Reflections of the current AMA President

Having a voice in complex policy decisions has never been more important

The Australian health care system is one of the best in the world. The foundations of our system are a well trained medical workforce, a commitment to quality and standards, and a delicate balance between public and private health systems.

Doctors and other providers working in our health system have a strong commitment to improvement. There is potential for improvement both in clinical outcomes and efficiencies. The past few years have been a period of clinical engagement, something not to be taken for granted.

While there is much to be learnt from overseas experience, our system is one that should be envied. Our system is unique, and caution should always be exercised when applying solutions developed overseas to the Australian health system. There are too many examples of solutions that have been imported enthusiastically only to be found to be not quite as good as initially thought. The latter realisation usually comes to light just as Australia implements the program.

The solutions and expertise reside with our clinicians here in Australia. Engaging with our doctors is key, not only to improving clinical results, but also to achieving financial efficiencies. This was illustrated so well by the recent failure of the personally controlled electronic health record in terms of its development and subsequent uptake. The advice of doctors wasn't heeded and hundreds of millions of dollars were wasted.

Perhaps that is why it was so surprising that there was no consultation with the Australian Medical Association (AMA) or any other health group in relation to the copayment proposal and other health-related measures of the recent federal Budget.

While all AMA presidencies have their challenges, I suspect that there has never been a more important time to have strong professional representation.

The challenges are already here. While the so-called general practice copayment has occupied the headlines since the announcement of the federal Budget, there are many other budget issues that we need to grapple with.

For instance, the freeze on non-GP Medicare rebates has received almost no attention. Normally there would have been much said about this measure. Will all health funds still index their own schedules? If so, what is the implication for premiums? If not, will there be a reduction in use of no-gap or known-gap arrangements? Will patient out-of-pocket expenses increase?

With more than 3000 medical graduates expected to require internships this year, and with their predecessors requiring prevocational posts and training positions, the “training pipeline” remains a high priority and the central concern for our doctors-in-training. Three hundred extra general practice training positions, which the AMA welcomes, were announced in the federal Budget. However, apart from the loss of the Prevocational General Practice Placements Program, we are concerned that General Practice Education and Training has been subsumed by the federal Department of Health, with loss of its clinical leadership. The pending open tender for regional training providers must be watched with caution.

Indigenous health is a priority for the AMA, and always has been. Improvements are hard fought. This is not a time to cut Indigenous health funding. If inefficiencies are found, they need to be redressed, or the funding redirected. It should not be cut. The implementation of the new National Aboriginal and Torres Strait Islander Health Plan is an opportunity to ensure that successful programs are expanded.

The role of private health insurers (PHIs) in general practice is being examined closely by the federal government. While there may be a limited role, expansion of the role of PHIs in general practice should be viewed with scepticism and serious caution. Denials from PHIs that managed care is on the agenda ring hollow when we see some PHIs introducing preoperative assessment or approval processes for a range of procedures.

The AMA and the medical profession it represents are only too willing to engage with governments to get the right result for our health system and for patients. The health system is complex, and adjustments to policies in one area usually have consequences in many others. We may not necessarily always agree with proposals, but doctors have the knowledge and experience that can help avoid unintended and unwanted adverse consequences of various health policies.

Associate Professor Brian Owler, a Sydney adult and paediatric neurosurgeon, became President of the AMA in May 2014.