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Monday, 26 May 2003
Page: 14916


Mr SNOWDON (5:49 PM) —My purpose this afternoon is to address the House on an issue which is of interest and concern to some elements of the Alice Springs community—that is, the establishment of an after-hours general practice, which is planned to be opened mid-year. The Northern Territory Department of Health and Community Services has been working with the Commonwealth Department of Health and Ageing, local GPs and the Central Australian Division of Primary Health Care to ensure that after-hours services are available. Substantial contributions are being made towards this exercise by both the Northern Territory and the Commonwealth governments. This new facility will be housed in the hospital premises, where the Northern Territory government will refurbish the former eye clinic hospital and let it rent-free to the new service.

The value of the Territory's contribution is approximately $140,000 over two years—being $75,000 for a one-off refurbishment, $20,000 in ongoing operational costs each year and $12,000 per annum in rental revenue forgone. The Commonwealth is contributing in excess of $260,000 over two years to establish the new after-hours service and to extend the existing Central Australian Aboriginal Congress service.

The interest that has been aroused in the community about this is not about the fact that the service is being established but about the fee structure which is being proposed. This clinic, it is hoped, will take the weight and the pressure off the public hospital's emergency department and provide a more appropriate service to many who do not need emergency service. The fee structure for the clinic is proposed to be $70 per visit and $50 for concession card holders. Some argue that this fee may result in a more appropriate service, but it is clear that there will be a large number of people who will not be able to afford this payment and who will continue to use the hospital's emergency department for after-hours general practice type consultations.

I was of the understanding that the purpose of the clinic was to divert people away from the public hospital who could otherwise be general practice patients. The difficulty we have here is that a large number of those people who ought to be going to general practices other than the emergency services at the hospital will not be attracted by the proposition of paying a $70 up-front fee or a $50 up-front fee if they are cardholders. I understand that if they are tourists the fee will be around $100. The issue which raises its head here is that the Commonwealth and the Northern Territory governments have invested in an after-hours service that will, in a sense, not deliver any bulk-billing services after hours to the people of Alice Springs. This is clearly an indicator of the failure of the government's health policy, because at the moment there are no bulk-billing private practices in Central Australia. Central Australian Aboriginal Congress is a bulk-billing practice, but it is not a private practice in the same sense as the other three private practice clinics in Alice Springs.

From the clinic's point of view it is an understandable position. Why should they charge fees which are less than they would otherwise charge in their private clinics during a working day? Because if they charge $60 or $70 as an up-front fee when people attend the clinic during the day, to provide a service at a lesser cost at an after-hours corporate clinic, where there are a number of practices involved, would in fact mean that they would be diverting patients away from their own commercial enterprise. There may be some truth in this argument. Nevertheless, it raises a very serious question. What we are now being led to believe is that in this new practice there is no attempt by the Commonwealth or the Northern Territory governments to induce these doctors to put their fees down.

Recently there have been discussions about the Trade Practices Act and doctors setting fees in these types of practices. It is clear, as a result of advice, that GPs may agree on patient fees in light of a decision by the ACCC on 19 December to grant an authorisation to the Royal Australian College of General Practitioners. In very simple terms, it seems that the ACCC will allow GPs in partnerships with corporate members to agree on patient fees without risking a breach of the act. I might make this observation: they might agree on a $70 fee or they might agree on a $40 fee, but in the case of Alice Springs we are being told that the fee which will be set will be equivalent to the highest fee charged in Alice Springs. I would argue that in this type of practice we ought to be insisting that the fees be minimal. I appreciate the point which is made by those people in general practice in Alice Springs about this diverting away from their own practices, but we are talking about a considerable investment of government funds, of taxpayers' funds, for the provision of after-hours service. I think there is a fair expectation on behalf of the community that the fees which are set in this sort of service mirror the support which has been given by the federal government and the Northern Territory government.

It is very important that we do appreciate, however, that this particular service is important because there are very few after-hours services in Alice Springs. Because there is a paucity—in fact, nil—of bulk-billing medical practices in Central Australia, there is no competition for these practices which are charging up-front fees, and the Commonwealth government has brought no pressure upon these practices to bulk-bill. I understand the arguments which are made by some about the issue of bulk-billing. But there are many people in my constituency, many people in Central Australia, who are relatively poor—and for them to front up with $70 will be a big ask. I also appreciate that there are others who, in the normal course of events, are prepared to pay this sort of money and able to pay this sort of money. But the bottom line is—and I refer to the response by the Leader of the Opposition to the government's budget—that the issue here is really about the way the Medicare system has been eroded by the government over the years since it was elected, since 1996.

This after-hours service allows an uncapped income for doctors. They are guaranteed $50 an hour, whether or not they see a patient, for simply being there, for four hours. Then they will receive 60 per cent of all the takings from the patients. So if the clinic sees two patients per hour for four hours—that is, eight patients at $70 an hour per patient—the doctors' income will be $140 per hour or $560 for four hours. If the clinic sees three patients per hour then the doctors will earn $185 an hour or $740 per four-hour session. I understand the argument about the market and I understand the argument which has been put to us by the members of the private practices in Alice Springs about the need for them to have parity in their charging. But I make this observation: this is an exercise where the taxpayers are investing considerable resources to provide an after-hours service to the general population of Alice Springs. What we may well see here is a lessening demand on the emergency services at the Alice Springs Hospital, but the people who will no longer go to the Alice Springs Hospital are the very same people who will go to those general practices in the course of their everyday consultations.

I ask the doctors involved in this exercise: why won't they accept the capping of fees? Will they allow differential fees being charged by different doctors in this practice? For example, if a doctor normally charges $40 up-front, should they be able to, if they are required and asked to, charge $40 up-front—or should they accept the fee which they would now receive by charging $70 up-front? This practice is one which is welcomed by the Alice Springs community. I will be very interested in monitoring its performance over the next few months, just to see what impact it does have on the calls on the emergency services of the Alice Springs Hospital. But I make this point and this observation: this reflects very poorly on the federal government's health policy. There is a need for us to understand that there is a responsibility on the medical profession to understand that the money which is put in by taxpayers deserves a return—and the return ought to be a public service which does not demand the highest possible fee that doctors are able to charge in the market in Central Australia.