Senator CHRIS EVANS (2:00 PM) — My question is directed to Senator Patterson, the Minister for Health and Ageing. Does the minister have any explanation as to why the September quarter Medicare statistics show a further 2.7 per cent decline in the rate of bulk-billing by GPs and why only 71 per cent of GP visits are now being bulk-billed? Can the minister confirm that the decline reflected in the latest figures was the largest ever quarterly decline and the second consecutive largest annual decline since the introduction of Medicare, amounting to a drastic fall of 9.4 per cent since the election of the Howard government? Minister, why is it becoming harder and harder to see a bulk-billing doctor under the health policies of the Howard government?

Senator PATTERSON (Minister for Health and Ageing) —One of the main reasons that it is becoming harder to see a bulk-billing doctor is because of Labor's neglect of the health system when they were in government for 13 years. You do not create doctors overnight. You do not grow doctors overnight. It takes a minimum of five or six years. If they do a postgraduate course, it can take eight years to get them out into general practice and then three more years for general practice training. The seeds of this problem were planted under Labor. We have put 160 more students into medical training since 2001. Every year we will graduate 160 more students but, again, that takes time. We have spent $560 million on programs to get doctors into rural areas.

A low bulk-billing rate in rural areas is not new. There were low bulk-billing figures under Labor, but did Labor care? One of the issues that affects bulk-billings is the number of doctors. The higher the number of doctors, the higher the rate of bulk-billing. You can go into some electorates and the rate is 90 per cent or so, because that is where you have a higher number of doctors. We have seen an 11 per cent increase in doctors in rural areas in the last four years—an estimated full-time doctor quota of 4.3 per cent. It is the first time that we have seen a turnaround. But that $560 million is going to take a significant period of time to have an effect. As I said, Labor neglected it. When Labor's figures in 1990 were the same as they are now, I did not hear them say, `We should be doing more to increase bulk-billing.' They did nothing to increase it.

Mr Smith goes out and claims that we have done nothing to GP rebates. Over the last four years, GP rebates for short consultations have gone up 14 per cent and, for long consultations, they have gone up 20 per cent. There has been an overall increase in incentive payments for doctors to stay in rural areas. We have seen a significant increase in practice incentive programs. Mr Smith has a solution. He will increase it by most probably reducing the rebate. What is that going to do? That is going to put enormous pressure on public hospitals. The Labor Party are going to fund GPs by reducing the rebate.

They talked about reducing the rebate on ancillaries. Fifty per cent of the rebate on ancillaries goes to dental treatment. So talk to the pensioners who go and get their dental treatment with ancillaries because the states do not do enough about dental treatment. Talk to the states about why people take out ancillaries to have dental treatment because the states do not do it. Mr Smith is talking about getting rid of ancillaries. Nobody knows whether he will get rid of the private health insurance rebate. I was in a hospital on the coast of Queensland just recently—I think that I mentioned it the other day—and the staff there said that, without the rebate, their hospital would have gone under. What is that service doing? It is offering an after-hours service for GPs so that GPs can stay in areas and be relieved of the pressure.

We have done an enormous amount to address the issue, but it is because of the neglect. The thing is that Mr Smith does not seem to care about access and equity. That is the issue that I am talking to doctors about. In some areas, people are bulk-billed and, in other areas, people are not. That is the issue that is of concern to me. That is the issue that I am working on with general practitioners. I would like Mr Smith to come and talk to me and say, `This is an issue which needs addressing.' We need to ensure that we overcome the deficiencies that Labor put in place by not providing sufficient training places for doctors and by not providing sufficient training places in universities. Rebates went up a lot less under Labor than they have gone up under us. We also have to ensure that we get proper outcomes like immunisation, which we have without payments for GPs, going from a Third World country level to a First World country level. (Time expired)

Senator CHRIS EVANS —Mr President, I ask a supplementary question. I am sure that listeners are as confused as I am by that answer. The question was about why bulk-billing rates have reduced under the Howard government. We had a rave about the Commonwealth Dental Scheme, which the Howard government abolished, and something about Labor's neglect. Minister, the question was: why, after six years, is the bulk-billing rate falling? Why is it in the largest decline in its history? Why can ordinary Australians not get to see a bulk-billing doctor? Surely these figures must concern you. What are you going to do about arresting the decline in bulk-billing? Surely you can answer that direct question.

Senator PATTERSON (Minister for Health and Ageing) —One of the reasons that we have a decline is that the number of doctors that are now practising has declined in terms of the population. We have 160 new people in training places. Labor neglected the distribution of doctors. There were more doctors in inner-city areas and fewer doctors in country areas.

Senator Faulkner —You have been in government for nearly seven years.

Senator PATTERSON —Senator Faulkner interjects, `You have been in government for six years.'

Senator Faulkner —I said `nearly seven years'.

Senator PATTERSON —Let me say, again, that it takes six, seven or eight years to train a general practitioner. We put 160 new GPs in training in medical schools in 2001-02, and next year there will be another 160 medical students. They will graduate and they will begin to have an effect. But we also have a program to get doctors into rural areas—an outer metropolitan area program of $80 million to rectify the damage that Labor left. (Time expired)