Mr GEORGIOU (8:39 PM) —I wish to support the comments of the honourable member for Riverina on the Health Insurance Amendment (100% Medicare Rebate and Other Measures) Bill 2004. Medicare has been one of the cornerstones of the Australian public health system since it was introduced by Gough Whitlam almost 30 years ago. I take the honourable member for Blaxland's point: I do not think there is much point in beating around the bush and pretending that the coalition has always been unequivocally committed to Medibank or to Medicare as it now is. That is not the case. Many of us recollect the constant changes made to Medibank under the Fraser government—indeed some of us participated in them. There were our successive promises in the 13 years of opposition to fundamentally change the basic components of Medicare once it was reinstalled by the Hawke government.

The fact is, however, that, whatever the Labor Party says, this all changed with the demise of Fightback and when John Howard as Leader of the Opposition gave an unequivocal commitment that the coalition would fully retain the Medicare system. I believe this commitment has been honoured and indeed exceeded. One of the Howard government's great success stories has been its reinforcement of Medicare. It may have taken some ideological revolutions to get there, but once the commitment was made it was kept. The government has worked to secure the long-term viability of Medicare to ensure that all Australians have improved access to the multitude of medical services available to the community and to keep our medical system affordable for those who need to access it.

The Strengthening Medicare policy was an important step towards meeting these objectives. It is worth reflecting on some of its key components. Some 60 per cent of GP consultations in Australia involve medical services delivered to children under the age of 16 years and to concession card holders—pension, health care and Commonwealth seniors card holders. The government determined that when a bulk-billing GP treated these patients the payment to the doctor would be increased by $5, and further increased to $7.50 if the doctor were located in remote or rural areas which included all of Tasmania. These amounts have increased to $5.10 and $7.65 respectively as a result of indexation from 1 November of this year.

Before we turn our attention to the next step in this process—the 100 per cent Medicare policy that is the subject of this bill—it is worth while noting the success of the earlier bulk-billing initiative. The national bulk-billing rate at the end of the September 2004 quarter was 71.8 per cent. Since the Strengthening Medicare package was announced earlier this year it has risen by 5.3 percentage points, or eight per cent in relative terms. The national bulk-billing rate for Australians aged 65 years or older is even higher, with 82.1 per cent of all medical consultations in that category now being bulk-billed. In sum, in all states and territories the rate of bulk-billing continues to increase even before the introduction of 100 per cent Medicare in January 2005.

The 100 per cent Medicare will deliver additional benefits to GPs. It will make medical consultations even more affordable for patients. In our health system, medical benefits are based on a fee determined for each medical service, which is the `schedule fee'. Until now the medical benefit paid for a GP consultation has been set at 85 per cent of the schedule fee. That percentage applies to all out-of-hospital medical benefits. From 1 January 2005 the MBS will pay a 100 per cent rebate for schedule fees for all GP visits in lieu of the 85 per cent figure that applied historically. In dollar terms this change means an additional payment of $2.10 for a short consultation, $4.60 for a normal consultation and up to $12.90 for extended consultations in excess of 40 minutes in duration. For a standard 15-minute consultation in a GP's surgery, the new Medicare rebate will be $30.85.

Importantly, this very substantial increase in payments for a GP consultation will apply to all consultations. It does not matter whether or not the doctor bulk-bills the patient for a medical consultation. That is a very important point of distinction, both philosophically and in policy terms, between the government and Labor. The Labor alternative announced during the election campaign was to increase the rebate for GP consultations to 100 per cent of the schedule fee, but only in circumstances where the consultation was bulk-billed. The government is committed to the independence of the doctor-patient relationship. Under this policy the choice of whether or not to bulk-bill would remain with the doctor.

The increase in the rebate to 100 per cent of the schedule fee will apply to all medical consultations regardless of whether or not the doctor elects to bulk-bill the patient. If the doctor does bulk-bill, the doctor will receive the additional payment of $4.60. If the consultation is not bulk-billed, the patient will derive the benefit of the additional money to reduce the out-of-pocket costs. This is a policy position that allows doctors and patients to concentrate on the essential task of providing and receiving quality health care, knowing that minimal costs will be incurred by the patient. The higher rebate for medical consultations will apply to consultations delivered in a doctor's surgery, at the patient's home or in a residential aged care facility, and even to hospital consultations involving non-admitted patients.

It should be noted—and this is important—that this decision to increase the rebate to 100 per cent of the schedule fee in no way impacts on or detracts from other bulk-billing initiatives and incentives that I outlined earlier. The Howard government's $5 and $7.50 bulk-billing incentives, introduced as part of the Strengthening Medicare package, will continue to be paid over and above the base schedule fees. In a similar vein, entitlements under the Practice Incentives Program will not be impacted on by the 100 per cent Medicare initiative. As was pointed out, the 100 per cent Medicare initiative will cost $1.8 billion over four years. This is a commitment that can be made and a benefit that can be passed on to all Australians because this government has delivered such strong economic growth and prosperity over a substantial period. It is a policy that will ensure that Australians have better access to medical services and that those services are more affordable.

There are a number of other initiatives involved in the government's commitment to Strengthening Medicare, including Round the Clock Medicare, which funds a diversity of after-hours medical centres. One of the key elements of Round the Clock Medicare is its flexibility and its capacity to respond to different circumstances and environments. Labor's alternative, Medicare After Hours, relies on just one model—GP clinics co-located with public hospitals. This is a one-size-fits-all model that is characteristic of Labor and does not optimally serve the provision of better health care in the community. On some occasions, hospital co-located after-hours clinics will be an appropriate solution, but often community needs can be better met by different solutions: clinics in the community, perhaps located close to public hospitals; private hospitals themselves; or dedicated freestanding practices.

The bill also rectifies a drafting error in the initial legislation that established the safety net. Australians incur a range of costs for medical services that extend beyond a GP visit: specialist consultations, pathology and an ever-increasing array of radiology tests. Anyone who has experienced the costs associated with a serious accident or a complex long-term illness will know only too well how medical costs can quickly accumulate. The safety net is another example of the government acting speedily to provide assistance for Australians in these circumstances.

This bill ensures that eligibility for the safety net at the $300 threshold will be confirmed for all families that are eligible for family tax benefit part A payments. A drafting error in the original bill meant that families who deferred their family tax benefit payments might have missed out on safety net eligibility at the lower threshold. This bill confirms their eligibility and gives the minister the power to determine that a registered family is an FTB A family for the purpose of the safety net $300 medical out-of-pocket cost threshold.

As I said at the outset of my speech, after some vicissitudes in its attitudes towards Medicare the coalition has demonstrated an unequivocal commitment to Medicare and to ensuring that all Australians have improved access to affordable medical services. Strengthening Medicare and Round the Clock Medicare were important parts of that process; so too is the subject of the bill now before the House—100 per cent Medicare. The government can be rightly proud of its achievements across a broad spectrum of policies and programs, and health is one of these. This bill continues the government's commitment to providing all Australians with better access to, and more affordable, medical services. I commend the bill to the House.