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Wednesday, 28 May 2003
Page: 15176


Mr ZAHRA (12:35 PM) —I rise to speak in this second reading debate on the Health Care (Appropriation) Amendment Bill 2003. Having a doctor is important in country districts, there is no doubt about that, and I agree with my colleague the member for Riverina in relation to that fact. But I just make the point to her and to other people in the House that there is no point in having a doctor in town if you cannot afford to see the doctor. That is why I take a different view from the one that my colleague has expressed in relation to the importance of bulk-billing to people who live in country districts. We do battle in country districts to get doctors to come and set up practices in our regions, towns and communities, but we always have, and there are many sociological and economic reasons for this. I suppose I could take up all my 20 minutes here making excuses for the medical profession and for those people who have had carriage of this responsibility within the federal and state departments of health over the course of the last 20 years or so. But I am not going to do that. The point that I want to make is how important bulk-billing is to country people. Hard though it is to get doctors to set up in country districts, that is only half the task. We must have services in country districts which country people can access.

I make the point to the member for Riverina and other country members of parliament in this place that there is no point having those doctors there in our towns and districts if they charge an amount of money for their services that is too much for local people to afford. In that circumstance, we will end up with some people in the town getting health care and some people not getting health care. People on the other side might say to me, `At least someone gets access to that health care.' But I make the point that, if our objective and our philosophy is to try to get health care for just some people, we will never hope to succeed in getting health care for everyone. We have to have an objective that those people who need health care can get it in this country, irrespective of how rich or poor they are or whether they live in the city or in the country.

In my electoral district we have a bulk-billing rate of about 58 per cent. It is about 58 per cent in the Gippsland region, if you take the electoral district of McMillan and the electoral district of Gippsland. That is a very low rate of bulk-billing when compared with a number of other federal electorates in this country, although it is not as low as the electorate of my colleague the member for Riverina. We do not want it ever to be as low as that. We want the direction of bulk-billing in the Gippsland region to go up, not down. This is why we in our region have taken the view that the No. 1 priority for the federal government needs to be to address the decline in bulk-billing. We have seen situations emerge where some of the services we always used to take for granted in health care are no longer there in the Gippsland region. I have been advised by a number of people that getting access to the public dental health service, which is administered in my electorate through the Latrobe Community Health Service, now involves your being placed on a waiting list, which, depending on the care that you are looking for, may involve a waiting period of 48 months. That is for work that is classified as non-emergency dental work. The waiting time can even be as much as seven years for a different category of dental health services, such as people having their teeth examined with a view to consideration of whether they should have braces fitted by an orthodontist.

So that is 48 months for one range of services and seven years for the other. It used to be possible to access these services much more readily, when the Commonwealth had the Commonwealth dental health plan, which was got rid of by this government in the 1996-97 budget. The point that I am making here is that in our region we do not want to be a part of an ongoing reduction of health services to our district. We have seen a reduction in the public dental health services that our district gets, and we are seeing a reduction in the bulk-billing services that our district gets. My view is that we need to be courageous in the way we approach dealing with Medicare and in particular we need to be courageous in the way we approach redressing the problems that we have with bulk-billing.

I do not think it is good enough that there are large parts of the Gippsland region which have no bulk-billing doctor. I do not think it is a situation which can be readily understood by those people who do not represent country districts in this place. I have read the statistics showing what levels of bulk-billing different federal electorates have, and in the Gippsland region we are very envious of those federal electorates that have bulk-billing rates of more than 80 per cent—in some cases, more than 90 per cent, I think. We say to those people, `We want what you've got.' I guess a lot of people who live in the city would never imagine a situation where people had no access at all to a bulk-billing doctor. Some people have said to me, `If the doctor they go to does not bulk-bill, why don't they go somewhere else?' The simple answer to that question is that often there is nowhere else. There are many towns—as you would know, Mr Deputy Speaker Causley, representing a country district yourself—that are lucky enough to have one doctor in the first place, and there may be a considerable geographic distance between that medical practice and the neighbouring one. So shopping around, which is the usual bit of advice that people give in these circumstances, is not really a practicable or reasonable thing to ask people to do.

We are fortunate in my electorate to have a very good public health system. We have a number of outstanding public health institutions in our district. The Latrobe Regional Hospital provides outstanding care to people in the Latrobe Valley and in the broader Gippsland region. In Latrobe Regional Hospital, we have been fortunate to have had the strong leadership of Felix Pintado, and the rest of the staff and team there. They went through a difficult time when that hospital was privatised by the Kennett government. The Bracks government, upon coming to office, bought that hospital back for the people of the Latrobe Valley and brought certainty back to the services provided by the Latrobe Regional Hospital. It is a quality public health institution and provides an outstanding service to the people in the Latrobe Valley.

I am also fortunate to have the West Gippsland Health Care Group operating in my electorate, which provides services to the people in West Gippsland and the broader Gippsland region. We are lucky there as well to have that hospital ably led by Ormond Pearson and his staff. They do an outstanding job in providing services to people right across West Gippsland, including a growing range of services to people in the smaller rural districts that make up the West Gippsland region.

In the South Gippsland district, we are fortunate to have a range of small country hospitals that provide services to people who live in those particular localities. We have great hospitals in Wonthaggi, Leongatha, Foster and Korumburra. We are fortunate to have these hospitals. We rely on them heavily, particularly because of the limitations in our region for people to be able to access bulk-billing. I think it is generally understood in this place—even if it perhaps is not admitted by too many people on the other side—that, where you do not have bulk-billing doctors, more demand is placed on the public health service. In particular, it places more demand on accident and emergency units within regional public hospitals. That has certainly been our experience in the Gippsland region. It is another reason why it is important to have an adequate number of bulk-billing doctors available to everyone in country districts.

I was very concerned when the government announced that it intended to cut $918 million over four years from our public hospitals as part of its budget. A government that takes the view that it can provide more services to people by cutting funding to public hospitals is fooling itself. It is not being honest with itself and it is not being honest with the Australian people. A cut of $918 million will lead to only one thing—reduced services in those public hospitals. We know, because of what I mentioned before and because of what I think most people in this place accept to be true, that reduced bulk-billing in country districts will place more pressure on country hospitals.

This government has reduced bulk-billing, put more pressure on country hospitals and announced that there will be a $918 million reduction in funding for those same hospitals. I think that is a disgrace. I think it will lead to a substantial deterioration in the level of care and the level of health service that people in the country will be able to get from their local health services and hospitals. It is no coincidence that the amount of money that the government has allocated for its Medicare changes is almost exactly the same amount of money that they are taking out of public hospitals; the government is taking $918 million out and allocating $917 million towards their so-called Medicare package. The government is cutting from the public health system and the public hospital system so that it can fund their initiative to weaken Medicare further and reduce bulk-billing. I think this will be a real double whammy for country districts. I think we will see bulk-billing rates further eroded and a lesser service provided by country hospitals because the amount of money provided to them by the Commonwealth government will be reduced.

People in the Gippsland region are very interested in having greater access to bulk-billing. They support Labor's plan to save Medicare and restore bulk-billing. There is a commitment in Simon Crean's budget reply speech to save Medicare with a $1.9 billion package to reverse the collapse in bulk-billing by lifting the patient rebate for bulk-billing for all Australians, no matter where they live or how much they earn. A Crean Labor government will immediately lift the Medicare patient rebate for all bulk-billed consultations to 95 per cent of the scheduled fee, an increase of $3.35 per consultation; and a Crean Labor government would subsequently lift the Medicare patient rebate for all bulk-billed consultations to 100 per cent of the scheduled fee, an average increase of $5 per consultation.

In addition, Labor will offer powerful financial incentives to doctors not only to keep treating their patients without additional cost but to extend bulk-billing, especially in outer-metropolitan and regional areas where the collapse in bulk-billing is hurting families the most.

Under Labor's scheme, doctors in metropolitan areas will receive an additional $7,500 each year for bulk-billing 80 per cent or more of their patients; doctors in outer-metropolitan areas and major regional centres will receive an additional $15,000 each year for bulk-billing 75 per cent or more of their patients; and doctors in rural and regional areas will receive an additional $22,500 each year for bulk-billing 70 per cent or more of their patients.

These are Labor's initiatives to turn around the massive fall-off in bulk-billing. When it comes to talking about people's access to services, bulk-billing is a key part of any sensible approach to giving people from all walks of life access to quality health care. It is not all right to just talk about having doctors available in some communities and people paying if they can. There is no point in having the doctors in place if people cannot afford to see them. This is the point, and this is why I think bulk-billing is so important. This is why it had been a focal point in what Simon Crean, the Leader of the Opposition, has had to say in relation to this issue: bulk-billing is the thing.

I understand the argument that some people on the other side have run out: that it is important to have doctors in those towns, full stop. I understand that point; I know how hard it is to get doctors in those towns. We have been working very hard in the Gippsland region to try to make it a bit easier to get GPs to our district and to try to get people from our district into medical schools so that they can come back and practise in our region. We have tried that, we are doing that and we are busting a gut to try to make that a reality, but there is no point in having the service there unless people can afford to go to it.

In my mind, there is no point having a service there if only the people who live on the big properties who have a big black four-wheel drive can drive up to that service and get access. It is really not good enough that we could ever end up with a situation where some people can access a service and other people have to do without any service at all—not because the service is not there but because they cannot afford it. We are talking about something which affects people's lives in a very direct way. In the Gippsland region, we are fortunate with the quality of our public health services and the decency and commitment of our general practitioners who work hard and provide an incredibly important service to local communities, without whom we would really struggle.

I will make a point while talking about our local general practitioners. In the Gippsland region we have been blessed by the addition of overseas trained doctors who have come to our district, in many cases, from countries as far away as you could possibly imagine. They have very quickly become a part of our local community and have made an incredibly important contribution. Just quickly and off the top of my head, I can think of one fellow from Russia, Dr Boris Nezhov, who provides a medical clinic to people in the Latrobe Valley from his Hollie Drive medical practice in Morwell, near the Mid Valley Shopping Centre. He bulk-bills and when asked why he did so by another doctor he said, `That is what the people in the Latrobe Valley can afford.' I commend his attitude and I commend his decency in being prepared to provide a service that people can afford.

People like Dr Boris Nezhov and the other overseas trained doctors really add something special to the country districts where they are placed and where they set up their medical practices. They really add something to the mix of local GPs as well, and keep them fresh and dynamic in their thinking. We are lucky to have them. I am sure that I speak on behalf of everyone in the Gippsland region when I say that we are absolutely thrilled to have them and delighted at the important contribution they make to our district.

Health services are important. In particular, they are important to people living in country districts who do not have a wide range of other options in accessing a neighbouring hospital or health service. The health services that we have in country districts are particularly important for that reason. The government, by continuing to undermine Medicare, is undermining the health services of people in country districts. We must never lose sight of how important bulk-billing is to those people who live in country districts; that they can properly access services in the towns in which they live without having a situation where some people might be able to access it because they are able to afford it whereas other people will have to miss out because they cannot afford that vital service. (Time expired)