydney, North West Melbourne, Gippsland, South Brisbane, Adelaide, Perth (both North and South), Tasmania, the Northern Territory and the ACT.

The Government has committed $900 million to create 31 PHNs to replace Labor’s Medicare Locals scheme, which is being shutdown following the results of the Horvath Review that found many were top-heavy, expensive and failed in their primary goal of supporting seamless patient care.

Ms Ley said that, by being much more closely aligned with the boundaries of state Local Hospital Networks and having a clearer focus on outcomes, the PHNs would ensure far better integration between primary and acute care services.

The Minister said the PHNs would work directly with GPs, hospitals, other health professionals and the community to ensure better care, including by reducing the merry-go-round of treatment experienced by many patients with chronic and complex conditions.

“Primary Health Networks will reshape the delivery of primary health care across the nation,” Ms Ley said. “The key difference between Primary Health Networks and Medicare Locals is that PHNs will focus on improving access to frontline services, not backroom bureaucracy.”

But, ironically, Medicare Locals appear to be the backbone of many of the consortiums that have successfully tendered to operate PHNs – a fact acknowledged by the Minister.

Many of the successful PHNs were harnessing skills and knowledge from a range of sources, including allied health providers, universities, private health insurers and “some of the more successful former Medicare Locals”.

“There’s no doubting that, individually, there were some high-quality Medicare Locals across the country,” Ms Ley said. “However, there were also plenty that haven’t lived up to Labor’s promise.”

The AMA was a leading critic of Labor’s Medicare Local scheme because it had limited the involvement of local GPs.

At the time the Horvath Review was released, AMA President Associate Professor Brian Owler said that while some individual Medicare Locals had performed well in improving access to care, “the overall Medicare Local experiment has clearly failed, largely due to deliberate policy decisions to marginalise the involvement of GPs”.

Concerns have also been expressed that private health funds might try to use PHNs to interfere in the provision of primary care, and insurers Bupa and HCF have been involved in supporting tenders for four PHN consortia, including the Partners 4 Health consortium in Brisbane North, and the WA Primary Health Alliance covering the three Western Australian PHNs (Perth North, Perth South and Country WA).

But, according to an investigation by Medical Observer, the insurers will have no operational role and were involved strictly as support players.

Partners 4 Health is the trading name of Metro North Brisbane Medicare Local, and Chief Executive Abbe Anderson told Medical Observer HCF and Bupa were just two of many groups that had backed the successful application from her organisation.

“While MNBML has the support of a wide range of key participants – including those listed – I think we had over 30 organisations that provided us with letters of support and endorsement in our application,” Ms Anderson said. “But the PHN itself will be governed and managed by the same organisation that has been running the ML since its inception.”

Adrian Rollins

Health at the core of closing the gap

AMA President Associate Professor Brian Owler has warned that governments need to increase their investment in health in order to close the yawning gap in life expectancy and wellbeing between Indigenous people and other Australians.

In a veiled swipe at the Federal Government’s policy focus on school attendance and employment in Indigenous communities, A/Professor Owler told a major international conference on the social determinants of health that too often the importance of wellbeing was overlooked.

“Health is the cornerstone on which education and economics are built,” the AMA President said. “If you can’t go to school because you or your family are sick, truancy officers won’t work. If you can’t hear because of otitis media, you won’t learn. If you miss training opportunities because of depression or ill health, you won’t progress to employment. You can’t hold down a job if you keep having sick days.”

His remarks to a British Medical Association symposium on the role of physicians in addressing the social determinants of health came a month after Prime Minister Tony Abbott admitted that the nation had fallen behind on meeting most of its Closing the Gap targets.

While there has been some improvement in the life expectancy of Aboriginal and Torres Strait Islander people, Indigenous men still on average 10.6 years earlier than other Australian males, and the gap for women is 9.5 years.

In his speech, A/Professor Owler said that in many respects the term ‘social determinants of health’ was misconstrued, because health was in fact a determinant of social and other outcomes.

He said the fact that chronic and non-communicable diseases and other preventable occurrences such as suicide, trauma and injury accounted for a major proportion of the gap in life expectancy underlined the need for greater investment in health care, particularly Aboriginal community controlled health services.

“While those with chronic disease need to be cared for, prevention, particularly in the early part of life, is the key if we are going to see a generational change in health outcomes,” A/Professor Owler said.

He said hard-earned experience showed that health was fundamental to closing the gap, as was the need to work in partnership with Indigenous communities themselves.

“There have been many examples of governments trying to address the social determinants of health – but often they have failed,” he said, referring to policies including building inappropriate housing and taking children from their families.

The AMA President said any attempt to improve Indigenous health needed to acknowledge the fundamental importance for Aboriginal and Torres Strait Islander people of their connection with the land, and understand that in many Aboriginal languages health was a concept of social and emotional wellbeing rather than a physical attribute.

He told the London conference that this was one of reasons why the AMA was a foundation member of the campaign to achieve constitutional recognition for Indigenous Australians.

“Constitutional recognition is a vital step towards making Aboriginal and Torres Strait Islander people feel historically and integrally part of the modern Australian nation,” A/Professor Owler said. “Recognising Indigenous people in the Constitution will improve their self-esteem, their wellbeing, and their physical and mental health.”

Prime Minister Tony Abbott has taken a personal interest in Indigenous affairs, concentrating responsibility for many Indigenous policy areas within the Department of Prime Minister and Cabinet and overseeing the development of the Indigenous Advancement Strategy.

Priorities for the Strategy include improving school attendance, boosting Indigenous employment and improving community safety.

A/Professor Owler said these were all worthy aims, but the Strategy overlooked the central importance of health.

“What is missing from the core of the IAS is a focus on health,” the AMA President said. “Health underpins many of these outcomes. We need to get the balance right and we, the AMA, need to ensure that health is seen as a foundation to these outcomes.”

He said that “spending on health is an investment. Investing in health must underpin our future policies to Close the Gap, and to address what is, for Australia, a prominent blight on our nation”.

Adrian Rollins

Patients left stranded by health cover gaps

Patients are being forced into last-minute cancellations of vital surgery to repair eyesight, fix dodgy knees and hips and reconstruct hands, faces and chests ravaged by cancer because of unexpected gaps in their private health cover.

The AMA has called for private health insurance policies that exclude basic and common procedures to be banned, after a survey of AMA members found insurance companies are increasingly marketing policies with exclusions and caveats that patients do not fully understand, and which are forcing them to forego common procedures like cataract surgery, hip and knee joint operations and reconstructive breast, face and hand surgery.

In a submission to the Australian Competition and Consumer Commission on the private health insurance industry, the AMA said health funds were engaging in sharp practices that left consumers confused and unaware of major gaps and shortfalls in their cover.

“There is a significant disconnect between most consumers’ understanding of the services and rebates they are entitled to under their private health insurance policy and the reality of what their product provides,” the submission said.

It complained that insurers presented their products in a poor and confusing manner, and often they were explained incorrectly by frontline staff.

“The combined effect means that consumers have limited ability to ‘shop around’ and compare products, and to fully understand the products they have purchased,” the AMA said. “It is usually only at the time when people need to have medical treatment in a hospital that they first comprehend that their insurance policy is deficient.”

The number of policies being sold with exclusions and minimum benefits has accelerated as premiums have increased. A decade ago, just a third of policies had restrictions, exclusions or higher excess, but they account for around a half of all policies held now.

The Australian cited Private Healthcare Australia figures showing more than 985,000 policies were downgraded between February 2012 and December 2014, and the number is expected to surge higher following the latest average 6.2 per cent premium increase that came into effect on 1 April.

In its submission, the AMA said many practitioners were concerned that insurers were deliberately allowing people to take out health policies unlikely to suit their health needs, such as selling cover that excludes psychiatric care to patients with a chronic psychiatric condition.

In addition, firms are marketing changes to policies without fully explaining the consequences for consumers.

One doctor surveyed by the AMA reported that, “I’ve had patients who were told their premiums would not rise this year, but did not understand this had only happened because they had been shifted to a policy with exclusions. The detail was in the fine print”.

Insurers faced particular condemnation for marketing ‘public hospital only’ policies, which the AMA said were of no value to consumers.

One doctor observed that, “consumers are being sold a non-existent service because they wait the same amount of time for admission as public patients, and they are usually unable to choose their doctor. In some states or regional areas it’s completely useless because surgeons just can’t offer that service”.

In its submission, the AMA called for such policies to be withdrawn from the market.

The AMA reserved special condemnation for the pre-approval processes used by private health funds to try to dodge their obligations.

Under the Private Health Insurance Act 2007, private funds are required to pay benefits for hospital treatment for which a Medicare rebate is payable.

But AMA reported that some insurers were adopting a virtually default position of refusing to pay a claim, forcing patients to complain and challenge the decision.

“The two largest private health insurers are circumventing their obligations under the PHI Act by rejecting the payment of private health insurance benefits prior to procedures being performed,” the submission said. “In a situation where the…insurer refuses to pay, it is only the patient who has standing to pursue payment…through the courts. The reality is that few patients will do so.”

The AMA has called for policies that exclude common procedures, or provide cover only for treatment in public hospitals, to be banned.

Patient info could be caught in data net

The AMA has raised concerns the Federal Government’s contentious data retention laws could be used to compromise patient privacy and potentially undermine the doctor-patient relationship.

AMA President Associate Professor Brian Owler has written to federal MPs including Attorney-General George Brandis, Communications Minister Malcolm Turnbull, Shadow Attorney-General Mark Dreyfus and Shadow Communications Minister Jason Clare raising concerns about the potential for the laws to be used to gather detailed information about a person’s medical condition and health status.

“Metadata can potentially be used to create a profile of an individual based on access to health services,” A/Professor Owler wrote. “This might include the services they may call, emails to and from health providers, SMS appointment reminders and the like. When aggregated, this information could reveal a great deal about someone’s health status.”

Under the laws, telephone companies and internet service providers are required to retain the details of every electronic communication they handle, including the identity of a subscriber and the source, destination, date, time, duration and type of communication. The information stored, known as metadata, does not include the content of a message, phone call, email or an individual’s web-browsing history.

Under the legislation, passed with bi-partisan support late last month, 85 security and policing agencies will have access to an individual’s metadata for up to two years after it is created.

The Government has argued that the laws are crucial to thwarting terrorist activities and preventing serious crime, and has sought to reassure the public that the powers would be used carefully and sparingly.

But law experts and civil liberties groups have raised fears about scope for intrusion on individual privacy.

University of New South Wales law professor George Williams wrote in The Age that the laws would “permit access to the data of every member of the community. Where, for example, the information relates to doctors and their patients, or lawyers and their clients, a government agency will not need to gain a warrant, or to consider whether accessing this information is in the public interest.”

In his letter to the MPs, A/Professor Owler noted that the Law Council of Australia had also expressed concern about the detail of the legislation’s wording, “including with regard to potential access to health information”.

Greens Senator Penny Wright, who was among those who opposed the legislation, warned the measure could have the effect of deterring people from seeking medical help, including online support services.

“With [the] increasing use of online services for mental health, there is a serious risk that this Bill will undermine people’s trust in these online services, with a flow-on risk to access to mental health services and the mental health generally,” Senator Wright said in Australian Doctor.

A/Professor Owler has told senior Coalition and Labor MPs they need to address such concerns “to assure people and health professionals alike that the privacy of health information remains protected”.

Adrian Rollins

Your AMA Federal Council at work – 7 April 2015

What AMA Federal Councillors and other AMA members have been doing to advance your interests in the past month:

Name	Position on Council	Activity/Meeting	Date
A/Prof Brian Owler	AMA President	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia	5/3/2015
A/Prof Brian Owler	AMA President	Meeting with Royal Australasian College of Surgeons and Australian Plastic Surgery Association Presidents	4/3/2015
Dr Brian Morton	AMA Chair of General Practice	GP Roundtable	17/3/2015
Dr Stephen Parnis	AMA Vice President	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	5/3/2015
Dr Andrew Miller	AMA Federal Council Representative for Dermatologists	MSAC (Medical Services Advisory Committee) Review Working Group for Skin Services	20/2/2015
Dr Antonio Di Dio	AMA Member	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	5/3/2015
Dr Roderick McRae	AMA Federal Councillor – Salaried Doctors	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	5/3/2015
Dr Susan Neuhaus	AMA Federal Councillor – Surgeons	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	5/3/2015
Dr Robyn Langham	AMA Federal Councillor – Victoria nominee and Chair of AMA Medical Practice Committee	Australian Health Practitioner Regulation Agency’s (AHPRA) Prescribing Working Group (PWG)	5/3/2015
Dr David Rivett	AMA Federal Councillor	IHPA Small Rural Hospitals Working Group	5/2/2015
Dr Chris Moy	AMA Federal Councillor	PCEHR Safe Use Guides consultation (KPMG/ACSQHC)	11/3/2015
Dr Chris Moy	AMA Federal Councillor	NeHTA (National E-Health Transition Authority) Clinical Usability Program (CUP) Steering Group	19/2/2015
Dr Richard Kidd	AMA Federal Councillor	PCEHR Safe Use Guides consultation (KPMG/ACSQHC)	10/3/2015
Dr Richard Kidd	AMA Federal Councillor	Gateway Advisory Group	9/2/2015

AMA in the News – 7 April 2015

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

E-health record scheme a $1b flop, Hobart Mercury, 27 February 2015
The botched Personally Controlled Electronic Health Record program has been operating for nearly three years but fewer than one in 10 Australians has one. AMA President A/Professor Brian Owler said the scheme remains in limbo, and to have spent that much money and yet still not have anything of widespread value was terrible.

Upfront payments for doctors, Australian Financial Review, 3 March 2015
Health Minister Sussan Ley could end Medicare’s universal “fee for service” approach and pay GPs a lump sum per patient, rather than for each visit. Ms Ley has been in constant contact with AMA President A/Professor Brian Owler about potential changes to Medicare.

Dumped policy to cost $1bn, The Australian, 4 March 2015
Tony Abbott has dumped the GP co-payment but maintained a freeze on Medicare payments to general practitioners. AMA President A/Professor Brian Owler warned the freeze would force bulk billing rates down and increase out-of-pocket expenses for private health insurance policyholders.

Medicare rebate freeze to stay, Australian Financial Review, 4 March 2015
The Federal Government will keep more than $1 billion by freezing indexation of Medicare rebates, but has dumped the GP co-payment. AMA President A/Professor Brian Owler welcomed the decision to axe the co-payment, but said keeping the Medicare rebate indexation freeze was lazy reform.

Ley rules out bulk billing means test, Australian Financial Review, 5 March 2015
Health Minister Sussan Ley has ruled out means testing bulk billing as fix in the search for savings to replace the dumped $5 GP co-payment. The Minister said the Government will persist with its search for policies that would impose a value signal on Medicare. AMA President A/Professor Brian Owler said he was happy to co-operate with Ms Ley but did not agree a price signal had a place in primary care.

Don’t be shy about health, MX Sydney, 5 March 2015
New research shows Australians are still choosing to suffer in silence, instead of talking about an awkward health problem. AMA Chair of General Practice Dr Brian Morton said self-treating basic conditions is fine, but alarm bells should ring if the conditions are recurring.

Co-payment could still happen as GP gap-fee option considered, The Age, 9 March 2015
Despite declaring its Medicare co-payment dead, the Government is considering proposals to give GPs the option of charging gap fees for bulk billed patients. AMA President A/Professor Brian Owler said the AMA had long supported such a change, which he said would benefit patients who are currently privately billed.

Why we can’t keep trusting celebrity diet books, Women’s Weekly, 10 March 2015
AMA Vice President Dr Stephen Parnis said we live in an era where people sometimes equate celebrity with expertise, which is not the case. At best, alternative health and diet advocates may advocate something which is supposed to be therapeutic, but actually has no effect. But, at worst, it can be dangerous, he warned.

‘Price signal’ would hit old, poor hardest, The Age, 19 March 2015
Patients who visit the doctor most often tend to be older and poorer than those who visit their GP less, and would be hardest to hit by the introduction of a price signal. AMA President A/Professor Brian Owler said the data undermined the arguments of some proponents of a Medicare co-payment.

Valley of the unwell, The Herald Sun, 19 March 2015
The Goulburn Valley has emerged as the sickest spot in Victoria, with more than one in six residents seeing a GP more than 12 times a year. AMA President A/Professor Brian Owler said the report showed people who most frequently visited their GP have complex and chronic conditions.

Make vaccination law, The Sunday Telegraph, 22 March 2015
The Sunday Telegraph has launched a national campaign for pregnant women to get free whooping cough boosters in the third trimester. AMA President A/Professor Brian Owler called on Federal Health Minister Sussan Ley to fund the boosters.

Call to name medical ‘bad apples’, Sydney Morning Herald, 24 March 2015
Medical specialists who charge exorbitant fees should be named and shamed in a bid to rein in excessive charging. AMA Vice President Dr Stephen Parnis said more doctors than ever were accepting fees set by private health insurers, and almost 90 per cent of privately insured medical services were delivered with no out-of-pocket cost to the patient.

Doctors to anti-vaxxers: you’re endangering kids, The News Daily, 24 March 2015
AMA Vice President Dr Stephen Parnis told The News Daily that anti-vaccination groups don’t know better than the weight of evidence from the medical and scientific profession.

Misogyny in medicine: don’t put up with it, The Age, 25 March 2015
AMA President A/Professor Brian Owler said he was proud of Australia’s medical profession and added it was challenging to hear assertions that doctors were acting in unacceptable ways, particularly when it came to sexual harassment.

Radio

A/Professor Brian Owler, 666 ABC Canberra, 18 February 2015
AMA President A/Professor Brian Owler talked about the proposed $5 cut to Medicare rebates and the prospect of a $5 co-payment for GP visits still on the table. A/Professor Owler said the idea floated by the Federal Government had not been raised with him.

Dr Stephen Parnis, Radio Adelaide, 23 February 2015
AMA Vice President Dr Stephen Parnis said he was concerned about the Trans-Pacific Partnership trade agreement and what it could mean for affordable health care, with fears it could raise the cost of drugs and limit access to biological agents used in treatments.

A/Professor Brian Owler, 666 ABC Canberra, 3 March 2015
AMA President A/Professor Brian Owler discussed the Federal Government’s decision to abandon the GP co-payment. A/Professor Owler said it was a good result for GPs and their patients because the policy was poorly designed.

A/Professor Brian Owler, Radio National, 3 March 2015
AMA President A/Professor Brian Owler talked about the Federal Government dumping the Medicare co-payment. A/Professor Owler said the AMA would not support a mandatory price signal, but did not see it as unreasonable for patients who can afford it to make a modest contribution to the cost of their care.

A/Professor Brian Owler, 4BC Brisbane, 31 March 2015
AMA President A/Professor Brian Owler talked about the Federal Government changing aviation rules to require two people in a cockpit at all times. The AMA is not sold on the idea of doctors who treat pilots being able to break doctor-patient confidentiality if they think a pilot is unfit to fly.

Television

A/Professor Brian Owler, ABC News 24, 3 March 2015
AMA President A/Professor Brian Owler talked about the Government dumping the GP co-payment. A/Professor Owler said the tragedy of this whole negotiation period was that other pressing health issues had been neglected.

A/Professor Brian Owler, Sky News, 3 March 2015
AMA President A/Professor Brian Owler discussed the dumped Medicare co-payment and the Medical Research Future Fund.

A/Professor Brian Owler, Channel 9, 17 March 2015
AMA President A/Professor Brian Owler discussed suggestions that teenagers should undergo a psychological assessment before any cosmetic surgery. A/Professor Owler said cosmetic surgery was the source of a number of patient complaints.