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Thursday, 25 March 2004
Page: 22015

Senator ALLISON (6:43 PM) —I rise tonight to talk about the launch yesterday by the rural health groups of a 10-point plan and the recommendation in that plan that grants be made available to local councils in rural and remote areas to provide what are known as walk-in, walk-out clinics for GPs. It was very encouraging for us to see the consensus that is growing in momentum around the country for sensible policy solutions like this to the issues that face regional Australia.

Last year in the A Fairer Medicare debate, I advocated walk-in, walk-out clinics on behalf of the Democrats as one way of overcoming the barrier to getting more GPs into country areas. It was part of our comprehensive response—Committed to Medicare—to the government's package. The government was not interested in this more flexible way of getting Medicare dollars into country areas that are currently missing out but, for those in the wider health policy world, it resonated. I received a lot of letters from people who can see that, as a country, we are wasting opportunities to solve longstanding problems.

Witnesses to the inquiry into Medicare said that a significant barrier for doctors serving in the bush, particularly young doctors, was the need to set up shop. It can be a huge financial burden. Purchasing or renting premises, fitting them out as a clinic, finding staff and so on are all reasons why young doctors are perhaps less likely to see a practice in one particular country town as their lot for the next few decades. The Rural Doctors Association report on the viability of rural and remote practices said:

The capital cost of premises and infrastructure and the negative impact this had with regard to recruitment of doctors and on incomes was seen as having significant negative impact on viability.

In essence, the report says that the small business market-oriented approach to health services does not always work well in rural areas, and younger doctors who are not interested in working 60 or 70 hours a week are looking for more flexible and alternative approaches. This means flexibility is needed on the part of the government as well as a willingness to be innovative and to show leadership. It is not good enough for governments to accept the fact that people in remote areas attract $80 a year on average per capita from Medicare when people in the best suburbs of Sydney or Melbourne receive more than $200.

The government should be driven by fairness and equity, not by Treasury and the bean counters. We should not simply be looking for opportunities to avoid spending. We need to get away from the notion that services are just about profit or should at least pay for themselves. Bus services generally lose money out of peak travel times but, if they provide a good service to people who otherwise would not have transport, then we say they have a social and environmental legitimacy. We can expect the government to make sure buses are provided and, if necessary, are publicly funded. That is what taxes are all about. There will be debates about how you step in. Some of those will be ideological and others will be based on good economic sense. Sometimes you will provide an explicit subsidy to a private operator, sometimes you will pay extra to the socially disadvantaged and sometimes it will make good economic and social sense to maintain government ownership.

So what about health infrastructure in small country towns? The government could argue that sinking a lot of money into bricks and mortar with the associated problems of maintenance is not economically sensible. I think it would be hard placed to do so because Minister Abbott has just announced on 18 March an extra $3 million for the revitalisation of regional private hospitals—the bush nursing hospitals on the whole, which have always been private and are another reason why there is inequity in our health system with regard to country and city.

The Ardrossan Community Hospital in South Australia has just received $170,500 to build a new front entrance and redevelop the hospital administration area. Ballan District Health and Care in Victoria has got money for refurbishing bathrooms and replacing floor coverings. The Mildura Private Hospital in Victoria got $94,964 for establishing a telemedicine service at the hospital and providing important educational resources to improve training. All of that says the government recognises that, if you want services in the bush, there has to be infrastructure and someone has to pay for it. In the cases I have just cited, the government has decided it will contribute to infrastructure that has private ownership in order for services to be provided. There is an expectation that the infrastructure associated with public hospital provision is a state matter. States can decide to contract out to private hospitals or they can own their own infrastructure—and they do. Regardless of that, it is still a state matter.

So why shouldn't there be an expectation that infrastructure that is considered an essential component of services that the federal government is responsible for is therefore funded? I have argued for the past two years that rural and regional Australia miss out on Medicare dollars, and this Medicare deficit needs to be addressed. At the moment it makes perfect economic sense for the federal government to decide not to fund GP clinics because in many cases local councils are doing this themselves, but they are doing it out of desperation.

There is another option, such as that at Corryong, where three GPs are employed on salaries. This resulted from a collaborative approach by the hospital when three GPs left the area leaving the entire town without primary health care. In a paper about that service, one of the doctors talks about the great advantages for doctors which we do not often hear about from the AMA and other organisations. He says:

The advantages of public sector employment as a GP are seldom elaborated. The principal benefits are the freedom to practise medicine the way one wishes in a truly collaborative environment with one's medical colleagues and other members of the health team. Salary and conditions for public sector medical staff, including GPs have evolved to be highly competitive with the net outcomes for medical practitioners in other forms of practice, eg corporate medical centres or private practice. Additional advantages include the overhead costs for practice support staff and equipment being met by the employer, in this case being the local Health Service, and the provision by the employing body for Medical Indemnity Insurance. Implementation of such a model of medical service in a small isolated community requires an imaginative, committed and highly competent local Area Health Service management structure. Compatibility of the Board, its Executive and the individual GPs is essential.

So there are other options. We do not need to just look at GP services and primary health care in that small business model.

We will wait with interest to see whether the Medicare package that has been agreed and the safety net which was dealt with in the Senate recently make a difference to bulk-billing rates, whether they are increased in rural areas, whether we have places where there are still no GPs in rural areas and whether MedicarePlus can be made better by measures such as walk-in, walk-out clinics. I am pleased to support the call by those rural health groups. The Democrats are obviously singing the same tune. I strongly recommend to the government that this approach be adopted.