Interview with Leon Bryner - FIVEAA
Friday, 10 November 2017
Topics: New Medicare listings for patients; codeine; COAG Health Council; Gayle’s Law; private patients in public hospitals
Let’s talk to the Federal Health Minister Greg Hunt. Greg, thanks for coming on today.
It’s a pleasure, Leon.
First of all, we’ll start with the good stuff. We’ve got special treatments for heart disease, epilepsy, stroke, breast cancer, lymphoma, liver tumours, which are going to get a lot cheaper. When and how much?
In fact, as of yesterday, so 1 November, it’s what’s called MBS items, so the public treatments that are available through Medicare.
So, in other words, the Commonwealth will now cover the cost of those, and there are 33 new Medicare items, but to make it real, probably one of the most talked about areas is genetic testing for the BRCA1 and BRCA2 gene.
This is where there’s a genetic mutation, it can be passed from generation to generation. I met a woman, Carol, yesterday. Through the testing she’s discovered that her children, she’s in her early seventies, her children have it and that there’s a risk it could be with the grandchildren.
They can therefore have extra care in relation to the risk of breast or ovarian cancer. These tests could have cost anywhere between $600 and $2000. Now they’ll be available through bulk billing or, essentially, for the public that means it’s free.
The same thing with support for an aortic valve implantation, which is just incredibly important for patients with heart conditions, and with lymphatic cancer, they’ll be able to get PET scan treatment.
So really critical things, and as the health system evolves and we’re able to get better treatments, the beauty of it is we’re able to pay for them and the public gets better access to higher quality treatment at an earlier time. Just a good day and a good outcome.
Alright. I just want to quickly ask you about codeine.
Because it is an opiate and it’s addictive and you’ve got to be careful and it’s effective as pain relief, but is it likely, is it inevitable that if you want to have anything with codeine in it at all you’re going to need a script?
Yes it is. It was a decision, and I’m very empathetic and sympathetic about this, it was a decision made over two years ago by all of the state and territory chief pharmacy and chief medical officers. They’ve seen the opioid addictions around the world.
There’s 100 deaths a year through over the counter use in Australia, and that number and rate is increasing. The AMA and all of the health bodies have said there are better drugs available, ibuprofen and paracetamol combinations.
It will still be available to anybody through a doctor, and the alternatives will still be available at every pharmacy and, indeed, all of the health authorities are saying those alternatives are more effective, but it was a decision taken just over two years ago, and on which there was a long lead-in time and it’s implemented under state law.
I realise that, for some, it wouldn’t be their preferred outcome, but when all of the medical authorities do this, this decision, by medical authorities, delivered through the state laws, then I guess we have to respect that.
I’m talking with the Federal Health Minister Greg Hunt.
Greg, earlier this morning, we had a caller who has a knee problem, and they’re taking rather high doses of analgesics, and you know some of those can be well, they’re opiates, a lot of them. She’s got a three-year wait to get an appointment.
Now, I’m mentioning this because in the last two or three days, Adelaide’s general practitioners have said that SA Health is privatising its public hospital outpatient clinics.
What they’re doing is they’re getting GPs to refer members of the public as private patients so SA Health can get the Federal Government to pay. Now, what this is doing, according to the doctors, is blowing out the waiting time if you do not have private health insurance. What’s your attitude to this?
Well, this is absolutely correct. So, what’s happening, the public hospitals should be and are rightfully available to everybody, and you should be able to see the specialist and the doctor of your choice and get the emergency care when you need it.
But over and above that, there is a process of harvesting, and that is where some of the state governments are making sure that their public hospitals are recruiting private patients, and that has two impacts.
One is that it drives up the cost of private health insurance and it has a Federal cost subsidy. I’m trying to deal with and we’re making big progress on private health insurance, because that’s important to so many people.
But the real issue here is that it blows out the waiting time for public patients, particularly those who can’t afford private health insurance, those who might be in more difficult financial circumstances, and they are the victims of this practice of harvesting private patients, of deliberately trying to siphon them into the public hospitals.
It’s especially the case, as we’ve heard, in Adelaide at the moment, and that means that waiting lists blow out.
So, I am raising this tomorrow with the states at the national health meeting or the Council of Australian Governments Health Meeting, but I don’t think it’s an appropriate policy. It’s not good medical practice.
Those that are least able to deal with their own health are the ones that are most affected, and it is a case of privatising the public hospitals and it’s not something that I support and it’s something that I want to work on and, frankly, say to the states, it’s not right. Not something that should be happening.
I have a feeling that if you only say that, they might nod their head and say oh well, we’re doing this because you’re cutting our funding or you’re not giving us enough. That’s going to be their response.
Except our funding is going up from 19 to 20 to 21 to 22 billion, and it’s increasing at a significantly faster rate than state funding.
At the end of the day, we’ll continue to be adding our funding quite significantly. I know that we will have had a very large growth in Commonwealth funding at a far greater rate than the states and territories, but that’s not the real issue.
The real issue here is it doesn’t actually help the state system, because in many cases around the country they’ve then had to place public patients in private hospitals at a much greater cost.
And so a policy that’s been driven by some of the state treasuries ultimately is a false economy, and for everybody listening today, you can just imagine that for seniors, for lower income families, those who are least able to cover the cost of their own health, they’re just being forced onto longer and longer waiting lists as these private patients are being harvested and brought in.
And there’s a role, legitimate, absolute role, for patients to be able to seek their service anywhere, but there’s not a role for artificially harvesting them, and it’s the genuine public patients who pay the price with that.
Have you any leverage to actually force the issue? I mean, you can say you’re not happy, but in this..
Yes, we do.
Tell me what it is.
We’re in a unique position. We have coming up the negotiations over the 2020 to 2025 hospital funding agreement.
As I say, I’ve just run through the increases from $1 billion a year increase at federal level, well over 5.5 per cent, but this is one of the items, how we get reduced waiting lists in our state hospitals by stopping the practice of the harvesting of the private patients, as opposed to the legitimate role and use, so anybody can go where they get their best and most needed care.
And so that is an item which does go into those discussions, and it should be part of those discussions, and we are the funder of a significant proportion of hospital funding, just over 42 per cent growing to 45 per cent at federal level.
So we have a very significant lever, but above all else, the public have a right to say, hang on, you’re making our most vulnerable wait much longer than they need to, and that’s not an acceptable health outcome.
Alright, got a question, and this is from Ray. He says, why is it necessary to every year get a referral from my GP to send to the specialist who’s giving me ongoing specialist treatment, when the specialist knows more about my specific issue than the GP?
Cost wise, I’ve got to make a specific appointment with my GP for which they get a fee just to get a new referral, when the specialist already knows me and my health problem. I presume the specialist also gets a new referral fee, that’s a question mark, fee is paid for a new referral. Surely money could be saved by making all referrals to a specialist ongoing.
So Ray’s timing is perfect. The two questions that we have a Medicare Taskforce, which actually helped deliver the results yesterday of the new items that came on board that we started talking about, and this Taskforce is looking at two questions in relation to referrals, the frequency of referrals required to renew scripts, and the frequency of referrals required for ongoing engagement with specialists. And today, they’ll come back with some suggestions on that.
They give advice without fear or favour, they’re focused on what is the best outcome for the patient, and we’ve been able to get these new items, which come at a cost to the Government, but I’m very, very happy to pay that because they’re all about better health outcomes, and they’re looking for what the best outcome’s for the patient and the most efficient way to deliver it.
And something that’s been raised with me by many members of the public is these two cases of, is it required to go back as often as they do for scripts and as often as they do for referrals to specialists? So pretty good point by Ray.
Alright. Is it going to be fiery tomorrow, this meeting, do you think?
Look, there’s always a little bit of theatre, but our goal is to make progress on Gayle’s Law because of the tragedy in the South Australian Outback, and to provide better protection for nurses.
I think South Australia, to their credit, has helped lead that and I am very supportive of the South Australian initiative to better national protection for our nurses.
Secondly, I think we will make very good progress on what’s an historic anomaly, and that is that most people if they seek help for mental health issues, there are four million Australians a year who have some sort of mental health need, don’t have to report back to their employer or it to go on their record.
Doctors, if they want to seek early help, do have to put that on their record and it can be a black mark.
So therefore you have higher rates of mental health by people deferring their treatment so that the carers are not getting cared for. So we want to make progress on that as well.
So I think that’ll be two points of good cooperation, caring for the carers, and expanding the protection for our nurses.
Which is just reminding me that the previous Labor government cut back on the number of appointments available under a mental healthcare plan. Will your Government overturn that, given the focus on mental health?
Well, only yesterday one of the items we expanded was access to telehealth for mental health, which for people in the rural and regional areas and the more remote areas, is incredibly important.
We have only just yesterday made a decision and implemented that decision, which will give people access to up to 10 Medicare fully-funded mental health treatments.
Minister, thanks for coming on today. We’ll certainly keep in touch with you. That’s the Federal Health Minister Greg Hunt on important issues at 5AA.