Contest for AMA leadership positions

AMA Vice President Dr Stephen Parnis and AMA WA President Dr Michael Gannon are competing to lead the AMA for the next two years.

At the close of nominations on 11 May Dr Parnis, a Consultant Emergency Physician at Melbourne’s St Vincent’s Hospital, and Dr Gannon, who is Head of the Department of Obstetrics and Gynaecology at Perth’s St John of God Hospital, flagged their intention to contest for the position of AMA President, which will be decided at a ballot at the AMA National Conference on Sunday, 29 May.

The Vice President’s position will also go to a vote after Sydney GP and outgoing Chair of the AMA Council of General Practice, Dr Brian Morton, and immediate-past AMA Victoria President, and Chair-elect of the AMA Council of General Practice, Dr Tony Bartone, both nominated for the post.

Both AMA President and AMA Vice President serve a term of two years.

The AMA National Conference will be held in Canberra on 27 to 29 May.

Pathology deal a fresh assault on medical practices

The Federal Government has intensified its assault on medical practice incomes, promising to clamp down on rents charged for pathology collection centres in exchange for an end to the pathology sector’s damaging campaign over cuts to bulk billing incentives.

Just two weeks after it announced a two-year extension of the Medicare rebate freeze to 2020, ripping $925 million out of primary and specialist care, the Government has sliced further into practice earnings by stitching up a peace deal with Pathology Australia that analysts predict will force collection centre rents down by 30 per cent and leave major players like Sonic Healthcare and Primary Healthcare up to $100 million a year better off.

Prime Minister Malcom Turnbull announced the agreement during his first televised debate with Opposition leader Bill Shorten, declaring that it meant that “the concern that has been expressed about patients who go to have their blood tests done and so forth being charged extra, not being bulk billed, is… that concern is gone; the pathologists have agreed to continue bulk billing”.

But the Prime Minister’s boast could be premature.

Primary Healthcare, which holds 34 per cent of the market and is not a member of Pathology Australia, has written to doctors to distance itself from the deal, and smaller pathology providers complain it does little for them and they will have to begin charging patients a co-payment of up to $50.

AMA President Professor Brian Owler said the deal “doesn’t guarantee anything”.

“The cut to bulk billing incentives for pathology has merely been deferred. The cuts are still there, they’re still taking $650 million out of health over the next four years,” Professor Owler said.

Professor Owler said he had been in contact with Pathology Australia about the deal, and they had admitted there was no guarantee the pathologists would continue to bulk bill.

“They don’t have the ability to make that guarantee, and it will be up to the individual pathology companies to actually make that decision over time,” he said.

Under the deal, the Government has committed that, if it is re-elected, it will delay bulk billing incentive cuts by around three months while it introduces provisions to the Health Insurance Act to clarify what is meant by ‘market value’ and link it with local commercial market rents.

This will be backed by “appropriate compliance mechanisms”, and those seeking to register collection centres will need to provide more information.

Pathology Australia said the reduced rents would enable its members to absorb the bulk billing incentive cuts and sustain current rates of bulk billing. As a result, the organisation has agreed to drop its national “Don’t Kill Bulk Bill” campaign.

The announcement amounts to a backflip by Health Minister Sussan Ley.

In a review of Approved Pathology Collection centre arrangements last year, Ms Ley rejected pathology sector calls for a change in the definition of ‘market value’ and determined that existing regulations regarding prohibited practices and market rent were appropriate.

Macquarie Securities analyst Craig Collie told Guardian Australia that Sonic Healthcare could be up to $70 million a year better off under the Government deal.

Mr Collie estimated the company would save about $116 million a year on rent at its 2000 collection centres, which more than offset the $50 million cost of losing the bulk billing incentive.

Guardian Australia reported that both Sonic and Pathology Australia have been major Coalition donors in recent years.

There are around 4000 collection centres across the country, and medical practitioners have warned the Government will need to consult closely with general practice to ensure that the new regulations are not simply a form of price control that puts many existing leases into jeopardy.

The Government has declared there will be a moratorium on any new collection centre approvals until the new regulations are in place, and “the measure to remove bulk billing incentives will commence at the date that the changes to the regulatory framework take effect”.

But Professor Owler said that, even with the deal, there was no getting away from the fact that the Government was ripping hundreds of millions of dollars out of pathology services.

“To suggest that somehow the concern is now gone I think overstates the results of the agreement that was reached between the Government and Pathology Australia,” he said. “There will be some easing of costs pressures through this change to rents, but at the end of the day they are still experiencing a very significant cut.”

St Vincent’s Health Australia Chief Executive Toby Hall told the Adelaide Advertiser the axing of the bulk billing incentive would rip $3 million from his organisation’s bottom line, forcing them to consider “some form of patient co-payment. I think we’d have to look at between $20 and $50”.

And the deal has done nothing to address the cut to bulk billing incentives for diagnostic imaging services.

The Australian Diagnostic Imaging Association warned patients still faced cuts to their rebates for x-rays, CT scans, MRIs and ultrasounds, and smaller pathology companies cautioned they would be forced to charge out-of-pocket expenses despite the Government’s deal.

Adrian Rollins

AMA advocacy delivering for GPs

In reflecting on the last six years as Chair of the AMA Council of General Practice, I was reminded of the significant work the AMA does in advancing the interests of GPs and patients.

Much of this work has been in the background. The AMA has seen off many thought bubbles that thankfully have never seen the light of day.

There have, of course, been some very public battles, because successive governments have failed to appreciate the value and role of general practice.

In my time as Chair, we have had five prime ministers (albeit one twice) and four health ministers. Over that time we’ve seen some big visions in health, but progress has rarely matched the ambition.

When I first came to the role of Chair, funding had just been announced for the Practice Nurse Incentive Program (PNIP), Medicare Locals, additional GP Super Clinics, the establishment of Personally Controlled Electronic Health Records and chronic disease reform in the form of capped funding for bundled care for patients with diabetes.

The AMA welcomed the PNIP because it supported a GP-led model of team-based care, and offered significant extra funding for practices to employ a practice nurse. The AMA also won grandfathering arrangements to ensure practices were not disadvantaged by the removal of practice nurse items in the Medicare Benefits Schedule.

The former Government’s Diabetes Plan proposed the introduction of a capitated model of payment, replacing fee-for-service for eligible patients. The plan lacked detail and would have rationed access to care for patients. It was quickly dumped by the Government in favour of a trial that ultimately confirmed that the plan would have failed.

Over my term the AMA has continued to prosecute the reform of chronic disease items through its plan Improving the care for patients with chronic and complex care needs, and has outlined principles for formalising Medical Homes in Australia – elements of which have been incorporated in the Government’s recent Health Care Homes proposal.

AMA advocacy has helped ensure policy failures such as Medicare Locals and GP Super Clinics were short-lived, and after hours funding was returned back to practices via the PIP.

The inclusion of GP-referred MRI in the MBS may have taken a while, but we got there in the end. The introduction of these items is good for patients and has improved access to timely care.

I have also been delighted to see the importance of teaching championed by the AMA, with our efforts resulting in the PIP teaching incentive doubled and the ongoing funding of rural and regional teaching infrastructure grants. Our campaign to increase GP training places has borne fruit. There are now record numbers of doctors in training entering the GP training program.

Maldistribution of the GP workforce remains an issue, although the AMA has supported expansion of GP training places in rural and regional settings. We also played a big role in the establishment of the Rural Junior Doctor Innovation Fund to finance rural GP rotations for interns.

From a professional perspective, it is reassuring that more young doctors than ever want to be GPs, and that the colleges are to have a greater role in trainee selection.

I would have liked to have seen a commitment to fund the Pharmacist in General Practice Program in my time as Chair, but the ground work has been laid, and I am confident that in time the common sense of this proposal will prevail.

Of course, there are still challenges ahead, particularly around ensuring policies and funding arrangements that truly support GPs in providing quality preventative, holistic, coordinated and longitudinal care.

In closing, I wish to thank you and the members of the Council of General Practice for all the support. It has been a privilege to serve you. To my successor, I wish you all the best and every success as you lead the profession forward.

Cheaper drugs a path to better health

Medicines save lives and improve health and wellbeing when they are available, affordable, and properly used.

With Aboriginal and Torres Strait Islander people experiencing double the rate of chronic illnesses than their non-Indigenous peers, access to affordable prescription medicines is essential. Unfortunately, Aboriginal and Torres Strait Islander people are not accessing medicines at a level that is appropriate to their needs, with cost being reported as a major barrier.

As evidenced by the Closing the Gap (CTG) Pharmaceuticals Benefits Scheme (PBS) Co-payment measure, reducing out-of-pocket costs for medications increases access to, and use of medications, ultimately resulting in improved health outcomes.

Since its inception in 2010, the CTG PBS Co-payment measure has increased access to medicines for more than 280,000 Aboriginal and Torres Strait Islander people in urban and rural areas, by reducing or removing the patient co-payment for PBS medicines. Substantial reductions in hospitalisations have also been seen in areas with the greatest uptake of the CTG PBS Co-payment incentive.

While the outcomes under this measure have been encouraging, there is still a long way to go until we achieve equality in access to medicines for Aboriginal and Torres Strait Islander people.

A good starting point is to promote the CTG PBS Co-payment more widely to all prescribing doctors across Australia, to increase awareness and uptake of the initiative and build on its success.

In August 2012, Australian Doctor reported that, alarmingly, thousands of doctors were unaware of the existence of the CTG PBS Co-payment measure – an important initiative that has the potential to make a real contribution to closing the gap.

With chronic diseases being one of the main reasons for the life expectancy gap between Indigenous and non-Indigenous people, it is unacceptable that so many Australian doctors are unaware of such an important scheme.

Doctors working in Aboriginal and Torres Strait Islander Community Controlled Health Services are generally aware of this initiative, and regularly prescribe medications covered by the CTG PBS Co-payment measure for the benefit of their patients. However, many doctors working in mainstream general practice may not be aware of this scheme.

To participate in the CTG PBS Co-payment measure, practices must be able to first identify eligible Aboriginal and Torres Strait Islander patients. All patients across Australian medical practices should be asked whether they identify as being of Aboriginal and Torres Strait Islander origin by asking the National Standard Identification question – ‘Are you of Aboriginal or Torres Strait Islander origin?’ Once Indigenous patients are recognised, they are eligible to be registered for co-payment assistance.

Improved access to medicines is critically important if we are to see generational change in health outcomes for Aboriginal and Torres Strait Islander people.

The Australian Medical Association encourages all medical practitioners to increase their awareness of the CTG PBS Co-payment measure to improve health outcomes for Aboriginal and Torres Strait Islander patients.

Pathologists happy with new deal but it’s ‘another blow for GPs’

GPs have expressed concerns over the Coalition’s announcement that it will cap rent on pathology collection centres.

The deal would take place under a returned Turnbull Coalition Government and will help reduce regulatory cost pressures on pathology providers to help them provide affordable services and maintain current bulk billing rates.

It’s a move that is supported by the Royal College of Pathologists of Australasia:

“The Coalition’s new proposed plans will see a delay in the changes to the bulk billing incentive, as well as a solution to the high cost of rents being paid for pathology collection centres. In addition there will be a moratorium for the next 3 years on any further changes to Pathology Services Table without agreement from the profession. The RCPA believes this will result in the profession maintaining the current billing practices and high quality services and efficiencies offered,” Dr Michael Harrison, President of the RCPA said.

However the Royal Australian College of General Practitioners says the changes are another blow to GPs, on top of the ongoing Medical Benefits Freeze.

“The RACGP has always supported universal access to healthcare services and therefore welcomes the announcement of continued bulk-billing arrangements for pathology services,” RACGP President Dr Frank Jones said.

“However, the proposed changes effectively create an anti-competitive environment, where multi-national corporations who make hundreds of millions of profit each year are propped up, while GPs running small businesses lose funding.”

AMA President Professor Brian Owler said the deal “doesn’t guarantee anything”.

He also said there is no guarantee that the pathologists will not abandon bulk billing.

When he spoke to Pathology Australia, they admitted they don’t have the ability to make that guarantee.

“It will be up to the individual pathology companies to actually make that decision over time,” he said.

Latest news:

E-cigarettes most popular with young people

The use of e-cigarettes in New South Wales is highest in young people, however they are mostly using them less than weekly.

Research published in the Medical Journal of Australia found that 16% of respondents age 18-29 were currently using e-cigarettes.

Unlike older e-cigarette users, these respondents weren’t using the products to help them quit smoking. Instead they said it was because e-cigarettes tasted better and they could smoke them in places where cigarettes were banned.

The study found adults over the age of 55 were the most frequent users of e-cigarettes and those over 30 were more likely to use the products to help them quit tobacco.

Related: E-cigs: a help or a harm?

However researchers expressed concerns about this, saying many users in the sample were smoking both conventional and e-cigarettes.

“For avoiding the risks of smoking-related premature death, however, reducing cigarette numbers is much less effective than quitting, and future research should investigate whether tobacco smokers using e-cigarettes to cut down are doing so as part of a cessation strategy or in the hope of reducing smoking-related harm,” the authors wrote.

According to an accompanying editorial in MJA, there is a lack of evidence that e-cigarettes were any more effective than other unassisted cessation or conventional nicotine replacement therapies.

“A Cochrane review reported the evidence as being of ‘low/very low quality’, and a recent metaanalysis concluded that they, in fact, reduced the probability of quitting,” they wrote.

Recent statistics released by HealthStats NSW certainly seem to back up that evidence. According to new data, the 45-54 year old age bracket has seen tobacco smoking rates jump more than 2% in the last year.

While smoking rates overall have fallen in the last year from 15.6% to 13.5%, the results haven’t been seen in the older age groups.

Anita Dessaix, manager of Cancer Prevention at the Cancer Institute NSW told Fairfax media that older people would find it harder to quit as most took up smoking as teenagers.

“The message particularly for old people is not to despair and keep trying and that there is hope and support and that they can quit smoking,” Ms Dessaix said.

Latest news:

To screen for depression or not?

Screening may be appropriate to reconsider once we can ensure adequate response to any identified potential cases

Depression presents a significant public health challenge for both the community and the medical profession. In Australia, depression and anxiety affect a substantial proportion of the population (4.8% of men and 10% of women) and is responsible for 8% of the total loss in disability-adjusted life years.1 It is the top-ranking cause of non-fatal disease in the Australian community for women,2 and is also associated with an increased risk of ischaemic heart disease and suicide, both causes of early death.

Depressive disorders present diagnostic challenges, not least because in some cases depression is the first presentation of bipolar disorder. Further, treatment may be complicated and limited owing to the symptomatic heterogeneity of depression; complex comorbidities with anxiety, substance abuse, physical health problems or other factors; and the ongoing stigma that hinders many individuals from openly discussing their mood problems. As a result, rates of detection, diagnosis based on clinical presentation, and sufficient intervention remain inadequate. Indeed, a recent meta-analysis from the United Kingdom suggests that the diagnosis was only correct in 47% of cases presenting in primary care.3 This does not account for those cases that fail to present in the first place, supporting calls to consider widespread screening for depression, especially in primary care settings where the majority of depressive disorders are treated. But is screening for depression in primary care a useful and viable option?

In January 2016, the United States Preventive Services Task Force published its latest recommendation statement in relation to screening for depression in adults.4 The statement recommended that sufficiently reliable self-report tools are now available to make screening for depression feasible and reliable in primary care. The task force further opined that screening leads to accurate diagnosis and treatment in this setting. Clearly, the latter component is critical to render screening valuable, and the authors drew heavily on the developing evidence around models of collaborative care and depression care management.5,6 The task force recommended use of the Patient Health Questionnaire-9 (PHQ-9), but as noted in an accompanying editorial,7 the statement acknowledged that the positive predictive value of the PHQ-9 is only 50%, and that it cannot be considered a replacement for appropriate clinical assessment. In other words, screening is important but it cannot be relied upon.

The idea of screening-led prevention and early intervention is inherently attractive. Within Australia, efforts thus far have focused on high-risk groups such as pregnant or perinatal women and Aboriginal and Torres Strait Islander populations.8,9 However, a pragmatic perspective that acknowledges the limitations of current mental health service delivery for broader treatment of depression would also have to recognise that international evidence for broad primary care population screening is mixed.

After several years of research and development, the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders were released in late 2015.10 The guidelines conceptualise both depression and bipolar disorder along a spectrum with considerable overlap, and discuss in detail the diagnosis and management of both conditions. The guidelines do not specifically recommend screening in primary care or other settings. This is because self-assessment via the internet and other self-report screening measures is likely to raise concerns but not necessarily identify those who need help or ensure that they seek proper advice. Once suspicion of depression has been raised by a clinician, the use of a standardised psychiatric measure is preferable but the question remains as to whether general practitioners should initially use their clinical judgement or a screening tool to identify depressive illness. To this end, they can be equipped with measures that corroborate key symptoms but reliance should never rest solely on self-report measures.

Historically, depression has been underdiagnosed, and the stigma of its incidence remains a challenge to encouraging patients to access treatment. We can anticipate increased capacity for the treatment of depression in the new world of integrated mental health service delivery promised in the Australian government’s response to the National Mental Health Commission review of mental health programs and services. The stepped care model has the potential to provide optimal support for people with a major depressive disorder. Once these initiatives are established and further data have been gathered as to their suitability and appeal, perhaps then it will be time to revisit the recommendations regarding screening. However, at this point in time there does not appear to be sufficient evidence of pragmatic value to warrant the burden that implementation and continuous screening for depression in primary care would impose.

Cost of GP visit could reach $30

Doctors forced to abandon bulk billing because of the Government’s decision to extend the Medicare rebate freeze are likely to charge many of their patients up to $30 a visit, according to AMA President Professor Brian Owler.

In a stark warning of the big financial hit to household finances from the Budget decision to keep rebates on hold until 2020, Professor Owler said any fee charged would not be a token amount.

“Once the billing starts…it’s not going to be a small amount…it’s not going to be $2 that they invoice people, they’re talking about invoicing $30, because the reality is there are significant costs associated once they move towards the system,” he said. “It changes the whole model of practice that they’ve been operating on.”

The Government has been accused of using the rebate freeze to introduce a patient co-payment “by stealth”, after previous attempts to introduce a $7 and a $5 co-payment were abandoned following a huge community backlash led by the AMA.

Medical practices to this point have largely absorbed the effects of the freeze, which was first introduced by Labor in 2013 and has since been extended twice by the Coalition Government, but Professor Owler said many had now reached “the tipping point”.

“Many GPs are now contacting the AMA, asking for assistance in how they transition their practices [from bulk billing to charging fees],” he said. “This is now a reality that bulk billing rates are going to go down.”

The AMA President said GPs had no choice because the costs of running a practice, such as rent, staff, utilities and equipment, were rising remorselessly and even when rebates had been indexed they had failed to keep pace. Combined with a seven-year rebate freeze, it meant the rebate was far short of the cost of providing health care.

He said many specialists already charge out-of-pocket expenses, and “I think now we’re going to start to see this play out more and more in general practice”.

Adrian Rollins

Why doctors will stop bulk billing

Patriotism is supporting your country all the time, and your government when it deserves it ~ Mark Twain.

Although federal health bureaucrats seem to think bulk billing rates will increase, about 30% of GPs say they will stop all bulk billing soon. In a previous post I explained why. As a result of government policy to freeze patient Medicare rebates, doctors are faced with three options. They can:

take an estimated $50,000 pay-cut;
see more patients more often;
charge more.

Some will choose option 1, because they don’t want to or cannot charge their patients more, and are also unable to work more. The reality is however that most GPs will not be able to afford this option.

Others will go for option 2: they may, for example, see 7-8 patients per hour instead of 4-5. They may decide to work more days and longer hours. The question is of course: how safe is this?

Can doctors continue to offer good care when they are churning through high patient numbers? It will certainly feed the epidemic of burnout, depression and suicide among doctors and medical students.

What the Medicare rebate freeze is all about
Medicare is shaping up to be a major election topic. Still, the freeze on the patient Medicare rebate is a complex topic for many. It was a lot easier to understand when Medicare was called the Health Insurance Commission, but the principle is still the same: Medicare pays a contribution towards the doctor’s fee on behalf of the patient. Many GPs have accepted this contribution as a full payment, which is called bulk billing.
The ‘indexation freeze’ everybody is talking about means that this Medicare contribution will not be increased annually, in line with the increasing cost of living. The shortfall will have to be made up by patients which means that the out-of-pocket expenses will go up as doctors stop bulk billing. The freeze on the patient Medicare rebate was introduced by the Labour government in 2013, and will continue under a Coalition government until 2020 and possible longer. The rebate has not kept up with costs and inflation for a much longer period.

3-tier system

Then there is option 3: doctors will charge more, which will increase out-of-pocket costs for patients. As RACGP president Dr Frank Jones mentioned in this interview, we may see a 3-tier system in Australia soon:

“Dr Jones warned poorest patients would feel the impact of the freeze hardest, while there was a risk doctors would churn through appointments more quickly.

He predicted it would lead to a three-tier billing system: doctors would bulk bill their most disadvantaged patients, charge other health care cardholders a concessional rate, and private patients would be charged the Australian Medical Association’s recommended fee.”

In 2015 the RACGP surveyed GPs on how they planned to manage the patient rebate freeze. Of the 566 members who responded, the majority (57%) said they would have to increase out-of-pocket costs for patients.

GPs said they would have to do this either because the practice would stop bulk billing and begin charging a gap or co-payment (30%), or the practice would increase out-of-pocket costs for non-concessional cardholders (27%). Only 8% indicated that they would not increase out-of- pocket costs for their patients.

How fees will go up

It is to be expected that many practices will start cost-cutting: staff levels may be minimised and investments in new equipment, training & education, IT or buildings may become a lower priority. This is a risk for the quality of care.

Practices will determine a fair and equitable fee based on their increasing practice costs, professional time and services. The RACGP and AMA support GPs to set fees that accurately reflect the value of the services they offer, such as the recommended fees in the Australian Medical Association’s List of Medical Services and Fees.

Practices will review their patient demographics and billing profile and optimise the utilisation of MBS items. Pensioners and/or health care card holders may be charged an extra fee which will be much higher than the bulk billing incentive of $9.25.

Practices may decide that certain services will attract fees, for example dressings and other consumables, treating doctor’s reports, off-work/off-school certificates, phone/video consultations, data entry or certain surgical procedures.

Updating practice management software to streamline Medicare claims and EFTPOS payments may be required in some cases. Expect notices to go up in surgeries across the country to tell patients about the changes in billing policies. Unfortunately there will be practices that will have to close their doors.

What can you do?

Join the ‘You’ve been targeted’ campaign which aims to lift the freeze on your Medicare rebates. Go to the website of the Royal Australian College of General Practitioners (RACGP): yourgp.racgp.org.au/targeted to access campaign materials including a template letter you can send to your local political candidates demanding the freeze be lifted. Please contribute to the discussion on social media using the hashtag #youvebeentargeted.

https://www.youtube.com/watch?time_continue=110&v=LmYhIxivF0s

Sources: Text and images courtesy of the Royal Australian College of General Practitioners (RACGP)

Dr Edwin Kruys is a Sunshine Coast GP who blogs about healthcare, social media and eHealth. This blog was previously published on doctorsbag and has been republished with permission. If you work in healthcare and have a blog topic you would like to write for doctorportal, please get in touch.

Other doctorportal blogs

Election 2016 – what the major parties say

Health, as befits one of the major functions of Government, is shaping as a key battleground in the 2016 Federal Election.

In its first term in office, the Coalition Government has left no area of health policy untouched. Medicare rebates have been frozen, there is a thoroughgoing review of 5700 MBS items underway, Medicare Locals have been replaced by Primary Health Networks, Health Care Homes and the My Health Record are being trialled, national agreements on public hospital funding were abandoned as part of plans to renegotiate the Federation, and the role of the private sector, especially health insurers, in providing health services is being examined.

These changes have come against the backdrop of steadily increasing demand for health services. Advances in health care and medicine have meant that Australians are living longer than ever, and as lives extend, the number of patients living with multiple chronic health conditions has risen. Caring for these patients is imposing ever-increasing demands on GPs, specialists and hospitals.

Coincidentally, advances in medical science are delivering new and more effective treatments that are saving and improving lives – but often at a hefty cost.

In this Australian Medicine special, each of Health Minister Sussan Ley, Shadow Health Minister Catherine King, and Australian Greens leader Senator Richard Di Natale lays out their broad vision for health policy.

These should be seen as their first, rather than final, word on health during this Federal Election, and Australian Medicine will provide comprehensive coverage of the detailed policy pronouncements as they are made during the course of one of the longest campaigns in Australia’s recent political history.

Health Minister Sussan Ley

Building a 21st century health system for all Australians

The health policy directions we have outlined in the recent Federal Budget are underpinned by a key and very important objective; to ensure patients and consumers are at the centre of all our decision making.

Ultimately, we are all here to ensure patients have a better health outcome, and this can only be achieved by working together to make sure our service delivery is well-integrated, efficient and focused.

It is well documented that the Commonwealth needs to spend its health dollar wisely, landing that funding as close to patients as possible.

Simply throwing more money at the system is tantamount to ‘placebo policy’: it may make some feel better but it won’t treat the cause.

In the last 12 months, through the Council of Australian Governments, (COAG), every State and Territory has had significant input into what the primary and health care sector needs to look like in coming years.

Central to these discussions is our desire to reduce the barrier patients face across a fragmented system, with an aim of keeping people well at home and, where possible, out of hospital.

Since becoming Health Minister, I have consulted widely with many of you on the ground, and we are now undertaking important reforms like Health Care Homes, not only because it is the right policy but as a show faith for your co-operation and support in this process.

Health Care Homes will trial a new way of funding chronic and complex care, which will ensure patients receive integrated, coordinated care to better meet their needs.

It’s important to note in addition to the $21 million already committed to complete trials over two years, bundled payment models during this period will be funded as certain Chronic Disease Management MBS items and cashed out to support this initiative.

Moving closer to a national rollout, we will obviously assess what further funds may be required in consultation with you and your representatives.

There are a number of other integrated reforms that we are undertaking to help build a Healthier Medicare and put patients first.

Our clinician-led review of all 5700 items on the MBS is also progressing steadily, under the careful consideration and advice of your peers.

At the most recent COAG, it was agreed an additional $2.9 billion in Commonwealth investment for public hospitals was required for ongoing needs, but with a greater focus on patient outcomes, quality and safety, particularly for those being treated for a chronic illness.

All children and concession card holders will now be eligible for affordable access to dental care through a new national public dental scheme, which will see the Commonwealth double its contribution towards frontline public dental services from July this year.

Australians with mental health issues will also begin receiving the integrated care they need from 1 July, as we begin trialing new once-a-new generation reforms providing patients with personalised care packages.

Our world-class Pharmaceutical Benefits Scheme gives Australians access to affordable medicines, with the Government’s reforms saving patients as much as $20 per script on common everyday medicines, with further price cuts to come.

We’ve also ensured savings to taxpayers are being reinvested in new innovative medicines, with the Turnbull Government making nearly 1000 listings on the PBS over the past three years – triple that of the previous Government.

This includes our watershed commitment of over $1 billion to eradicate hepatitis C within a generation.

This is being supported by new reforms announced in the Budget, allowing patients to get faster access to life-saving medicines and medical devices up to two years earlier, by breaking down international trade barriers and red tape.

We are actively working to protect and increase immunisation rates against deadly and debilitating viruses, with incentives for GPs to catch up overdue children, a national all-age vaccination register and ‘no-jab, no pay’ deterrents.

Also, with an eye to the future, we want patients to find it easier to navigate the health system through the digital ‘My Health Record’, which will allow everything from a patient storing prescription information, through to doctors having life-saving access to someone’s allergies in a medical emergency.

There are many more initiatives, and I encourage you to visit www.health.gov.au to find out more at

Can I take this opportunity to acknowledge your outgoing AMA President, Professor Brian Owler. While we have not always arrived at the same position in relation to health policy, I acknowledge his fierce advocacy on behalf of the AMA and its members.

I look forward to a collegial working relationship with his forthcoming successor and hope we can work together to develop policies which ensure every dollar ‘works’ in a constrained budgetary environment.

The Turnbull Government also appreciates the efforts of many GPs to keep costs down during the current Medicare rebate indexation pause, which was first introduced under the previous Government back in 2013-14.

I would like to reaffirm my commitment to the possibility of a review of this pause as further improvements and inefficiencies are identified through our Healthier Medicare reforms.

In closing, be assured across all areas of the health sector I continue to have an open ear, open door approach, and welcome constructive dialogue in balancing our joint desire to maintain and build a progressive health system for all Australians.

My email is Minister.Ley@health.gov.au if you would ever like to raise any ideas or questions.

Shadow Health Minister Catherine King

General practice is the heart of Medicare and deserves respect

One of the most disappointing aspects of Malcolm Turnbull’s election manifesto is its continuing attack on primary care.

After being devalued in the Coalition’s first two Budgets by the GP Tax and then the four year freeze, the profession could have been forgiven for hoping a change of leader marked a change in approach to general practice.

Sadly, as we now know, this was not the case, and the shock decision to extend the freeze out to six years effectively signals that under the Coalition, Medicare rebates are now effectively locked at their current rates.

The signal this sends is that the Coalition does not value general practice, and does not believe the services rendered by GPs are worth being properly renumerated for.

I can give you an assurance that Labor most emphatically does not share this view, and a Shorten Labor Government will place general practice at the forefront of Australia’s healthcare system.

By the time voters go to the polls, our health policy will leave the profession and their patients in no doubt about the contrast between Labor’s respect for general practice, and the Coalition’s approach of the last three years.

That is because Labor believes general practice is the heart of Medicare, acting as the first line of preventive health care, catching and managing illness and disease before far worse outcomes lead to greater costs for both patients and the health system.

Indeed, all of the evidence internationally is that the stronger a country’s primary health care system, the better its health outcomes are.

We know from a number of studies that “health systems with strong primary health care are more efficient, have lower rates of hospitalisation, fewer health inequalities and better health outcomes including lower mortality, than those that do not”.

That is why, when last in Government, Labor did introduce a number of measures to improve general practice, including continuing incentives that improved access and increased bulk billing rates; being properly renumerated for the treatment of chronic disease; provided incentive payments for the treatment of practice nurses and a number of other measures.

But as we look to the future of general practice, we are also conscious of the way Medicare has evolved over more than 30 years now.

No serious health expert disputes the need for Australia’s health system to better manage patients with chronic conditions, and Labor welcomes the proposals of the Primary Health Care Advisory Group to better manage the care of the one-in-five Australians living with two or more chronic health conditions.

Last year’s OECD Health Care Quality Review warned Australia’s ageing population will lead to a growing burden of chronic disease, and highlighted the need for greater investment in primary care to tackle the rise in chronic disease.

But unlike the current Government, a Shorten Labor Government will pay more than lip service to general practice being central to care coordination, as will be made clear in our primary care policy.

Labor understands these reforms can only be achieved in co-operation with doctors, and that co-operation can never succeed if the profession is constantly blindsided by Budget night surprise raids and politically inspired attacks on the integrity of doctors.

I know doctors want to be a major part of the solution.

So too does Labor, and if Labor is elected to Government I can assure you we would want to be advised by you as GPs about what the best system should look like, and how patients can best be looked after.

Australian Greens leader Dr Richard Di Natale

Investing in health care

The Greens believe good health care is an investment, not a cost. As a wealthy country we are lucky to have the opportunity and the means to make high-quality healthcare available to everyone.

Of course we should always seek to ensure we get the best value for our money, but as effective new treatments become available we believe securing affordable, universal access should be the objective.

Spending that leads to better health outcomes and longer lives represents good value for money, and should be prioritised. Australia’s health spending is not unusual by comparable global standards. Among OECD countries, the average spend on health is about 9 per cent of gross domestic product – not much different from where Australia sits now. By contrast, the European average is greater than 11 per cent, and the United States spends 17.1 per cent of GDP on health in a system that delivers worse outcomes.

And yet under this Government, which sees health merely as a cost to the bottom line, the harsh cuts continue. This year’s Budget has seen the Government extend the freeze on indexation of the MBS. This is a co-payment by stealth, which we recognise will force doctors to make a difficult choice about passing on the costs to patients, knowing that hitting patients will almost certainly lead to avoidable and costly presentations to hospital in some cases.

Deeper cuts to the Flexible Funds, with still no certainty about where the axe will fall, is leaving providers of essential services vulnerable and patients at risk.

There is so much to do to extend true universal access to all, including in particular to Aboriginal and Torres Strait Islander Australians whose health outcomes continue to lag behind the rest of the nation. We need secure, targeted investment, not cutbacks, and it was a huge disappointment to see the Government commit no funding at all for the Implementation Plan of the National Aboriginal and Torres Strait Islander Health Plan in this year’s Budget.

The Greens believe in a system which meets the challenges of changing demographics and rising chronic disease. It is time for a real plan for the future of our primary care system, which puts patients at the centre of their care, with continuity of care and appropriate funding. The Government’s Healthcare Homes plan risks this important reform by under-resourcing the trial.

The Greens have long championed the Denticare scheme, believing that the mouth should be treated like any other part of the body in terms of access to the health system. We continue support its expansion, seeking universal dental care for all Australians over time.

Spending more on health care is not unsustainable – it is a matter of priorities, and the Greens choose to prioritise good health care.

The Greens are committed to maintaining a health care system that is publicly funded, of the highest quality, and available to all. We want Australians to have access to the latest drugs and treatments that medical science has to offer. All Australians, no matter where they live, should share equally in the benefits of our health system.

The Greens will be announcing a suite of fully costed health policies throughout the election campaign, setting out our vision for the health system in Australia. We encourage AMA members to watch out for our announcements – which will provide a positive, equitable plan for the future.