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Monday, 23 June 2003
Page: 17218


Mr COX (5:30 PM) —Thank you, Mr Deputy Speaker.


Mr Slipper —Is this your maiden grievance debate speech?


Mr COX —For this parliament, it is my maiden grievance debate speech. The latest figures show the proportion of doctors' services bulk-billed has fallen by 20 per cent over the last two years in the outer southern suburbs of Adelaide in the electorate of Kingston. The December 2002 figures show a bulk-billing rate of only 58.1 per cent. This is a precipitous drop from about 78 per cent only a couple of years ago. What has caused it? The Howard government has refused to maintain the value of the Medicare rebate and it has now fallen below the cost of running a general practice in large parts of Australia.

The Howard government has been forced to respond to this crisis but its Medicare initiative has failed. The best way to illustrate why it has failed is a tale of two doctors' surgeries on either side of Doctors Road. Doctors Road divides the suburbs of Morphett Vale and Hackham in my electorate. This is a case study of the problems facing general practice in outer metropolitan areas in Australia today. There is a chronic shortage of doctors, and financial pressures mean bulk-billing is rapidly vanishing. In the outer southern suburbs of Adelaide there has been a long-term shortage of more than 30 doctors. That problem has become much worse, with three practices closing in the last few months.

The practice on the Morphett Vale side of Doctors Road bulk-bills all its patients. It is large and well organised, with two sites, seven doctors and a practice nurse. The doctors in this practice had been waiting for the Howard government's Medicare package before deciding whether they could continue to bulk-bill. With it they will get an extra $1 per consultation. After almost 30 years of bulk-billing, they will now reluctantly start to charge a gap fee.

The practice on the other side of Doctors Road is in a shopping centre at Hackham. It is a small family practice. The doctor and his wife, who is the practice manager, stuck to bulk-billing until November last year. They had found three doctors who, in their retirement years, were prepared to work for them for the going rate, which is about $70 to $80 an hour. The only reason that this doctor and his wife were able to continue bulk-billing until last November was that they were paying themselves exactly half of what they were paying people who worked for them. Reluctantly, they gave up bulk-billing last November and began to charge a $5 gap fee.

That $5 gap fee is about the amount per service Labor's new Medicare policy would provide to a practice in an outer metropolitan area with the socio-demographics of that practice in Hackham. So, if Labor's policy were implemented, one of those practices would be able to keep bulk-billing and the other would be able to return to bulk-billing. With the Liberal government's policy, neither of those practices will be able to bulk-bill. Both practices are operating in a low- and middle-income area where there are many families and retirees on tight budgets. Both practices are providing quality medicine.

As gap fees rise and the shortage of doctors worsens, many people are missing out on the primary health care they need. People either cannot find a doctor or cannot afford to pay the gap fee. Doctors cannot bulk-bill when the Medicare rebate is below the cost of running a family practice. Low- and middle-income Australians need Medicare and they need their government to put resources into saving it.

One aspect of the Howard government package will actually worsen the shortage of doctors in outer metropolitan areas. Allowing doctors to swipe both a Medicare card and a credit card at the same time—the Medicare card for the rebate and the credit card for the gap fee—means it will be easier for doctors to put up their charges, because there will be less resistance from their patients to paying those gap fees. They will not have to pay the full charge instantly and so they will find it much easier to accommodate the gap fee on their credit card.

In the leafy inner suburbs, where people are affluent and do not feel the impact of a $20, $30 or even a $40 gap fee, doctors' incomes are going to get a big boost. I predict that in two years GPs will be driving Mercedes and Porsches and looking at even more expensive residential real estate. When that happens, the disparities in income between doctors working in outer metropolitan areas and those working in the leafy suburbs will become that much greater. That will make it much more difficult to attract doctors to practise in lower income outer metropolitan areas.

And what of the people on lower incomes living closer to the city? Under the Howard government's package, participating doctors will only be required to bulk-bill Commonwealth card holders. To qualify for a health care card, a family of four must have an income of less than $32,600. If they have more than that, in those areas where doctors charge high gap fees, they face enormous doctors bills.

There are some practices in the outer metropolitan areas that have had to pay extra to attract doctors. The additional salaries that they are paying in those areas are quite often in the order of $30,000 or $40,000 a year. Those practices do not bulk-bill even health care card holders at the moment—and they certainly will not be able to bulk-bill health care card holders and pay those salaries in those areas under the Howard government's package.

One of the doctors in my electorate told the ABC's World Today program that there was nothing in the Howard government's Medicare package that would stop him charging $100 per visit and that, if he did so, he would be doing his patients a favour because they would reach the gap insurance limit faster. That is the brutality of the Liberal government's health care system. We are seeing the first steps towards a two-tier American style health system. The affluent will face higher fees but be fully insured; people on low incomes will rely on doctors who are prepared to work for the fee the government is prepared to subsidise. The fact is demand and supply will not match for the second tier and that seems to be a matter of monumental indifference to this government.

And we ought to reflect on how the government is funding its Medicare package. If you have a look at the measures document in this year's budget, you find that the Howard government is spending $917 million over four years on its Medicare package. The same budget document shows a measure which is a reduction in the Commonwealth's subvention for public hospitals in the states. If you add up that row of numbers over the four years you find that, in comparison with the $917 million the Commonwealth is spending on its Medicare package, the Commonwealth is cutting its funding to public hospitals in the states by $918 million. That shows this government's priorities. That is the first step of many that there will be in the health care area where—as GST payments increase to reach the level of financial assistance grants that the states were previously receiving under the old arrangements—the Commonwealth will withdraw specific purpose payments. It will do this in areas like health and education.

This is the first big instalment of that. Life will become more difficult for the states to fund the public hospital system and, as far as the patients are concerned, there is going to be a big shift from public provision of medical services to private provision of medical services. The rebates will continue to be held down; they will be held down below the cost of running a practice as they are indeed below the cost of running a family practice even with the government's new Medicare initiative. People will either pick up the cost of gap insurance out of their own pockets or, if they are in the lower income areas where there are very few doctors—and very few doctors who are able to work for the sorts of payments that the Commonwealth will be promising under the Howard government's Medicare package—they will miss out on medical treatment.