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Wednesday, 25 September 2002
Page: 7291


Ms HALL (11:25 AM) —Later in my speech I will make some comments on bulk-billing. That is something I had not intended to do when speaking on this piece of legislation, but I need to put on record the facts and figures that relate to my area—facts and figures that have been researched and are accurate, not figures that have been pulled out of the air with obviously no validity whatsoever. I will discuss that a little later. I will give a very detailed explanation of bulk-billing within my electorate, which across the board, including veterans, stands at a bit over 60 per cent—hardly the figure that the previous speaker was discussing.

The Health Legislation Amendment (Private Health Industry Measures) Bill 2002 amends the National Health Act 1953 and the Health Insurance Act 1973. The amendments are basically technical ones that we on this side of the House do not have any problems with. Overall, this should make the whole system work a little better, so there is no problem there. The legislation seeks to remove unintended differences between contractual gap cover arrangements which were introduced in 1995 and gap cover schemes, as well as to transfer the oversight of this to the Health Insurance Commission. The gap refers to the difference between the fee that doctors charge for services provided in a hospital and the combined Medicare and health insurance benefits for those services.

I have been contacted in my office on a number of occasions about the problem with the gap. It has caused hardship for a number of people when they have had a stay in hospital. They have found that there is quite a difference between the money they get back from the health insurance fund and the cost of the services they received from their doctor. I think it is really important that governments do address this issue and that there are schemes in place that deal with this. One of the issues contributing at the moment to an increase in the size of the gap is the problem with medical indemnity. A number of specialists within my area have charged their patients a $200 gap fee up front to cover that insurance. That is something that I do not think is acceptable and that I have forwarded on to the Minister for Health and Ageing. I hope it is something that she will address.

I would like to refer to a health survey that I have been conducting within my electorate. It has been sent to everyone in the electorate. I must say, it is early days at this stage; I have received just under 1,000 responses. I asked people in the Shortland electorate to rate nine different questions from one to nine, in order of importance. The questions related to having a doctor who bulk-bills; being able to see a doctor locally when sick, which is a very big issue in the Central Coast part of my electorate; retaining Medicare; listing medicines on the Pharmaceutical Benefits Scheme to make them more affordable; increasing the costs of prescriptions; having a Commonwealth dental health scheme; having access to medical specialists in your area; and having affordable private health insurance. The last question I asked was about having no gap payment for surgery or a stay in a private hospital.

It is really interesting that only two per cent of those who have responded to the survey to date said that the no-gap payment for surgery was the most important issue. I thought I would expand it out to look at the people who listed it in their top three in order of importance. Even in doing that, only 14 per cent put that in their top three. That compared with the 33 per cent of the people who said that having a doctor who bulk-bills was their No. 1 issue, 19 per cent who put that as their No. 2 issue—which takes it up to 52 per cent—and nine per cent who put that as their No. 3 issue. So that is 61 per cent, as opposed to 14 per cent. There is quite a disparity there in the way people view the importance of the gap payment. You can link that to another question, on having affordable private health insurance, which only four per cent put as their first choice. There was strong support for retaining Medicare—over 60 per cent of people put that in their top three. To make a valid comparison, 21 per cent of people put affordable private health insurance in their top three.

I really try to listen to the people of Shortland, and the survey I sent out was scientifically valid. It was not a survey that was designed to elicit a special response from people. It was designed to obtain a response that was free of manipulation, and the wording was in no way emotive. So it seems to me that if I am listening to the people of Shortland, I would have to say that having a doctor who bulk-bills, retaining Medicare and being able to see a doctor when they are sick—something I indicated earlier is a real problem in the Central Coast part of the Shortland electorate—are the top three issues. Two of the least important are having affordable private health insurance and not having to pay a gap when they stay in a private hospital. This is important information, not only for me, not only for us in the opposition. I believe it is something that the government should listen to, too.

I might slip sideways to what the previous speaker said about bulk-billing and her comment that there is absolutely no crisis in bulk-billing. I had no intention of talking about various aspects of bulk-billing as it relates to my electorate. In the northern part of the Shortland electorate that falls within the Lake Macquarie City Council area, we contacted 24 doctors. Out of those 24 doctors, only 19 bulk-bill pensioners. There were some doctors who would forward off their accounts and charge the pensioners between $5 and $10 to save them going to a Medicare office. But I think it is very important to point out that something like 22 per cent of doctors within the northern part of Shortland electorate were bulk-billing. It was a little less—under 20 per cent—in the southern part of the electorate, which is on the Central Coast. And an incredibly low percentage—under 10 per cent—of doctors in both the Lake Macquarie part of Shortland electorate and the Central Coast part of Shortland electorate bulk-billed all their patients.

It is not true to say that bulk-billing has increased. There has been a dramatic decrease within my area and the areas of other members on this side of the House. We have actually monitored what is happening. It is not hearsay; it is fact. I needed to put that on record, but my contribution from here on will be quite brief.

Prior to 1995, the National Health Act 1953 prevented private health insurance funds from providing benefits that were greater than the medical benefits schedule. Seventy-five per cent was provided by Medicare and 25 per cent by private health funds. The 1995 amendment allowed the establishment of purchaser-provider agreements between hospitals and doctors, and between hospitals and insurance companies. This was welcomed by some people. In the electorate of Shortland, not too many people welcomed it because it was not seen as a high priority—but some did and it was very important that it was dealt with.

The Health Legislation Amendment (Gap Cover Schemes) Act 2000 amended both the National Health Act 1953 and the Health Insurance Act 1973. The amendments allowed private health funds to establish gap schemes. That helped some people but there are still some problems with it, as all members in this House would know. Health insurance funds claim that doctors are not participating in gap schemes within the spirit of the legislation. Some unscrupulous doctors even used the establishment of gap schemes to increase the cost of their services. That has been fairly widely documented, and it is something that members on either side of this House oppose.

The AMA has serious concerns about using gap cover arrangements because it feels that they compromise the independence of the relationship between doctors and patients. There is probably a relationship between the two points that I have just made. Doctors like to be able to determine what prices they are charging their patients. In the overall scheme of things, probably the people who miss out and whose needs are not considered are those who rely on doctors, the government and health funds to ensure that the money that they are contributing—massive amounts of money—to health insurance is going to deliver them a service for which they will not have to pay a gap. The Consumer Health Forum of Australia was generally supportive of gap fund legislation.

The government has put a lot of money into health insurance. The government made a choice, as is its prerogative, to invest in health insurance rather than public hospitals. I know that if we were in government our priorities would be funding public hospitals and ensuring that doctors bulk-bill, that Medicare is retained and that all Australians get access to good quality health coverage and services. The kind of service you receive should not be determined by your ability to pay private health insurance.

The previous speaker also referred to the cost of health services. The country whose health service costs are amongst the highest is the United States. The model that this government seems to be moving us towards is a model that is very much driven by the private market and one in which access to health services—being able to receive medical treatment when you need it—is determined by your ability to pay.

We on this side of the House believe that basic quality health care is the right of all Australians; it is not a privilege. The government should do some independent research of its own and find out just how supportive Australian people are of private health insurance and the issues raised in this legislation. It should find out whether or not Australian people are concerned about having a doctor they can go to who bulk-bills, about retaining Medicare and about having enough doctors in their area to have an appointment with their doctor when they are sick and not have to wait between seven and 14 days. We support this legislation. It is technical in nature. I have absolutely no problems with it.