Who should we be listening to in the debate over co-payments in the health system? Why do Governments take advice from unions, such as the AMA, with clear vested interests, rather than from expert researchers and consumer groups? In the following piece, Anne Cahill Lambert builds on Marie McInerney’s work on the co-payment to question the role of ‘expert’ in the health policy arena. She writes:
I am intrigued about the latest furore about the $7 Medicare co-payment. Aside from the fact that I don’t agree with it, I have been fascinated about who has been consulted or whose views have been reported.
Dealing with my disagreement first, the major claim is that a free public health service is unsustainable. Of course, Medicare is not free. It is a universal health system that is predominantly supported through a levy on taxpayers. I think many commentators, including our Health Minister, are muddling the terms universal and free. The beauty of our Medicare system is that all citizens are covered. It is the centrepiece of Australia’s health system of which I am extremely proud.
Digressing for a moment; in early August 2014, Minister Eric Abetz drew a link between termination of pregnancy and breast cancer. The Prime Minister and others were quick to discredit such links while Liberal back bencher Wyatt Roy said he supported the Australian Medical Association’s view on this, as would most Australians. And the President of the AMA was interviewed at length and by a range of media organisations on this matter.
At the time, I was fascinated that the AMA was seen as the ‘go to’ voice on this matter. The AMA is clear in articulating is role, inter alia.:
It is the peak body for doctors and medical students.
- It promotes and protects the professional interests of doctors.
Whether the AMA likes it or not, it is predominantly the union for doctors. There’s nothing shabby or shady in this. It cannot be all things to all people. Its members, who are doctors or medical students, vote for their leadership team and therefore the organisation’s direction. Thus, the vast majority of Australians do not have any say over who or how the organisation is run.
Let’s deal with what the AMA isn’t: it is not the epicentre of leading research outcomes in this country. Certainly, some of its members are outstanding researchers. But this is different from the AMA itself being able to formulate public health advice on the latest developments in health care research.
If I were looking for a value-add voice on, for example, the suggested link between termination of pregnancy and breast cancer, the AMA would not be my first port of call. I’d start with the NHMRC, or Cancer Australia or the Cancer Council, or the Clinical Oncology Society of Australia, to name a few.
So too, the discussion about the co-payment for Medicare services. There are many academic organisations that have undertaken a thorough analysis on whether a co-payment is needed and what the impact will be. The Grattan Institute, for example, has written, at last count, four articles in the last couple of months about co-payments and the health budget generally. The Institute is not aligned with any political party.
Despite organisations like the Grattan providing an independent analysis of what the co-payment means, the AMA has been involved in detailed discussions with the Health Minister in providing a model to protect vulnerable patients from co-payment. Happily, the Health Minister has seen this model for what it probably is: a windfall for doctors.
But why should the AMA’s views receive so much government (and media) attention, when compared with experts in this area, predominantly the taxpayer. The taxpayer already knows how much they spend in gap payments. I live in a region where there are very few bulk-billing doctors; so most patients already make a co-payment. Indeed, the AMA claims that about 80% of doctors bulk bill: I’d like to know where they are because we can’t find them!
The AMA President was quick to comment on Senator Abetz’s silliness; whereas, if, for example, the president of the CFMEU were asked to comment, s/he would have referred inquiries to a more authoritative organisation such as Cancer Australia. Similarly, as explained, the AMA has had plenty to say on the co-payment in terms of vulnerable patients. Yet its proposal has more to do with shoring up the income of doctors than protecting the vulnerable.
I am delighted that the Health Minister has dismissed the AMA’s model, but am still anxious that he does not have a good understanding of what the co-payment will mean to the vulnerable, to people who already pay a large gap, and ultimately to the health system because people will stop consulting medical practitioners if this co-payment is introduced. In the long run, it will cost the health system many more dollars than it saves as the impact of not consulting medical practitioners festers into significant ulcers.
Given that the Prime Minister stated categorically in the lead up to the election that he would not cut health, it is my contention that he needs to consult with the people who elected him and not just the AMA. While the academics have analysed the impact of the co-payment, others such as the Consumer Health Forum (CHF) have the coalface stories. Yet, their voice is glossed over, mostly because the AMA is extremely loud, and in my view bold, about what it thinks should happen.
Organisations like CHF are able to get consumers (taxpayers) together to provide first hand information directly to the Health Minister. The views of those with chronic illnesses are especially important, given that the impost of a co-payment will impact them significantly as key visitors to GPs.
The so-called Eddie the Experts in this space, aka the AMA, need to butt out and let consumers have a much louder voice on the topic of co-payments. Only then is the Health Minister likely to have a good understanding of what this means.
PS: I love doctors. I’m married to the best looking one in Australia.
Conflict of interest: Anne Cahill Lambert is a consumer member of the Health Program Reference Group of the Grattan Institute. She has had no input to the Institute’s papers on co-payments. Once upon a time, she was also a member of CHF, but has not been a member since 2012. And her good looking husband is not a member of the AMA.
Anne Cahill Lambert, AM, has much to say on a range of matters including consumer participation. She has a Bachelor’s degree in health management and a masters in public administration. She’s on twitter: @ACLambert