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Wednesday, 28 May 2003
Page: 15171

Mrs HULL (12:15 PM) —I rise today to speak in support of the Health Care (Appropriation) Amendment Bill 2003. I would like to personally congratulate the government on its eighth budget. I welcome the many measures that are outlined in the budget that will be of benefit to the people in my electorate of Riverina and to the entire country. The 2003-04 budget outlines a number of areas that are aimed at encouraging general practitioners, medical students and specialists to practise in rural and regional areas. The programs that have been implemented by the government—including the regional health strategy, which supports medical students and offers incentives to attract young doctors to rural general practice—have helped stem the growing tide of doctors choosing to leave our regional areas in favour of metropolitan and coastal centres.

Over the past five years, there has been an 11.4 per cent increase in the general practitioner labour supply in some of our rural areas. By providing additional funding, training and support, these programs are encouraging our doctors, our nurses and other health workers to remain in rural Australia. Since 1996, the government has spent about $2 billion on targeted rural health and aged care to boost access in rural and remote areas to doctors, specialists and nurses. Rural scholarship schemes have been embraced by the medical community, with almost 2,400 scholarships for medicine, nursing and pharmacy awarded at the end of 2002-03. The Rural Australia Medical Undergraduate Scholarships scheme provides assistance of up to $10,000 a year until graduation to help students meet accommodation, living and travel costs incurred whilst studying for their medical degree. In 2003-04 the government expects to spend over $31 billion on health, which represents an increase in health spending of around 65 per cent since this government came to office.

Spending on public hospitals will also increase to record levels, with $42 billion to be provided to state and territory governments for public hospitals. This represents a growth of 29.5 per cent over five years. Under the Australian health care agreements, the federal government provides state and territory governments with substantial payments to fund public hospitals. It is up to those states to stop their cost shifting and start delivering services. The proposed new agreement offers $42 billion over five years, an increase of $10 billion or 17 per cent in real growth nationally. The funding offered to the states has been calculated to provide for inflation, population increases, ageing effects and growth in service utilisation. Nothing could be fairer in this allocation.

Due to the government's policies to encourage and assist Australians to take out private health cover, the number of patients visiting public hospitals has fallen. The figures show that between 1999 and 2000, for the first time in the history of Medicare, public hospitals treated 4,500 fewer patients. However we still have this long waiting list for surgery. Operating theatre hours for our specialists and our proceduralists have been cut out completely. This I cannot understand. I cannot understand why fewer patients are going through public hospital systems—due to the private medical insurance measures put in place by the Commonwealth government—and more people are utilising private hospital systems yet there are more cuts in surgery operating theatre times for our local practitioners, our local surgeons and our local specialists. It has got to the point where I have lost some of my proceduralists from my country towns. Griffith has lost its only operating proceduralist, whose operating hours were cut completely. He wants to keep up his skills. He was travelling to Wagga Wagga and operating at a private hospital there so he could keep his skills up, because he could not get the hours that he needed. How is it that fewer people are going through the public hospital system and more people are going through the private hospital system, but we are still cutting the operating and theatre times that are available to our doctors, who need to keep their skills up in order to service the public, particularly in rural and regional areas?

Australian families are now more easily able to afford private health cover. More Australians are utilising this cover and receiving treatment in private hospitals. The number of private hospital patients increased in the same period that public hospital patients decreased. Private hospital patients have increased by 245,129. This is really good news for the public hospitals, which should have more resources available to them if more people are going to private hospitals. Public hospitals should be putting those resources into treating public patients. People think that is what should happen. If you cannot afford to buy private health cover, you need to know that places will be available for you as a public patient in the hospital system and that they will not be taken up by people who have private health insurance who refuse to take themselves into private hospitals and pay additional gaps et cetera.

If you can afford to pay for your treatment, you certainly should. It would open the access to treatment when they need it for those people who cannot afford to pay for it. Those people who have private health insurance should utilise private health facilities to free up further places and take the strain off the public hospital system, as is currently happening. The Commonwealth has put the measures in place, so why aren't we seeing better outcomes in public hospital systems, particularly in rural and regional areas?

Under the proposed new agreement, New South Wales—the state that I come from—will receive $3.4 billion in additional funding, providing those public hospitals throughout the state with $14.1 billion from the federal government, to be matched by the states. Surely we should start to see some evidence of some added activity in those hospitals. Under the new agreement, the states will be expected to match the Commonwealth's rate of growth year by year to receive 100 per cent of the available funding. I think it is perfectly sensible to do that. States that choose not to match the Commonwealth's rate of growth will only receive 96 per cent of the available funding, and that is absolutely correct—so they should. It is obviously in the best interests of the states to match the Commonwealth and ensure greater funding for public hospitals, public patients, people in New South Wales and people across Australia.

If the New South Wales government choose not to abide by the conditions of this agreement, they will forfeit $1.1 billion in funds for public hospitals in New South Wales—which then, in turn, puts the onus on the New South Wales government. It means that, if they forfeit this and if they are not meeting these payments—which they should be able to do, remembering that they have fewer patients going through their systems at the moment, which should ultimately mean more money in their pocket—they are affecting local communities, which will lose valuable services and will not receive promised upgrading of services and, in particular, new hospitals, such as the one we need in Wagga Wagga. Now that we have a pre-election commitment from the Carr government, we are looking forward to the New South Wales government ensuring that they meet these Commonwealth grants and funding in order that we can capture some of this additional $3.4 billion to build the new, state-of-the-art, developed hospital in Wagga Wagga that they have been waiting for for some 25 years.

I congratulate the government on the amount of funding that it has offered to the states for public hospital systems. It is fair that we should expect the states to match this Commonwealth funding, because, as we are aware, the states are responsible for the primary funding of these hospitals. The Commonwealth government continues to provide a great deal of funding for the health care of all Australians, as recently announ-ced. As the House is aware, I represent the rural and regional electorate of Riverina, which, like many other regions, has great difficulty in attracting general practitioners and specialist services. So it was with great pleasure that I listened to the Treasurer deliver this government's eighth budget and recognised that there are many additional programs and funding announcements in it that will greatly benefit my constituents in Riverina into the future. Additional funding for health care centres in small rural communities will provide a range of health care services that are focused on primary care. More doctors will be provided where they are needed most, with 150 additional GP trainees and 234 additional medical school students—at a cost of around $232 million—absolutely targeted to rural and unfortunate outer metropolitan areas. They are areas that we sincerely have to recognise have difficulties as well.

I am proud of that work and I am proud of that funding because my electorate is the recipient of the University of New South Wales School of Rural Health, formerly the Greater Murray Clinical School, that was established in Wagga Wagga. It was the first of the clinical schools that was established. The roll-out of those schools was predicated on the success of that school in Wagga Wagga. We have achieved that. We have delivered success. We have delivered outcomes. We have delivered these students, who are now looking at their future careers being in rural and regional areas. After that original success, those clinical schools were rolled out right across Australia. I am very proud of the work that my community advisory board put in to ensure that this was a successful school. I am proud of the people who have made it successful, including Professor Khadra and Professor Sandy Reid and the GPs and procedural specialists, such as Associate Professor Gerard Carroll and Associate Professor Graeme Richardson, and the Albury practitioners and specialists and the Griffith people. Everyone has put in an enormous effort, over and above their commitment to practising medicine in rural and regional Australia, to ensure that we have a future—to ensure this school is successful and to ensure that the operation and the curriculum identified in the school brings about results and outcomes for rural and regional people. This we have done.

Just two weeks ago, I was able, with the Hon. Tim Fischer, former Deputy Prime Minister, to open Harvey House in Wagga Wagga and establish a conduit for our graduates and students to feel proud of the facility that they train in so that they can continue to offer their services when they finish their degree and are out in rural and regional Australia. Just last week, I opened a house in Griffith that is going to satisfy training requirements, putting our young doctors, trainees and students into a sensational form of accommodation. This will ensure that they have a quality of life experience whilst they are training and whilst they are practising in the hospitals and with the GPs in rural communities. They will have a quality of accommodation that makes their experience a complete and a quality of life experience so that they feel predisposed to coming back out into rural areas and becoming part of those regional communities.

Speaking to these students in the last few months in particular delivers to me a sense that, yes, this government has got it right. Actions are finally being put in place to ensure that rural and regional areas and people are going to finally get the quality of doctors and health services that they are entitled to. This is the beginning of the future, of a move forward to re-establishing a quality of health system right across not only my electorate of Riverina but also Australia. I am enormously proud of that.

In addition, there are payments that will be provided to long-serving GPs in rural and remote areas, to encourage them to continue to practice in those areas. This assistance will help my local communities to retain and also to attract GPs to service our regional residents. There are a number of communities in the Riverina that face extreme challenges in order to keep a general practitioner, and the challenge is growing. If a community is forced to find a replacement, it is very difficult. This retention payment provides an incentive to enable GPs to stay in those communities to ensure delivery of a valuable service.

I want to mention Hay, which is the most amazing little town. It is a beautiful town, and I encourage anybody that wants to go there and have an experience to call in and look at what it has to offer, particularly with attractions such as the new Shear Outback, a testament to the shearers of Australia. Hay does it all on its own. It is isolated, and if the people of Hay want to make it happen they have to make it happen for themselves. In the last two years—not even that—Hay has had 22 locums. How can that community feel secure about their ongoing health issues and pregnancies, how can they feel secure in the knowledge that, if they develop a disease or a condition, they are going to have a continuing practising professional able to manage their treatment, their progress and their life? That situation is unacceptable. The types of payments that this government has put in place are the first group of initiatives ever put in place that are specifically targeted at and caring for rural and regional people—and they have been delivered by the Howard-Anderson government since 1996. We have become a meaningful race of people—country people have again started to matter—and that has only come about under this government since 1996.

The government's Rural Retention Program, which was established in 1999, will continue to provide incentive payments. In 2003-04, approximately 2,400 doctors are expected to receive rural retention payments. That is a fantastic initiative to ensure that my people are getting the quality of health treatment that they deserve. Funding of $10.3 million is being provided over four years to subsidise the medical indemnity costs for rural obstetricians and gynaecologists. That will indeed assist us with the provision of valuable obstetric services. This issue is one with which I have been sincerely and personally involved. I had a very close shave when private hospital obstetric services nearly closed down in December of last year due to this one issue of medical indemnity. The government put its best foot forward and ensured that we were able to keep those services and obstetricians in Wagga Wagga to deliver services right across the Riverina.

Women living in rural and regional areas are also a priority for this government, which recognises the additional medical challenges that women can face. The rural women's GP service provides access to female general practitioners. I note that Temora, one of my communities in the Riverina, is finally getting their first fly-in fly-out woman GP, to service the needs of women who cannot travel to another town, such as Wagga Wagga, to access a female GP. They are now going to have this service in Temora, and I welcome that.

In addition, the government will provide financial incentives for GPs to offer bulk-billing in rural and regional locations. It is dreamtime to think that bulk-billing is a major issue for country people, particularly those in the Riverina, where we suffer and have always suffered the lowest rate of bulk-billing. Bulk-billing is not an issue for them, because they do not get it. The opposition does not get it either: in the past, these people have not received bulk-billing. What they want is a doctor. They do not want access to bulk-billing; they want access to a doctor. That is their major priority. They do not want their health outlet and service to be 22 locums visiting in less than two years.

This debate about bulk-billing has been hijacked and completely distorted. It may be particularly prominent in city areas, but in country areas you are not used to getting bulk-billed and it does not matter. We have been fighting for a bulk-billing service in Wagga Wagga for over nine years, and it has never happened. Very few of our doctors provide bulk-billing. My constituents want a doctor when they need one. They want access to a Medicare rebate so that they are not out of pocket for three months or so, while they post it off and then have the cheque sent back and then have it cleared through the bank. They want to be able to go to the doctor and pay the difference if they need to—if they do not need to, that is terrific as well, but that is up to the doctor. They want a doctor—that is their issue—and they want to know that the health services available to them are as equitable as they are in city areas. The debate has been totally hijacked by bulk-billing. Bulk-billing is totally irrelevant at this point to country people, bearing in mind that my electorate has one of the lowest bulk-billing rates. Generally, bulk-billing is propped up by the smaller doctor who satisfies an isolated rural community, because generally he is the person who does the bulk-billing. This will only help to relieve the issues associated with those communities.(Time expired)