Senator FORSHAW (2:10 PM) —My question is directed to Senator Patterson, the Minister for Health and Ageing. I ask: Minister, are you aware that the Department of Health and Ageing has revealed that it has not undertaken any modelling on the impact of the government's proposed changes to Medicare in any of the following areas: the increase in out-of-pocket charges to patients who do not have a health card, the changes to bulk-billing rates as a result of the package, or the inflationary impact of the package? On what basis did the Prime Minister conclude on 28 April: `I don't think there is anything in this package to encourage doctors to inflate their fees'? On what basis did he make that conclusion, when the department involved has not conducted any economic research on the matter? Minister, why have you been so slipshod in the development of your so-called A Fairer Medicare package?

Senator PATTERSON (Minister for Health and Ageing) —Let me tell senators what has an inflationary impact on gaps in general practice. It has an inflationary impact when you do not have enough doctors in an area—when you have too few doctors in an area—and they, therefore, can choose not to bulk-bill. The areas where we have the highest bulk-billing rate are areas where there is a large number of doctors. Guess where that is? It is in the inner city areas of Sydney, Melbourne and Brisbane.

Senator Cook —The leafy suburbs.

Senator PATTERSON —It is not just the leafy suburbs. There are many suburbs in inner city Melbourne, Sydney and Brisbane that are not leafy suburbs. We inherited a maldistribution of general practitioners—far too many in the city, far too few in the country. As I have been saying for a long while, some people have never seen a bulk-billing doctor. In 1984, when bulk-billing was first brought in, Dr Blewett sent out a letter to people. Coincidentally, recently I was looking through some of the letters that went out to people. Dr Blewett wrote—and this was aimed at people on low incomes: `If the doctors choose to bulk-bill you, then you will pay no gap. If the doctor chooses not to bulk-bill you, you will pay a gap.' It was never meant that everybody would be bulk-billed, not since the inception of Medicare. Senator Forshaw will find—in fact, I do not know whether he will find this, because I doubt he goes out to the country—that in areas where you have fewer doctors, you have less bulk-billing.

Since we came to government we have spent $562 million on programs to get doctors into rural areas. Over the last four years we have seen an increase in the number of doctors in rural areas of 11.4 per cent—4.7 per cent in the last year alone. We have had to improve access. When I go out and talk to people, as I do, they say to me, `We want access to general practitioners.' The A Fairer Medicare package also includes a significant number of nurses to work in, and assist, general practice. As I move around general practices, they keep talking to me about practice nurses, to assist them and take the load off them. We cannot create doctors overnight. We have used incentives to move doctors into outer metropolitan areas. The $80 million outer metropolitan package was planned to shift 150 doctors over four years—I think 107 doctors now have moved—into outer metropolitan areas. Access to doctors is very important to Australians. Whether they bulk-bill very much depends on the number of doctors in a particular area.

Let me also say that, during the last six years of Labor, rebates went up by nine per cent in a high-inflation, high interest rate period. Under us, rebates and incentive payments for delivering outcomes—including giving doctors incentives to actually assist people in managing their diabetes, asthma and mental illness—have gone up by 30 per cent in the same period. The Labor Party never did anything about it. We have increased remuneration for doctors. We have actually increased incentives for doctors to stay in rural areas—$562 million to relocate doctors; to do something about the maldistribution we inherited. The actual number of doctors has a significant effect on bulk-billing. Let me just remind Australians that almost seven out of 10 visits to a GP are bulk-billed and almost eight out of 10 visits for people over 65 are bulk-billed.

Senator FORSHAW —Mr President, I have a supplementary question. Given that senior health industry figures view this minister as nothing short of embarrassing—

Government senators interjecting—

Senator FORSHAW —they were their words—and given that her ministerial career is on the slide, will the minister at least give the Senate a cast-iron guarantee that the so-called A Fairer Medicare package will not lead to an increase in doctors' fees? Will you give that assurance, Minister?

Senator PATTERSON (Minister for Health and Ageing) —When Ms Gillard gives an assurance that doctors' bills will not increase. We are unable to dictate to doctors what they charge, and never have. Nor did you and, I presume, nor will you. The issue is that we have too few doctors, particularly in outer metropolitan and rural areas, and they are the areas where we see larger gaps. Let me also say that, under Labor, the gap for going to see a GP increased significantly more than it has under us during the same period. Go back and look at your record on the increase in gaps.