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Thursday, 25 August 1994
Page: 396

Senator WOODS (4.22 p.m.) —It is very interesting to listen to Senator West—a few of those old chips on the shoulders were coming out again through the anti-doctor bashing for which she is renowned. Doctors, of course, are quite competent in treating the sorts of things Senator West mentioned, like glue ear. Senator West does not seem to be aware that there are family medicine training programs without which one cannot become a GP. What does she think those focus on—cardiac transplants in the back room? For goodness sake, she should get up-to-date. She should really get her feet on the ground as well.

  I clearly understand what Senator West is saying—that there is no doctor in Adaminaby, which has a population of 300 or 400. There is also no social worker, counsellor, occupational therapist, speech therapist, physiotherapist and dietitian, and no railway and youth and community services department. This is a community of a few hundred people. Is Senator West seriously suggesting that such a community would have that? Of course not—that is in Cooma, which is 30 to 40 kilometres away, and that is the problem. One can have those things in Cooma but one cannot actually have those things on site when it comes to the day-to-day needs of a small community like that, which is one of the nicest communities in the world. If one had to chose an idyllic place to live, one would live somewhere like Adaminaby and enjoy the pleasures of the surrounding mountains.

  There seems to be broad agreement about the problem. To my knowledge, the government—to use Senator Crowley's expression—has been addressing it since 1990. Although I liked her expression, `We now have rural doctors and the AMA et cetera to focus on this.' In all honesty, I have to point out that it was the rural doctors who got not only the government but also the opposition, to be equally fair about it, to focus upon a major problem. So it was something which the profession actually did raise and has been very active in raising ever since.

  What are the numbers? Of metropolitan GPs, around 15,000 care for 13 million people; that is one per 800 people. In the rural area there are 3,000 GPs caring for five million people; that is almost double, or perhaps slightly more than double—one GP for 1,650 people. Clearly, as Senator West said, there is a maldistribution problem rather than a shortage overall. There is no question that we would all agree with that. Nonetheless, I am not sure I would find a doctor on every corner but, still, Senator West was accurate in other regards.

  What of the number of vacancies? It is probably 400 or 500 in procedural and non-procedural GPs. On top of that, of course, we need 400 or 500 locums plus a couple of hundred specialists. So there is a major problem which may, as Senator West said, have been going on for 30 years but, certainly, is a problem now which is escalating out of control. Whichever area of expertise one asks in that regard, they will all agree that the problem is deteriorating.

  The question which nobody seems to have addressed yet is: does this matter? The answer, clearly, from a recent report published by the ANU entitled `Rural health outcomes' is yes. The only thing that really matters is whether people are sicker in given areas. Rural health outcomes are worse than metropolitan ones: there is a 90 per cent increase in female deaths from pneumonia and influenza; 50 per cent more diabetes; significantly more overweight and heavier smokers; a higher incidence of heart disease, cardiovascular accidents, genital-urinary diseases, respiratory diseases; and, indeed, they live shorter periods of life.

  Seventeen per cent of rural residents have significantly poorer outcomes in health terms. Sadly, there is a correlation with spending because less government money is spent in rural areas per capita. And this is without touching upon the details of one other major shame for Australia which is the terrible status of Aboriginal health, which we are only addressing peripherally here today. We have looked at some of the reasons. I think there is broad agreement about those reasons: the isolation for families and schooling for the children; the higher responsibility through being expected to be able to cope with the whole range of things that perhaps the metropolitan GPs are not expected to cope with; the lack of ongoing education; very importantly, the lack of locums; and again, as Senator West mentioned, the decline in available hospital support.

  Why are hospitals being closed? Senator West blithely blamed the states. However, she forgets that in fact the sizeable chunk of funding for public hospitals, large and small, is allocated by the federal government, and the federal government's share of that contribution has been reducing steadily since the entrance onto the scene of the Labor government. The decline in funds runs into billions of dollars, and that is why hospitals are having to be closed, and that is why the most inefficient ones, which are the ones in the country, are the ones which go first. If one is trying to run an efficient hospital system, sadly, those are the ones which have to go. If that funding is not restored by the Commonwealth government, those sorts of constraints will continue to occur.

  One of the issues raised earlier by Senator Sandy Macdonald was the question of litigation insurance, medical defence insurance by GPs. A document tabled earlier by Senator Crowley indicates that something like 687 GPs who used to deliver babies no longer deliver babies, and that is over a period of some three or four years. This relates to the rise in the cost of indemnity which next year, I believe, will be about $7,000 or $8,000 per GP. At that sort of level the GP has to deliver something like 30 babies, allowing for his overheads, before he even makes a cent on his Medicare rebate.

  In that situation, why would one bother? Why would one go through the risks of litigation, the extra work and being called out at night for no return at all? Let me just say in passing, because time is constrained, that the proposal by `Ms Tito' which will basically say that there is a no blame option, that is, anybody who does not get a good health outcome is entitled to compensation, is absolute lunacy in financial and social terms.

  What are the solutions? Clearly, we need more doctors in the area. How do we get them there? There are a number of key things, one of which is to get people from the bush to go to medical school. Senator Lees very sensibly touched upon one issue there: we need to make sure that in the current situation where drought is ravaging the bush families who want to send their children to medical school are not financially constrained from doing so. Adjustments to Austudy or the introduction of a similar allowance are very important issues for bush families

  If one comes from the bush, one is more likely to go back. One needs to actually make sure that, as in New South Wales, there are some rural doctor's initiatives. The New South Wales department under Ron Phillips has put in a few important initiatives. The rural doctors resource network as a way of supplying locums is a crucial incentive to have locums available to back-up these doctors. There are five rural health training units either established or being established around New South Wales. It is important to ensure that students do undergo electives and get a taste for some of the attractions and benefits of the system.

  It is vital that people in rural areas have access to the very best of health. It is a vital responsibility for the Commonwealth to ensure it does its best to ensure that.