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Speaker 1: My name is Lily Madden and I'm a proud Arunda

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Speaker 1: Bunjelung Calcottin woman from Gadighal Country. The Daily ozz acknowledges

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Speaker 1: that this podcast is recorded on the lands of the

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Speaker 1: Gadigal people and pays respect to all Aboriginal and Torres

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Speaker 1: Strait Island and nations. We pay our respects to the

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Speaker 1: first peoples of these countries, both past and present.

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Speaker 2: Good morning and welcome to the Daily os. It is Monday,

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Speaker 2: the twentieth of November. I'm Billy fitz Simons.

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Speaker 3: I'm Emma Gillespie.

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Speaker 2: Earlier in the year we asked if you had been

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Speaker 2: struggling with finding a bog billing GP, and overwhelmingly the

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Speaker 2: answer was yes. I recently went to my GPU to

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Speaker 2: get a mental health plan review. It cost me one

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Speaker 2: hundred and sixty dollars up front.

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Speaker 4: Sorry, yeah, paid for two and a half minute our appointment.

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Speaker 2: It's just getting out of control now.

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Speaker 3: A new report from the Royal Australian College of General

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Speaker 3: Practitioners the RACGP, has found that the number of GP

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Speaker 3: clinics filling all patients has halved in the last year.

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Speaker 2: In today's Deep Dive, I'm going to speak to doctor

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Speaker 2: Anita munyof the Victorian chair of the RACGP about what's

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Speaker 2: led to this drop and what it means for you

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Speaker 2: and the future of bog billing in Australia. But first

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Speaker 2: today's headlines. The White House has denied a Washington Post

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Speaker 2: exclusive that Israel and her mass are close to a

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Speaker 2: tentative US broken deal to pause conflict. According to National

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Speaker 2: Security Council spokesperson Adrian Watson, they have not reached a

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Speaker 2: deal yet, but we continue to work hard to get

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Speaker 2: to a deal. The Washington Post article claimed to the

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Speaker 2: pause could last for five days and free women and

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Speaker 2: children hostages in exchange for a five day pause in fighting.

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Speaker 3: The New South Wales Rural Fire Service has remembered an

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Speaker 3: enthusiastic and committed volunteer firefighter who died at the scene

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Speaker 3: of a blaze in northern New South Wales. Captain Leo

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Speaker 3: Franson was hit by a falling tree while fighting the

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Speaker 3: Hudson Fire near Walgut last week. He was taken to

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Speaker 3: Lightning Ridge Healthy Facility, where he later died. The RFS

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Speaker 3: said the loss would be felt deeply across the service

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Speaker 3: and that it was providing support to France AND's wife

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Speaker 3: and two children, as well as his fellow Fieries.

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Speaker 2: Australian mining billionaires Andrew Forrest and his ex wife Nicola

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Speaker 2: have purchased the iconic Australian hat brand Acubra from the

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Speaker 2: Kier family, who have owned the brand for five generations.

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Speaker 2: Stephen Keer, chairman of the company, said, after we saw

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Speaker 2: how the forests have invested in local manufacturing with Aaron Williams,

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Speaker 2: we decided they were the right custodians for a Cubra.

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Speaker 2: The amount the forest paid for the hat brand was

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Speaker 2: not disclosed.

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Speaker 3: And the good news the government of Dominica is establishing

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Speaker 3: the first sperm whale reserve in the world. Over fifty

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Speaker 3: sperm whale families live in Dominica's waters, but the species

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Speaker 3: is listed as vulnerable, with their global population under threat

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Speaker 3: from whaling, pollution, fishing nets, oil spills and contaminants. It's

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Speaker 3: hope the reserve, located in the Caribbean Islands bioregion, will

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Speaker 3: help protect the endangered spec and support the biodiversity of

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Speaker 3: the Caribbean.

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Speaker 2: Doctor Anita, thank you so much for joining us on

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Speaker 2: the daily OS.

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Speaker 4: My pleasure to star.

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Speaker 2: Can you just explain for those who might not know

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Speaker 2: what bulk billing actually is.

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Speaker 4: Okay, So all the people in Australia who paid tax

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Speaker 4: pay a certain amount of tax to contribute to our

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Speaker 4: Medicare scheme. So. Medicare is an insurance scheme that was

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Speaker 4: set up in the mid eighties and it was designed

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Speaker 4: to be the way the government gives a contribution to

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Speaker 4: patients when they go to see a doctor to help

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Speaker 4: them pay for the cost of getting healthcare. And so

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Speaker 4: in the beginning when Medicare was set up, the amount

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Speaker 4: that the Medicare scheme gave as a contribution basically covered

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Speaker 4: the whole cost of seeing someone like a GP. And

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Speaker 4: as a result, the government asked the patients and the

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Speaker 4: gps to come to an agreement whereby if the government

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Speaker 4: gave the patients money directly to the doctor, the doctor

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Speaker 4: agreed not to ask the patient for an additional contribution

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Speaker 4: on top, which is called a gap payment. And because

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Speaker 4: at the time the government contribution was a good one,

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Speaker 4: everyone was in agreement, and so the transfer of money

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Speaker 4: from government directly to doctor without going through the patient

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Speaker 4: they termed bulk billing. So if I see a patient

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Speaker 4: and that patient is bulk build What that means is

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Speaker 4: the patient is signing a form that says to the government,

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Speaker 4: don't give me the money, give it straight to my doctor,

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Speaker 4: because that covers the entire cost of seeing the doctor

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Speaker 4: on the day.

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Speaker 2: So if your bulk builled, it means that you don't

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Speaker 2: have to pay any out of pocket cost, right correct.

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Speaker 2: And so a new report has found that the number

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Speaker 2: of GP clinics that are bulk billing all of their

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Speaker 2: patients has halved in the last year. Can you explain

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Speaker 2: why that percentage has halved in the last year.

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Speaker 4: So since about the two thousands, the amount that the

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Speaker 4: federal government was willing to give patients to help them

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Speaker 4: cover the cost of seeing a GP has not kept

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Speaker 4: pace with how much it costs for GPS to give

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Speaker 4: a person that service. And then over time they also

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Speaker 4: froze how much they would increase the contribution to general

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Speaker 4: practice services. So put all those things together and we

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Speaker 4: end up now where what the government is willing to

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Speaker 4: give on the majority of general practice services is probably

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Speaker 4: worth around about thirty or thirty five percent what the

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Speaker 4: service is actually worth, according to the Australian Medical Association.

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Speaker 2: We pold our audience about this topic and more than

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Speaker 2: four in five of them said that due to cost concerns,

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Speaker 2: they have put off seeing a doctor for a non

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Speaker 2: urgent medical issue. How big of an issue do you

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Speaker 2: think that is?

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Speaker 4: So this is a catastrophe, And this is the exact

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Speaker 4: situation we were pleading with governments over many, many years

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Speaker 4: not to get to, because we know that, particularly for

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Speaker 4: vulnerable populations, Australians in a first world country are sometimes

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Speaker 4: making a decision in some weeks whether to go to

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Speaker 4: the supermarket and purchase food or go and see their GP.

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Speaker 4: And I think that that is totally unacceptable. And I

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Speaker 4: think all young people, all vulnerable people in particular, need

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Speaker 4: the reassurance that they can get health care that they need,

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Speaker 4: because if they don't get it early and they get

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Speaker 4: it when they are sicker, it actually costs the health

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Speaker 4: system much more anyway. And so we're trying to argue

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Speaker 4: that investing in primary care, where we keep people well

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Speaker 4: and we stop illnesses from getting out of hand, is

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Speaker 4: actually cheaper in the long run than allowing people to

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Speaker 4: get very sick before they finally turn up to an

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Speaker 4: emergency department desperate for help.

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Speaker 2: So the federal government recently introduced new bulk billing rules,

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Speaker 2: and they tripled incentives for gps to bulk bill some patients.

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Speaker 2: Has that helped it all?

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Speaker 4: It's too early for us to know, because the scheme

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Speaker 4: started on the first of November. We're only two weeks

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Speaker 4: in and we intend to try to gather data Before

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Speaker 4: the first of November. There was an additional payment of

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Speaker 4: six dollars to a GP who bulk billed someone from

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Speaker 4: a vulnerable population, so a child, or a pensioner or

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Speaker 4: a healthcare card worker. And of course that incentive also

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Speaker 4: did not keep up with the cost of running a practice,

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Speaker 4: so the federal government made an agreement to triple that

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Speaker 4: amount to try to get bulk billing rates to rise

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Speaker 4: again for vulnerable populations. Only we don't know what impacts

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Speaker 4: that's having because the things that are affecting general practice

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Speaker 4: in terms of how likely it is a practice can

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Speaker 4: stay open from a financial point of view is much

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Speaker 4: more complex than what the triple incentive is going to

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Speaker 4: be able to solve. So it's very early days.

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Speaker 2: There's been a lot of media coverage around this. Can

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Speaker 2: you shed some light on how gps are feeling at

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Speaker 2: this time?

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Speaker 4: So general practitioners have been warning anyone who would listen

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Speaker 4: for the last fifteen years that we were going to

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Speaker 4: get to this point because there was not enough investment

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Speaker 4: into general practice and primary care, and we knew that

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Speaker 4: this was coming for a very long time, and our

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Speaker 4: warnings have not been heeded. So now we're in this

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Speaker 4: situation where it's difficult for general practices to stay open.

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Speaker 4: Some of them are closing. In fact, the only way

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Speaker 4: a lot of them can stay open is by charging

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Speaker 4: a gap to the patients because the Medicare contribution is

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Speaker 4: not enough. So this is a situation that is heartbreaking

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Speaker 4: for GPS because we knew it was coming and we

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Speaker 4: wanted to avoid this. And it's also heartbreaking to us

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Speaker 4: because we need to recruit GPS into our profession, and

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Speaker 4: a lot of medical students know that it is probably

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Speaker 4: the toughest of the professions to enter in medicine, and

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Speaker 4: that the government gives the least amount of money to

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Speaker 4: our profession, so it's very hard to convince people to

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Speaker 4: join general practice when the environment is so harsh. So

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Speaker 4: we need a lot more investment, but we also really

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Speaker 4: need a change in attitude towards our profession across the

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Speaker 4: whole country, including at government.

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Speaker 2: Do you think they're is a world in which bulk

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Speaker 2: billing ever becomes more widely used.

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Speaker 4: Again, that really is going to be determined by how

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Speaker 4: much the government is willing to invest in general practice services.

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Speaker 4: I think bulk billing really is the future will be

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Speaker 4: mainly for vulnerable populations. If I'm honest, I don't think

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Speaker 4: that the Australian taxpayer can afford for every single person

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Speaker 4: in the country, from millionaires through to people who are unemployed,

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Speaker 4: to get every single medical service for free. We don't

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Speaker 4: have enough money for that. We are a small country,

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Speaker 4: so we have to be clever about how we use

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Speaker 4: our money. But I think that we should have all

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Speaker 4: vulnerable populations getting medical services essentially for free. And we

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Speaker 4: need to review Medicare. Medicare was created well over forty

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Speaker 4: years ago. It's not really fit for purpose anymore. It

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Speaker 4: needs to be overhauled.

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Speaker 2: In your eyes, what is the key solution to all

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Speaker 2: of these issues?

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Speaker 4: So there isn't a key solution because this is what

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Speaker 4: we term wicked problem, and wicked problems mean that they

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Speaker 4: have such complexities that there's not one single solution and

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Speaker 4: that's what makes this so very hard. But knowing that

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Speaker 4: we are recording a podcast particularly for young people. I

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Speaker 4: think an easy and quick win is to develop services

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Speaker 4: that are particularly targeted at vulnerable populations where they know

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Speaker 4: they can go and get health care they need without

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Speaker 4: fear of high payments. There's an opportunity to create Medicare

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Speaker 4: contributions that are specific for young people and vulnerable people

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Speaker 4: that are higher that say to the GP, we're going

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Speaker 4: to cover that additional cost because it is a priority

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Speaker 4: to us that these people get seen. So there are

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Speaker 4: some options, but there are many different components to our

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Speaker 4: health system, so we need to come up with more

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Speaker 4: complex solutions within which those two simple ideas have just

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Speaker 4: described could flourish.

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Speaker 2: Doctor Anita, thank you so much for your time. We

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Speaker 2: really appreciate it my pleasure.

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Speaker 3: Thank you so much for joining us on the Daily Ods.

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Speaker 3: If you learned something from today's episode, there's one thing

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Speaker 3: you can do in five seconds and would mean so much.

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Speaker 3: Share this podcast to your Instagram stories. It helps get

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Speaker 3: the word out about the Daily Ods and it helps

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Speaker 3: keep the conversation going. We'll be back again tomorrow, actually

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Speaker 3: Sam and Zara will be back again tomorrow, but until then,

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Speaker 3: have a great start to the week.