Senator LEES (10:52 AM) —I would like to start off where Senator Allison finished by thanking the committee, all the people who made submissions and, in particular, all of the people who came along to the dozen or so hearings and presented evidence to the committee. I have to begin by saying that, as we went through this process—all the hearings and submissions—we found only one group at one hearing that was fully supportive of what the government is doing. The overwhelming response was opposition. At the end of the day I have to say this is not a fairer Medicare package but a smaller Medicare package, because that is effectively where we would be going. I support what Senator Barnett said about Medicare being related to adequate access for all Australians to affordable services; but the only Australians accessing affordable services under this package would be those with health care cards—the rest of us would be off in another system that would get more and more expensive as time went on.

I do have to object to some of the comments that Senator Barnett made, particularly those relating to us `skewing' the information before us or that in some way this whole process was skewed. I have to say to the government senators that their aggressive approach at times undermined our ability to work constructively and get to the bottom of what we needed to present to this chamber—and hopefully what the new health minister will need to do to get any legislation through this chamber. I hope he is reading this report as we speak.

I will turn to some of the core problems. A core issue is the affordability and viability of general practice. I will talk later about some of the recommendations relating to increasing the number of places in general practice et cetera. The problem is that we cannot fill the training places now. Doctors coming fresh from university look around for what they are going to do and head off into specialties because, firstly, GP practice is so complex these days and, secondly, it is so underfunded. As one registrar said to me last week, it is the most difficult of all the specialties and it is the lower paid—probably at least 50 per cent less than he could get if he chose to go off into another specialty. We have to do something about that. Maybe fee for service is not the answer. The Practice Incentives Program is good but, as the recommendations say, it needs to be looked at for its complexity and the amount of paperwork it puts GPs through. Certainly, the practice incentives are a good way of supporting GPs on the one hand and getting them to look at things like prevention on the other.

The key recommendation for me is the fact that we cannot just target these changes at cardholders. We must look at a system that will get us back to rates of at least 70 per cent bulk-billing across the community and give the doctors the flexibility to decide who is bulk-billed. As doctors appeared before us, we found that even when they were not in bulk-billing practices most of them were in fact bulk-billing most of their cardholders, children and older patients. But we need to give them the financial incentives to broaden that out and ensure they bring in all the low-income families. I really think doctors are the best ones to make the decision as to who they bulk-bill.

Looking at some of the specific recommendations, 8.1 relates to the bonded medical school places. We all found it necessary for the bonding time to start during training, partly because doctors start putting down their roots and establishing relationships in those first few years out of uni, if they have not already. We cannot then expect them to move out into the areas we want them to. The part of this recommendation relating to nurses not being linked to the bulk-billing of only cardholders is extremely important. Extending opportunities for GPs, particularly in the city practices, to have access to practice nurses is another absolute essential. Providing GPs with support for IT and getting them online is also an absolute essential for rural and remote doctors in particular, but it is an expensive exercise and it comes back to what I will be talking about later today in the debate relating to the sale of Telstra. There is enormous potential for e-health, but we have to provide doctors out there with the bandwidth services, the Internet access and the ability to use those new opportunities.

Recommendation 12.2 relates to co-locating GP services with public hospitals in those areas where there are few, if any, doctors bulk-billing—indeed, few doctors. This relates to one of the good recommendations in the government's proposal: an extension of the existing scheme, which we found in the Hunter and that is already spreading to other states. Whatever mix is negotiated, however it is done, we have to get greater coordination and cooperation between the states and the Commonwealth when it comes to providing after-hours services. We do not want people queuing for hours in our public hospitals, using what will effectively become very expensive services. We need a triage system, whereby those enormous numbers of people who just have a cold or flu and turn up at emergency can be diverted away from the emergency rooms and into more appropriate support.

The recommendation relating to research is extremely important; it was one of the issues highlighted at the three-day health summit that was held at Old Parliament House a few weeks ago. We must do more to do the research and get the detail as to what is working, what is not working, what is causing the adverse events et cetera and then build that information into our system. Systematic reform is something I have been arguing for now for about 10 years. We need to look again at all the cost shifting and buck passing between the Commonwealth and the states and develop a health system that really works for people on the ground.

Turning to other important issues, I cannot understand what the problem is with the existing safety net. This is what the committee has said in its report:

If we were to do a survey of Australians, maybe one per cent of them would know that there is that safety net in Medicare. The government needs to publicise what it already has. It is a good system; there is absolutely no need to involve private health insurance in GP services. Indeed, I think one message to the minister out of this report should be that it has absolutely gone—that that part of the government's package might as well be ditched now, before they even bother to bring something different back into this place. But we must take it further.

I would also like to go beyond this report to look at the MAHS program provision of allied health services for GPs. We looked at psychologists, physiotherapists, dieticians and a raft of other allied health services. Doctors want to work beside these other professionals in the general practice setting so that they can provide for their patients the appropriate care at the appropriate time. One issue that was highlighted for me was the need for young people to have better psychiatric services—better mental health services. At the moment, certainly in my home state, they are virtually nonexistent, whether public, private or whatever. If GPs could be the gatekeepers, the fund keepers, and were able to access these services through psychologists—who could spend one or two hours, not seven minutes, with a young patient who was under stress—I think we would save a lot of money in the long run, not to mention what we would be able to do for people.

I would argue that we also need to go further in the whole area of prevention, but time does not permit me to do anything more now than to look quickly at some of the issues in the government report. They have actually recommended a new system—and I hope this is something the minister is going to look at—where we would have item numbers for nurses. This is something I never thought this government would come at. It is very expensive; it would eat up a lot of the $500 million that we talked about as being the extra money this package needs, but it is very pleasing. They have also talked about—and I briefly mentioned this—more registrar places for GPs. I say again, the problem is we cannot fill the ones we have, because general practice is no longer as desirable as it was. The report also looks at overseas trained doctors. The solution does not lie in getting more people in from overseas. We have to sort out the issues we have here and, certainly, making sure that anyone from overseas is trained properly is essential—that is another issue. The strangest of all their recommendations is to lift the rebate for private health insurance from 30 to 35 per cent, heading up to 40 per cent. What an extraordinary waste of money! I think we can find far better things to do with the limited resources this country has than to throw money down the private health insurance drain.