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Thursday, 17 October 2002
Page: 8036

Mr STEPHEN SMITH (12:08 PM) —The opposition supports the Health Care (Appropriation) Amendment Bill 2002. The bill amends the Health Care Appropriation Act 1998. These amendments allow the Commonwealth to discharge its financial responsibilities under the 1998-2003 Australian health care agreements. Under the Australian health care agreements, the Commonwealth provides financial assistance to the states and territories for the provision of public hospital services. The amendments will increase the maximum amount the minister may grant by way of financial assistance to a state, a hospital or other person under section 4 from $29.655 billion to $31.8 billion and will require the Minister for Health and Ageing to present to each house of the parliament, as soon as practicable after 30 June 2003, a statement of the total amount of financial assistance paid under section 4. The act provides the legislative basis for grants of financial assistance under the Australian health care agreements, including health care grant and national health development fund payments to the states and territories, and Commonwealth owned purpose outlays for mental health, palliative care and case mix development.

The bill will provide legislative authority for the Commonwealth to meet its responsibility under the Australian health care agreements to provide financial assistance to the states and territories for the provision of public hospital services, and for the Commonwealth's own purpose, until 30 June 2003, when the Australian health care agreements expire. If the bill is not passed, the Commonwealth will lack the legislative authority to continue to make payments to the states under the Australian health care agreements, and on that basis the opposition clearly supports it.

The bill does provide an opportunity to make some brief comments about the upcoming renewal of the Australian health care agreements. As is made clear by the bill and the explanatory memorandum to the bill, the current Australian health care agreements expire on 30 June 2003. The Commonwealth and the states and territories are currently negotiating renewed agreements. Here I have, frankly, a sobering message to deliver. In my view, there has been a substantial amount of misplaced optimism about the Commonwealth's approach to the agreements, as a result of the health minister's conference communique in April this year, which spoke in terms of best care and health outcomes and national objectives of improved care. Some said that for the first time the Commonwealth and the states were genuinely talking about health outcomes and that disputes about health financing would be a thing of the past. As very recent history shows, that will not be the case.

You have only to go back to the 1995 and 1996 Council of Australian Governments meetings to see similar Commonwealth-state communiques. The 1996 communique, signed by the Howard government, spoke in terms of joint objectives, joint setting of priorities and partnership funding. The only problem is that nothing came of it. On the contrary, the Howard government slashed funding to the states in 1996. Public hospitals bore the brunt of those cuts, and they have never fully recovered. The adverse consequences of declining GP bulk-billing for public hospital emergency departments—so clearly pointed out by state health ministers in a letter to Health Minister Patterson in August—together with the government's approach to aged care accommodation, see our public hospitals in the troubled state that they are in today.

It is only a matter of time before someone in authority in the Howard government—and that is certainly not the health minister—comes along and simply says, `This is what the state and territories got last time and this is what they will get this time, plus or minus a small percentage.' Regrettably, consistent with the government's approach to health financing generally, that is likely to be a budget bottom line judgment, not a judgment which takes any heed of health outcomes. To the contrary, I see the agreements as an opportunity to build on Labor's Medicare alliance proposal. It is an opportunity to determine not who should pay but what we are paying for. The agreement should be a building block to stop perverse cost shifting incentives and to deliver more effective health care for all Australians. That would be a better way to build the future of health care under these agreements.

In conclusion, I might take the opportunity, given that this is a bill which relates so centrally to the financing of our public hospitals, to pay compliment to all those health workers in our state and territory public hospitals who have performed so valiantly and so well in the aftermath of the Bali terrorist attacks. They are doing their best to ensure high quality health care for Australians and overseas nationals so tragically injured in those terrorist attacks.