WEBVTT - Is the bulk billing era over? 0:00:01.200 --> 0:00:03.520 My name is Lily Madden and I'm a proud Arunda 0:00:03.760 --> 0:00:08.520 Bunjelung Calcottin woman from Gadighal Country. The Daily ozz acknowledges 0:00:08.600 --> 0:00:10.760 that this podcast is recorded on the lands of the 0:00:10.800 --> 0:00:14.360 Gadigal people and pays respect to all Aboriginal and Torres 0:00:14.360 --> 0:00:17.279 Strait Island and nations. We pay our respects to the 0:00:17.320 --> 0:00:20.079 first peoples of these countries, both past and present. 0:00:25.320 --> 0:00:28.360 Good morning and welcome to the Daily os. It is Monday, 0:00:28.360 --> 0:00:31.040 the twentieth of November. I'm Billy fitz Simons. 0:00:31.120 --> 0:00:32.320 I'm Emma Gillespie. 0:00:32.360 --> 0:00:34.879 Earlier in the year we asked if you had been 0:00:34.920 --> 0:00:38.879 struggling with finding a bog billing GP, and overwhelmingly the 0:00:38.920 --> 0:00:41.839 answer was yes. I recently went to my GPU to 0:00:41.840 --> 0:00:44.320 get a mental health plan review. It cost me one 0:00:44.400 --> 0:00:46.120 hundred and sixty dollars up front. 0:00:46.440 --> 0:00:49.360 Sorry, yeah, paid for two and a half minute our appointment. 0:00:49.479 --> 0:00:51.760 It's just getting out of control now. 0:00:51.840 --> 0:00:55.120 A new report from the Royal Australian College of General 0:00:55.120 --> 0:00:59.240 Practitioners the RACGP, has found that the number of GP 0:00:59.360 --> 0:01:03.320 clinics filling all patients has halved in the last year. 0:01:03.760 --> 0:01:05.960 In today's Deep Dive, I'm going to speak to doctor 0:01:06.000 --> 0:01:10.440 Anita munyof the Victorian chair of the RACGP about what's 0:01:10.520 --> 0:01:12.760 led to this drop and what it means for you 0:01:12.840 --> 0:01:15.959 and the future of bog billing in Australia. But first 0:01:16.000 --> 0:01:20.839 today's headlines. The White House has denied a Washington Post 0:01:20.880 --> 0:01:23.280 exclusive that Israel and her mass are close to a 0:01:23.360 --> 0:01:27.240 tentative US broken deal to pause conflict. According to National 0:01:27.240 --> 0:01:30.760 Security Council spokesperson Adrian Watson, they have not reached a 0:01:30.800 --> 0:01:33.000 deal yet, but we continue to work hard to get 0:01:33.040 --> 0:01:35.720 to a deal. The Washington Post article claimed to the 0:01:35.720 --> 0:01:38.240 pause could last for five days and free women and 0:01:38.319 --> 0:01:41.520 children hostages in exchange for a five day pause in fighting. 0:01:42.760 --> 0:01:45.720 The New South Wales Rural Fire Service has remembered an 0:01:45.959 --> 0:01:49.840 enthusiastic and committed volunteer firefighter who died at the scene 0:01:49.840 --> 0:01:52.800 of a blaze in northern New South Wales. Captain Leo 0:01:52.840 --> 0:01:55.720 Franson was hit by a falling tree while fighting the 0:01:55.800 --> 0:01:59.040 Hudson Fire near Walgut last week. He was taken to 0:01:59.120 --> 0:02:02.760 Lightning Ridge Healthy Facility, where he later died. The RFS 0:02:02.800 --> 0:02:05.440 said the loss would be felt deeply across the service 0:02:05.760 --> 0:02:08.240 and that it was providing support to France AND's wife 0:02:08.240 --> 0:02:10.919 and two children, as well as his fellow Fieries. 0:02:11.840 --> 0:02:15.040 Australian mining billionaires Andrew Forrest and his ex wife Nicola 0:02:15.200 --> 0:02:18.160 have purchased the iconic Australian hat brand Acubra from the 0:02:18.240 --> 0:02:21.399 Kier family, who have owned the brand for five generations. 0:02:21.840 --> 0:02:24.679 Stephen Keer, chairman of the company, said, after we saw 0:02:24.720 --> 0:02:28.239 how the forests have invested in local manufacturing with Aaron Williams, 0:02:28.600 --> 0:02:31.000 we decided they were the right custodians for a Cubra. 0:02:31.639 --> 0:02:33.800 The amount the forest paid for the hat brand was 0:02:33.840 --> 0:02:34.600 not disclosed. 0:02:35.400 --> 0:02:38.919 And the good news the government of Dominica is establishing 0:02:38.960 --> 0:02:42.920 the first sperm whale reserve in the world. Over fifty 0:02:42.960 --> 0:02:46.400 sperm whale families live in Dominica's waters, but the species 0:02:46.520 --> 0:02:50.120 is listed as vulnerable, with their global population under threat 0:02:50.160 --> 0:02:54.799 from whaling, pollution, fishing nets, oil spills and contaminants. It's 0:02:54.840 --> 0:02:58.440 hope the reserve, located in the Caribbean Islands bioregion, will 0:02:58.480 --> 0:03:02.840 help protect the endangered spec and support the biodiversity of 0:03:02.919 --> 0:03:03.519 the Caribbean. 0:03:07.400 --> 0:03:10.040 Doctor Anita, thank you so much for joining us on 0:03:10.160 --> 0:03:10.919 the daily OS. 0:03:11.120 --> 0:03:12.239 My pleasure to star. 0:03:12.440 --> 0:03:15.440 Can you just explain for those who might not know 0:03:15.800 --> 0:03:18.000 what bulk billing actually is. 0:03:18.400 --> 0:03:21.880 Okay, So all the people in Australia who paid tax 0:03:22.600 --> 0:03:25.720 pay a certain amount of tax to contribute to our 0:03:26.280 --> 0:03:30.560 Medicare scheme. So. Medicare is an insurance scheme that was 0:03:30.600 --> 0:03:33.200 set up in the mid eighties and it was designed 0:03:33.360 --> 0:03:37.520 to be the way the government gives a contribution to 0:03:37.960 --> 0:03:41.000 patients when they go to see a doctor to help 0:03:41.080 --> 0:03:44.480 them pay for the cost of getting healthcare. And so 0:03:44.880 --> 0:03:48.720 in the beginning when Medicare was set up, the amount 0:03:48.840 --> 0:03:53.320 that the Medicare scheme gave as a contribution basically covered 0:03:53.600 --> 0:03:57.160 the whole cost of seeing someone like a GP. And 0:03:57.280 --> 0:04:01.240 as a result, the government asked the patients and the 0:04:01.280 --> 0:04:06.200 gps to come to an agreement whereby if the government 0:04:06.360 --> 0:04:10.400 gave the patients money directly to the doctor, the doctor 0:04:10.480 --> 0:04:14.000 agreed not to ask the patient for an additional contribution 0:04:14.120 --> 0:04:17.000 on top, which is called a gap payment. And because 0:04:17.040 --> 0:04:20.680 at the time the government contribution was a good one, 0:04:21.200 --> 0:04:24.960 everyone was in agreement, and so the transfer of money 0:04:24.960 --> 0:04:29.360 from government directly to doctor without going through the patient 0:04:29.960 --> 0:04:33.560 they termed bulk billing. So if I see a patient 0:04:33.600 --> 0:04:36.200 and that patient is bulk build What that means is 0:04:36.640 --> 0:04:39.600 the patient is signing a form that says to the government, 0:04:39.680 --> 0:04:42.800 don't give me the money, give it straight to my doctor, 0:04:43.240 --> 0:04:46.880 because that covers the entire cost of seeing the doctor 0:04:46.960 --> 0:04:47.479 on the day. 0:04:47.720 --> 0:04:50.839 So if your bulk builled, it means that you don't 0:04:50.880 --> 0:04:54.479 have to pay any out of pocket cost, right correct. 0:04:54.960 --> 0:04:57.960 And so a new report has found that the number 0:04:58.000 --> 0:05:01.320 of GP clinics that are bulk billing all of their 0:05:01.360 --> 0:05:05.880 patients has halved in the last year. Can you explain 0:05:06.080 --> 0:05:09.320 why that percentage has halved in the last year. 0:05:09.800 --> 0:05:14.440 So since about the two thousands, the amount that the 0:05:14.480 --> 0:05:18.400 federal government was willing to give patients to help them 0:05:18.480 --> 0:05:22.279 cover the cost of seeing a GP has not kept 0:05:22.480 --> 0:05:26.120 pace with how much it costs for GPS to give 0:05:26.279 --> 0:05:29.840 a person that service. And then over time they also 0:05:30.680 --> 0:05:35.040 froze how much they would increase the contribution to general 0:05:35.040 --> 0:05:39.000 practice services. So put all those things together and we 0:05:39.240 --> 0:05:42.359 end up now where what the government is willing to 0:05:42.480 --> 0:05:46.560 give on the majority of general practice services is probably 0:05:46.640 --> 0:05:50.719 worth around about thirty or thirty five percent what the 0:05:50.760 --> 0:05:55.320 service is actually worth, according to the Australian Medical Association. 0:05:55.880 --> 0:05:58.640 We pold our audience about this topic and more than 0:05:58.720 --> 0:06:01.680 four in five of them said that due to cost concerns, 0:06:01.800 --> 0:06:04.680 they have put off seeing a doctor for a non 0:06:04.880 --> 0:06:08.200 urgent medical issue. How big of an issue do you 0:06:08.240 --> 0:06:08.880 think that is? 0:06:09.320 --> 0:06:12.640 So this is a catastrophe, And this is the exact 0:06:12.720 --> 0:06:18.440 situation we were pleading with governments over many, many years 0:06:18.800 --> 0:06:24.000 not to get to, because we know that, particularly for 0:06:24.320 --> 0:06:29.400 vulnerable populations, Australians in a first world country are sometimes 0:06:29.440 --> 0:06:32.919 making a decision in some weeks whether to go to 0:06:32.960 --> 0:06:36.719 the supermarket and purchase food or go and see their GP. 0:06:37.160 --> 0:06:41.400 And I think that that is totally unacceptable. And I 0:06:41.440 --> 0:06:46.560 think all young people, all vulnerable people in particular, need 0:06:46.680 --> 0:06:50.520 the reassurance that they can get health care that they need, 0:06:51.040 --> 0:06:54.040 because if they don't get it early and they get 0:06:54.040 --> 0:06:57.480 it when they are sicker, it actually costs the health 0:06:57.520 --> 0:07:01.960 system much more anyway. And so we're trying to argue 0:07:02.600 --> 0:07:06.799 that investing in primary care, where we keep people well 0:07:07.120 --> 0:07:10.400 and we stop illnesses from getting out of hand, is 0:07:10.520 --> 0:07:15.000 actually cheaper in the long run than allowing people to 0:07:15.080 --> 0:07:17.800 get very sick before they finally turn up to an 0:07:17.840 --> 0:07:19.920 emergency department desperate for help. 0:07:20.120 --> 0:07:24.840 So the federal government recently introduced new bulk billing rules, 0:07:25.440 --> 0:07:30.120 and they tripled incentives for gps to bulk bill some patients. 0:07:30.560 --> 0:07:31.800 Has that helped it all? 0:07:31.920 --> 0:07:34.640 It's too early for us to know, because the scheme 0:07:35.120 --> 0:07:38.040 started on the first of November. We're only two weeks 0:07:38.080 --> 0:07:42.560 in and we intend to try to gather data Before 0:07:42.640 --> 0:07:45.960 the first of November. There was an additional payment of 0:07:46.000 --> 0:07:50.680 six dollars to a GP who bulk billed someone from 0:07:50.680 --> 0:07:54.320 a vulnerable population, so a child, or a pensioner or 0:07:54.360 --> 0:07:58.680 a healthcare card worker. And of course that incentive also 0:07:59.040 --> 0:08:02.880 did not keep up with the cost of running a practice, 0:08:03.080 --> 0:08:06.640 so the federal government made an agreement to triple that 0:08:06.720 --> 0:08:10.840 amount to try to get bulk billing rates to rise 0:08:10.880 --> 0:08:15.520 again for vulnerable populations. Only we don't know what impacts 0:08:15.560 --> 0:08:20.240 that's having because the things that are affecting general practice 0:08:20.440 --> 0:08:23.320 in terms of how likely it is a practice can 0:08:23.360 --> 0:08:27.200 stay open from a financial point of view is much 0:08:27.280 --> 0:08:31.760 more complex than what the triple incentive is going to 0:08:31.800 --> 0:08:34.120 be able to solve. So it's very early days. 0:08:34.480 --> 0:08:37.880 There's been a lot of media coverage around this. Can 0:08:37.920 --> 0:08:42.079 you shed some light on how gps are feeling at 0:08:42.080 --> 0:08:42.480 this time? 0:08:43.000 --> 0:08:46.800 So general practitioners have been warning anyone who would listen 0:08:47.120 --> 0:08:49.840 for the last fifteen years that we were going to 0:08:49.880 --> 0:08:53.439 get to this point because there was not enough investment 0:08:53.720 --> 0:08:57.320 into general practice and primary care, and we knew that 0:08:57.400 --> 0:09:00.640 this was coming for a very long time, and our 0:09:00.679 --> 0:09:04.080 warnings have not been heeded. So now we're in this 0:09:04.200 --> 0:09:08.960 situation where it's difficult for general practices to stay open. 0:09:09.640 --> 0:09:11.880 Some of them are closing. In fact, the only way 0:09:12.040 --> 0:09:14.840 a lot of them can stay open is by charging 0:09:14.880 --> 0:09:18.200 a gap to the patients because the Medicare contribution is 0:09:18.240 --> 0:09:21.520 not enough. So this is a situation that is heartbreaking 0:09:21.559 --> 0:09:24.680 for GPS because we knew it was coming and we 0:09:24.800 --> 0:09:28.439 wanted to avoid this. And it's also heartbreaking to us 0:09:28.480 --> 0:09:33.040 because we need to recruit GPS into our profession, and 0:09:33.080 --> 0:09:36.280 a lot of medical students know that it is probably 0:09:36.280 --> 0:09:40.360 the toughest of the professions to enter in medicine, and 0:09:40.400 --> 0:09:43.120 that the government gives the least amount of money to 0:09:43.200 --> 0:09:46.480 our profession, so it's very hard to convince people to 0:09:46.559 --> 0:09:50.120 join general practice when the environment is so harsh. So 0:09:50.760 --> 0:09:53.360 we need a lot more investment, but we also really 0:09:53.440 --> 0:09:56.959 need a change in attitude towards our profession across the 0:09:57.000 --> 0:09:58.720 whole country, including at government. 0:09:59.040 --> 0:10:01.439 Do you think they're is a world in which bulk 0:10:01.480 --> 0:10:04.120 billing ever becomes more widely used. 0:10:04.240 --> 0:10:07.800 Again, that really is going to be determined by how 0:10:07.880 --> 0:10:12.400 much the government is willing to invest in general practice services. 0:10:12.960 --> 0:10:16.440 I think bulk billing really is the future will be 0:10:16.520 --> 0:10:20.920 mainly for vulnerable populations. If I'm honest, I don't think 0:10:21.000 --> 0:10:25.920 that the Australian taxpayer can afford for every single person 0:10:26.040 --> 0:10:30.800 in the country, from millionaires through to people who are unemployed, 0:10:31.640 --> 0:10:34.680 to get every single medical service for free. We don't 0:10:34.679 --> 0:10:37.280 have enough money for that. We are a small country, 0:10:37.920 --> 0:10:40.840 so we have to be clever about how we use 0:10:40.880 --> 0:10:44.640 our money. But I think that we should have all 0:10:44.760 --> 0:10:50.920 vulnerable populations getting medical services essentially for free. And we 0:10:51.040 --> 0:10:56.680 need to review Medicare. Medicare was created well over forty 0:10:56.760 --> 0:11:00.200 years ago. It's not really fit for purpose anymore. It 0:11:00.240 --> 0:11:01.360 needs to be overhauled. 0:11:01.840 --> 0:11:04.960 In your eyes, what is the key solution to all 0:11:05.000 --> 0:11:05.880 of these issues? 0:11:06.320 --> 0:11:09.040 So there isn't a key solution because this is what 0:11:09.080 --> 0:11:12.280 we term wicked problem, and wicked problems mean that they 0:11:12.720 --> 0:11:17.240 have such complexities that there's not one single solution and 0:11:17.280 --> 0:11:20.520 that's what makes this so very hard. But knowing that 0:11:20.600 --> 0:11:24.120 we are recording a podcast particularly for young people. I 0:11:24.160 --> 0:11:29.599 think an easy and quick win is to develop services 0:11:29.640 --> 0:11:33.640 that are particularly targeted at vulnerable populations where they know 0:11:33.800 --> 0:11:37.640 they can go and get health care they need without 0:11:37.720 --> 0:11:42.800 fear of high payments. There's an opportunity to create Medicare 0:11:42.920 --> 0:11:47.320 contributions that are specific for young people and vulnerable people 0:11:48.080 --> 0:11:51.600 that are higher that say to the GP, we're going 0:11:51.600 --> 0:11:54.640 to cover that additional cost because it is a priority 0:11:54.679 --> 0:11:57.040 to us that these people get seen. So there are 0:11:57.080 --> 0:11:59.720 some options, but there are many different components to our 0:11:59.760 --> 0:12:03.120 health system, so we need to come up with more 0:12:03.160 --> 0:12:07.160 complex solutions within which those two simple ideas have just 0:12:07.200 --> 0:12:08.319 described could flourish. 0:12:08.360 --> 0:12:10.520 Doctor Anita, thank you so much for your time. We 0:12:10.559 --> 0:12:12.079 really appreciate it my pleasure. 0:12:14.160 --> 0:12:16.760 Thank you so much for joining us on the Daily Ods. 0:12:16.840 --> 0:12:19.480 If you learned something from today's episode, there's one thing 0:12:19.520 --> 0:12:23.000 you can do in five seconds and would mean so much. 0:12:23.480 --> 0:12:26.920 Share this podcast to your Instagram stories. It helps get 0:12:26.960 --> 0:12:29.280 the word out about the Daily Ods and it helps 0:12:29.360 --> 0:12:32.880 keep the conversation going. We'll be back again tomorrow, actually 0:12:33.040 --> 0:12:35.640 Sam and Zara will be back again tomorrow, but until then, 0:12:35.880 --> 0:12:37.199 have a great start to the week.