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Monday, 16 June 2003
Page: 16458


Ms GRIERSON (7:10 PM) —I rise to oppose the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003. This is the big one—the sleeping giant in the health legislation agenda of this government; the one that the Prime Minister and the health minister say will save Medicare and give bulk-billing to those who need it most. The last time I looked, those who needed it most included everyone in Australia except perhaps the very wealthy, who can afford whatever they need. We all need it: health matters to everyone. The last time I looked, this legislation did not seem to have the intent of saving Medicare or restoring bulk-billing, and it certainly will not have that outcome.

Even though the PM is selling the message, I do not think anyone is buying it. In my electorate of Newcastle, no-one is really even trying to sell it to us, apparently. The Minister for Health and Ageing, charged with the wellbeing of the nation, thinks that she only has to be accountable in electorates where she gets the red carpet treatment. Well, unfortunately for Senator Patterson, we are not really like that in Newcastle—we are not into that sort of pomp and pretentiousness.

One of my local radio stations, 2HD, have been trying to engage in discussion with the health minister for many, many months. Reporting, as they do almost daily, on the pressures in the health sector, they naturally wanted to take the issues directly to the person who should understand them the most. But their entreaties to her office went unheard until Simon Crean, the Leader of the Opposition, was visiting our town and had published an article about the government's Medicare deal in our regional newspaper. Suddenly, her availability changed; but, after some tough questioning and some ego bruising, the minister declined any further dialogue, claiming HD had been nicer to Simon Crean than to her. Rather precious, I would have thought. The government put up the policies but they do not want to explain them to the Australian public. It seems that no-one is very impressed with the proposed changes to Medicare that this legislation facilitates—not the health profession, not the peak representative bodies and certainly not the patients left to find a GP who bulk-bills, who is available after hours, who does house calls when necessary or who visits patients in nursing homes.

So what does the Health Legislation Amendment (Medicare and Private Health Insurance) Bill 2003 actually say and what will its effect be? There are three components to the bill. The first component facilitates changes to private health insurance funds. This enables private insurers to provide cover for out-of-hospital expenses, to cover the gap between the Medicare rebate and the fee charged. That has not been available before, and obviously the government thinks we should be pleased that we can access more private health insurance just for visiting a GP. Does the government realise that families already pay well in excess of $50 every week of the year for private insurance? That is approaching $3,000 every year—after income tax, of course, and after the Medicare levy has been deducted. However, in this part of the legislation there is a $1,000 threshold before that private cover comes into play—so the patient must pay the higher premium to get additional cover and then pay the first $1,000 of expenses when they visit their GP before they can enjoy the benefits of these changes. Families will need to find the equivalent of buying a new fridge every year before they can redeem anything at all from this private health insurance. These changes presuppose out-of-pocket expenses of up to and above $1,000 per year to health consumers, perhaps exposing the government's lie that GP fees will not increase.

This provision also significantly alters the operation and basic premise of Medicare by destroying the universality of Medicare that aimed to provide health insurance to all Australians. Medicare was designed to prevent GPs who bulk-billed from charging a copayment, therefore keeping prices from escalating out of control. Now we see that these changes actually presuppose increased costs. I would predict that, if this legislation is taken up by GPs, prices will escalate out of control. These provisions also include specialists' costs. There has already been a reduction in the number of specialists offering bulk-billing services, because there are no incentives for them to do so. But specialists are to be included in these provisions dealing with their out-of-pocket expenses for patients, and I assume that means the government also anticipates an escalation of specialist fees. So in this component of the legislation everything is cleared for doctors to charge higher fees, private health insurers to offer a new product to consumers and patients to fork out more money on top of their income tax, their Medicare levy and their private health insurance. And I thought this was about health care. Not likely! With the Labor opposition, I will oppose this component of the legislation.

The second component of the legislation establishes a new concessional safety net. That sounds fair, but let us look at that a little closer. Closer examination reveals that there just may be a loophole that could encourage GPs to charge concession card holders, rather than bulk-bill them, for every visit. It is a complex loophole but needs close examination to avoid being exploited by GPs. It would appear that there are ways that this safety net can be used by GPs to make it more appealing. The new safety net is set at $500. So once concession card holders have spent $500 in out-of-pocket expenses—that is, the difference between the rebate and actual costs of the GP service—the government will cover 80 per cent of these out-of-pocket expenses. That will also be opposed.

The third component includes provisions to allow GPs to bulk-bill and charge copayments. Under these provisions, patients will be able to sign over their Medicare entitlements to the GP. Medicare was originally welcomed by GPs in the early 1980s, because bad debts were a problem for many doctors and Medicare ensured their payments were received and administration costs were kept down. In fact, Medicare administration costs are significantly lower than the cost of private health insurers. Perhaps in many cases credit cards did shift that debt problem, and of course the future bodes very well for people who have shares in banks. But it is not clear from the new provisions just what the costs of administering this new system will be to GPs. GPs already cite burdensome costs for online access to the Health Insurance Commission so that they can claim their Medicare rebate. I note some mention of government support for broadband access by doctors, but I do not think we should take on the whole broadband and Telstra situation here.

The AMA has already warned that the government's Medicare package is no guarantee that GPs will take up bulk-billing or access the bulk-billing and copayments scheme if it is costly to operate. There are lots of questions left unanswered. How will GPs check the concessional status of patients? What happens if GPs are misled about a patient's status and submit claims for rebate only to find that the patient is not an eligible concession card holder?

There are already growing complaints from GPs about the numbers of concession card holders in Australia, with the AMA saying that there are too many and that numbers should be reduced. So what about electorates like mine, the electorate of Newcastle, where at least one-third of the total population have a concession card? Will GPs consider my region to be financially viable? Will GPs take up the government's package? If the current decline in GPs and bulk-billing in my region is any indication, I do not think so.

The AMA has already warned that individual practices will have to do their own sums to see if these measures will be financially viable for them. The AMA has suggested that the package may be okay for practices with low numbers of concession card holders, as they will now be able to charge a significant copayment for other patients. But, in a GP practice where 80 per cent to 90 per cent of the patients are concession card holders, it is unlikely that they will consider this to be financially attractive to them.

This legislation actually builds in discrimination against GPs who predominantly service concession card holders. Just what will happen in areas like Newcastle with high numbers of concession card holders? Will GPs be allowed to simply close their books to concession card holders when they reach their ideal financially viable number? Who will provide services to those who miss out? The incentives in the government's package are not going to be attractive enough for GPs to take up this offer. The Department of Health and Ageing confirms that the government has done no real modelling as to what the real take-up rate would be for GPs. Does this mean that GPs will try to ensure a financially viable mix of patients and, in doing so, exclude large numbers of concession card holders? Is that why GP closures in my electorate are already predominantly occurring in the less wealthy suburbs?

The government's package introduces all sorts of anomalies and inequities into the Australian health system. For example, Australian families who have two children and earn just $32,300 a year are not eligible for a concession card. Yet self-funded retirees earning up to $80,000 for a couple or $50,000 for a single person per year will be eligible as concession card holders to access the new system through the Commonwealth seniors health care card for the purpose of bulk-billing. Where is the equity in that scenario? Those self-funded retirees have families, and they understand that what seems good for them will not be good for everyone else.

Let us get to some actual people in real places who will not be happy with this legislation. I draw the attention of the House to the people of Carrington, a suburb in Newcastle. Last week, their local medical centre closed. Until then, it was serviced by two excellent doctors who were held in high regard and affection by their patients, particularly Dr Omond, who had kept that practice going for some time and who bulk-billed almost everybody. He was faced with the situation that his partner was successful in gaining a position in a different field in Sydney, and he was unable to find anyone else to take over that practice with him. He can only provide a part-time service, having another role in our region, and that practice is now closing. The people of Carrington are certainly in panic. They know that they cannot find another doctor nearby who will bulk-bill. They know they have the option of going to the Hunter Street Medical Centre in the CDB. It has provided a total bulk-billing service after hours for a long time, but waiting times are two to three hours. When Dr Omond could not provide that service at Carrington, he left an answering message that advised patients to go to the local hospital's emergency department. All of us here know about that problem, and we certainly do in Newcastle.

A new after-hours GP service will be opening at John Hunter Hospital next month. I have full praise for the Hunter Urban Division of General Practice and our local Hunter Area Health Service, which was successful in getting this government to support a trial and now extend that. We certainly need this service and a lot more. Perhaps the government should look at an emergency package that provides that sort of service 24 hours a day. We are facing the most dreadful dilemma in Newcastle: we are 20 to 30 GPs short. Of course the further you go out from the CBD to the region, the bigger the problem becomes.

But the people of Carrington are not going to be easy to placate. They are good working-class people with a great community tradition, and they will not give in on this. They are prepared to put up a good fight so that other areas in Newcastle do not suffer the same fate because of this government's ability to look the other way when communities are suffering. I attended their public meeting in the middle of last week, when they reacted to this shock. Since then they have given me petitions with almost 400 signatures, and I know there will be more to come. They have public meetings planned for the next two weeks in my electorate, and they will keep this up—they have no choice.

That brings me to the people in Mayfield, another suburb in Newcastle. Their doctor of almost 25 years left a message on his answering service on the Friday before the June long weekend to say the practice would be closed over the long weekend and would resume and reopen on the Tuesday morning at nine o'clock. When people turned up, the door was locked. They knocked on the door; no-one came. They rang the phones; no-one answered. The closure of this practice happened overnight. It has been totally distressing for the people who have attended that practice. They were left absolutely with no information about why that practice had closed, what would happen to their medical records and where they should go for treatment. I feel for them. Many of them are older people, and they are emotionally upset by losing their GP and by losing their GP in these circumstances. Why has that happened? I have sympathy for the GP: he also has been trying to find another doctor to take over. He has been given an offer to work in a much larger medical centre on the Central Coast, where he is assured of more people with concession cards—self-funded retirees, perhaps, that will still get a concession payment—and of some patients on higher incomes. Mayfield is also a suburb where many people do not have a lot of spare cash.

People have been particularly distressed to find this week that their medical records, without any notification, were passed on to another GP, who is in the next electorate to mine, who has not opened her practice yet. They have been absolutely confused about what their rights in this situation are. I just point out, though, that they do have some rights, and doctors do have some responsibilities in these circumstances. They have to give an individual access to their personal information if they ask for it. But of course if you cannot get on the phone or through the door it is particularly hard to ask for it. They can be passed on to someone else as part of a commercial transaction—and I am not quite sure that that is the case here. The Privacy Commissioner's guidelines on privacy in the private health sector suggest that in a situation where a medical practice might be closing it is good practice for health service providers to notify individuals of the closure or cessation of their service, where it is practicable to do so. I would have thought that would have been the case for the people of Mayfield.

It also says that, in the event that the health information is to be transferred to another health service provider, consent for disclosure and collection may need to be obtained. No consent has been obtained, and certainly no information has been conveyed to the patients of the Mayfield practice—and that is particularly worrying for those people. I have had constituents contact me today to say they are being asked to pay a fee when they try to get those records. To get those records they are actually turning up at a chemist shop next-door to where this practice is proposed to be starting. That is just not acceptable, it is not professional and it is not fair. It is certainly distressing for people to have their private records transferred like that.

I urge the government to look into those situations. I urge the AMA to do the same. I have complete sympathy for GPs and the pressures they suffer. I know that they have had under this government no pay rise for seven years—I do not think this parliament has had the same situation. They have not had an increase in their rebate from patients, unless of course they increase to their paying patients the cost of each service. They do have different lifestyle demands. I think the general practice model worked very well when the man was the doctor, and the wife did not work but looked after kids, raised the family and integrated into the community—but times have changed. This government needs to look at those changes and say, `What do we need to do to make general practice attractive? What do we do when both partners are in professions and have high burdens on their time, as well as family demands and the demands of the general lifestyle we all live these days? What do we do when there is a shortage of relief doctors and locums?' Doctors cannot work 24 hours a day, seven days a week. They are not businessmen and businesswomen. Perhaps we have made it very difficult for them to manage the many tasks we ask of them. Their costs are high and their rewards are few, but they mostly remain very dedicated to their patients.

The situations in Newcastle are just two examples of the continuing situation we have faced since I became a member of parliament. These closures continue. The Hunter Urban Division of General Practice executive director is quoted as saying, `We are facing an epidemic about to hit our city.' It is very real. I call on the government to provide a rescue package for these extreme shortages and distressing situations. I also point out that what has happened—as has happened in many regions—is that local emergency wards of public hospitals are suffering. An article from the Herald on 5 May said that 12 ambulances and a rescue helicopter arrived within a 75-minute period at John Hunter Hospital, causing 40-minute to two-hour delays in just off-loading patients—let alone the delay they get when they actually get inside that emergency department. In Newcastle we are six physicians short in our emergency departments across our Hunter Area Health Service hospitals. We cannot get those doctors—we are trying very hard. I think we have recruited one from overseas. The government also needs to do something about its recruitment process so that we can expedite it in areas where there are shortages.

On 23 April another article said:

To fill rosters around the clock, which we are doing in our public hospital emergency wards, means specialist physicians are averaging one in four weekends on continuous 48-hour on-call duty.

We have major general work force shortages in health care and this package does nothing to alleviate them. I will oppose this legislation. I ask the government to look very closely at the situation in regions like mine. We are not a rural isolated area; we are a major city—the sixth biggest city in Australia. I will support the Labor package and promote it to my community. I certainly encourage them to demand better of this government. We once had the best public health system and the best health system in the world.