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Australian Journal of Pharmacy : March 2005
capital hill capital hill from our Canberra correspondent The politics of partnerships T HE Australian Medical Association has apparently decided to abandon any intention to develop partnering agreements with its healthcare industry confreres by issuing a series of attacks on the Pharmacy Guild of Australia. The Guild was one of a triumvirate of healthcare professional organisations in Australia which, in 1997, formed the Medicines Partnership to successfully rail against some of the less intended effects of the Federal Government’s then-proposed Therapeutic Group Premium initiative. It was as a result of this partnership that the Guild and the pharmaceutical indus- try—managed to convince the then Fed- eral Health Minister, Michael Wooldridge that the move was just bad policy and would work against the inter- ests of patients by bundling broad groups of drugs such as SSRIs into therapeutic groups to save the PBS money. It was just bad medicine for everyone concerned, and Wooldridge, ever the consumate political pragmatist, won the argument in Cabinet. The move was abandoned and modified to reflect sensi- ble policy. But the old government rule—where money has to be found and saved— remains divide and conquer. In a series of broadsides at the Guild over the past six months, the AMA has sniped at pharmacists on the basis of misinterpreting Guild motives that suggested, in some cases, that pharmacists might be able to prescribe for the chronically ill. In its typically blustering fashion, the AMA, not usually known for its ability to think first except in self interest, launched a tirade by press release against the Guild, which, to its credit, has remained publicly mute in response. The latest move appears to be designed to support the Federal Health Minister, Tony Abbott, in a bit of high profile kite flying on the question of floating patient co-payments. Now, let it be clearly understood that the Minister—and his government— aren’t great fans of the AMA, whose sup- port for re-electing Howard was loud and copious in the pre-election runup. As soon as they got what they wanted—namely, an open chequebook to hit the bulk billing trail—they upped their fees as soon as the incumbent government bums were back on the benches. It’s no surprise then, that the increase in bulk-billing trumpeted to the media recently by the Minister has come at a price—a $1bn blow-out to the health budget. The AMA, of all political organisa- tions—the government prefers to call it a trade union—should understand the nature of divide and conquer, and con- quer and rule. The existence of the Aus- tralian Divisions of General Practice, now headed by former Guild Federal Coun- cillor Kate Carnell, is testimony to how the AMA has failed its own members— some 18,000 GPs to be precise—and pre- sides over a falling membership within its own ranks. The GPs are now largely with the ADGP, which is the first cab off the med- ical rank that government turns to when discussing policy. And, this on the Gov- ernment’s part, deliberately, leaves the AMA out in the cold as a trade union with no real representation or political grunt, except by press release. The AMA and its constituencies are advocating now that the float in patient contribution will result in PBS cost savings because, if it is implemented, it will come out of pharmacy pockets, which it claims represent 20 per cent of PBS costs. Not so. The Guild has the real figures, and so does the Government, which is content now to sit back and watch the brawl develop to its own benefit. Just for the record, people ought to try and grasp that the Government already spends huge unnecessary taxpayer funds on over-prescribed drugs. Ask the Return 148 ? THE AUSTRALIAN JOURNAL OF PHARMACY VOL.86 MARCH 2005 of Unwanted Medicines organisation. Wastage costs this country heaps. And who got the ball rolling on RUM and Quality Use of Medicines? The Guild and the Pharmaceutical Society of Australia. By floating the patient contribution, the Government intent is to achieve savings under the patient contribution cap. But what the effect will be is precisely opposite; it will cause patients to forget the lessons of the $24m Dr James Wright ‘Save the PBS’ advertising campaign which resulted in the cost of medicine put clearly on the bot- tle for the benefit and education of patients. The elderly population, who hoarded medicine without realising the cost impli- cations, were astounded. The whole notion of discounting encourages patients to buy more. Ask Gerry Harvey. Harvey Norman goes from strength to strength as a retailer by convincing people they save more by spending more in a discount environ- ment. But, it’s different with taxpayer-sub- sidised drugs. Discounted co-payments mean more drugs will be dispensed. PBS costs will rise. The whole notion of co- payment is to discourage unnecessary use of medicines by having patients ask them- selves whether they really need a med- ication. It’s not just about preserving a sustain- able PBS—it’s about ensuring sustainabil- ity of getting medicines to the commu- nity—and in proportion to what the PBS can afford. The AMA would do well to cease its untimely self-interested sniping at phar- macy and concentrate on the real policy issues here so that it can take a place at the Medicines Partnership table on a con- structive basis. Perhaps then it can attain credibility by working with its health pro- fessional peers to engage government in a productive dialogue leading to better out- comes all round. ¦