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Thursday, 18 September 2003
Page: 20528


Ms WORTH (Parliamentary Secretary to the Minister for Health and Ageing) (3:54 PM) —I remind the shadow minister, in case she is unaware of it, that Paterson's curse is also known as Salvation Jane. The opposition spokesperson and others opposite think that if they print and say something often enough the public might believe it. This is desperate campaigning at this stage, because they know, accurately, that everyone is concerned about their health. That is very important. But to claim that this government is about attacking, dismantling or ruining Medicare—whatever adjectives they like to use—is absolutely, 100 per cent untrue. I firmly put it on the record now, as the Prime Minister has done in the past and as we did in the lead-up to the 1996 election, that we are absolutely committed—100 per cent—to maintaining Medicare. We are committed not only to maintaining Medicare but also to improving it. If you have something good and never do anything about it, never foster it or add to it, then it will fail. We are about making a fairer Medicare system; we are not about letting it run down.

The shadow minister made quite a few claims, and I will try to deal with some of them. One was about how much is spent on GP visits and the fact that there are fewer people visiting GPs now than there were in the past. That is not necessarily a bad thing. The medical benefits expenditure on GP services for the 2002-03 financial year was higher than that for the 2001-02 financial year. It was the highest amount ever paid to GPs in the history of the Medicare system, despite the fact that there were fewer services. While service numbers are lower than last year, this is a direct result of the initiatives of this government which are rewarding doctors for providing longer consultations—spending more time with their patients—and managing chronic diseases. This has many more benefits for the patient than just rushing them through the door, in and out again. Doctors were perhaps asking patients to come back for some pathology results or for another prescription, instead of providing repeat prescriptions. The shadow minister is shaking her head about that; she seems to think that, if a doctor gives you a repeat prescription, it is going to be good for your health to always use it. That is not the case.


Ms Gillard —The doctor decides.


Ms WORTH —The doctor can absolutely decide. The doctor can give repeat prescriptions and say, `Stop taking the medication if you're better by then, but keep taking it if you're not feeling better.' That does not apply in all cases—not if the prescription is for blood pressure medication or antibiotics—but for a lot of things it is good medicine, and it means that the patient does not have to come back through the door again.

The shadow minister is on the attack, which I suppose one should expect. But she should be honest enough to say what Medicare is all about. Medicare is not about GP visits and it is not about bulk-billing. Medicare is about free access to a public hospital; receiving a rebate for visiting a GP or a specialist, whether that be in a doctor's rooms or in a hospital; receiving a rebate for services such as pathology and radiology—of 85 per cent if that is out of hospital and 75 per cent if it is in hospital, with private health insurance making up the other 25 per cent of the schedule fee—and, of course, getting subsidised medicines through the PBS. As I said, the government are absolutely committed to Medicare, and we will not deviate from that commitment.

We are also, of course, committed to making private health insurance more affordable through the 30 per cent rebate. That is a commitment that the opposition have been unable to give, no matter how many challenges they have been given. They have not committed to keeping the 30 per cent rebate for private health insurance, and you will notice that the opposition spokesperson did not do that today. That is because it cannot be guaranteed. The Australian public should be alarmed about that. The Australian public and this government understand that we need a very strong public system and a very strong private system working together, because that is in the best interests of the public.

Others besides the shadow minister and her colleagues have had a few things to say about Medicare, bulk-billing and emergency departments. I will place on the record some of those comments. In 1987, Dr Blewett said:

What we mostly have in this country is not doctors exploiting bulk billing but compassionate doctors using the bulk billing facility to treat pensioners, the disadvantaged and others who are not well off or who are in great need of medical services, which was always the intention.

More recently, in May this year on ABC Radio, Trevor Mudge, then Vice President of the AMA, said:

Doctors are not going to suddenly charge large amounts to patients who can't afford to pay. They never have and they never will.

Dr Rob Walters, President of the Australian Divisions of General Practice, was in my office earlier this week, and he said very similar things. He would argue that doctors are being maligned when it is put that they will not know their patients; they will not know who is least able to afford. I think that is something opposition members should bear in mind. In 1983, Dr Blewett said:

Medicare will restore the right of access to health care. It is the comprehensive, universal, equitable, scheme that we see as essential to guarantee that access within the limits of a fee-for-service system.

The shadow minister will note the phrase `within the limits of a fee-for-service system'. Again in 1983, Dr Blewett said:

Where the doctor agrees, direct billing will be available to everyone, so that the patient does not have to claim a refund for the cost of medical treatment. But this is a choice left to the doctors.

At the Adelaide public hearing of the Senate Select Committee on Medicare, Dr James Moxham, President of the Australian College of Non Vocationally Registered General Practitioners, claimed:

The main driver of the bulk-billing rate is the number of doctors. It has nothing to do with rebates. Rebates do not influence bulk-billing. The rate of decline in bulk-billing will be almost halved by an extra 150 training places.

During question time—and the Prime Minister dealt with this very well—claims were made that there is overcrowding in state public hospital emergency departments because of the lack of access to bulk-billing. In an article in the Courier Mail, Dr Ian Knox, the Australasian College of Emergency Medicine President, said:

Overcrowding in State hospital emergency departments had nothing to do with GP-type patients and everything to do with a lack of beds.

On 28 August this year, in an interview with Anna Patty of the Daily Telegraph, John Vinen, Emergency Support Service Director at the Royal North Shore Hospital, said:

We are spending 50 per cent of our time on code red. Blaming the flu and the lack of bulk-billing is nonsense. We see virtually no GP patients.

There are people with other points of view and other arguments, which members of the opposition would do well to take on board before they make public inaccurate statements. The Prime Minister has already chastised the member for Lowe for that, but he is not the only one. The member for Scullin and others from the Labor Party have been claiming that families who earn more than $32,000 a year will be denied access to bulk-billing. This is said in urging people to sign a petition. Of course, that is absolutely downright wrong, as is the claim in material soliciting signatures on Labor Medicare petitions by the member for Lowe and others that there would be a $20 fee to visit a doctor. It states:

Now the Federal Government wants to charge a $20 fee every time you visit your Doctor. This will hurt families and seniors.

I suppose some people would argue that this is just fear politics. My personal belief is that when we are discussing the health of the people of this nation we should be more responsible. Labor has not always been perfect. In fact, the shadow minister mentioned today that the number of doctors' visits being bulk-billed was going down. They have gone down slightly but they are still nowhere near as low as they were some time ago.

Labor's opposition to private health care has put Medicare and our public hospital system under extreme and unsustainable pressure. Under the previous Labor government, private health insurance premiums grew by a rate of 11.3 per cent a year. Under this government, premiums have increased on average by less than five per cent a year. I cannot stress strongly enough that, until the Labor Party commits to maintaining the 30 per cent rebate under a future Labor government, the people of Australia should remain very scared, because that high level of increase would be adding $750 on average to their private health insurance costs.

By contrast, we are absolutely committed to keeping private health insurance and making it more affordable through the 30 per cent rebate—and that is the key. It represents a substantial benefit for almost nine million Australians. The nine million Australians with private insurance will be very concerned that the shadow minister has failed yet again to confirm that any Labor government would maintain this very precious part of our medical system.

Claims have been made about how we are wrecking Medicare. How can it be claimed that we are wrecking Medicare when we are spending an extra $917 million on the A Fairer Medicare package and when we have already announced 234 additional medical school places to be based across Australia and bonded to rural and regional areas? GP training places will be increased, with an additional 150 places every year over four years. Incentives for doctors to bulk-bill pensioners and concession card holders have been announced. There will be 457 additional full-time nurses for GP practices located in outer metropolitan areas of work force shortage, benefiting around 800 GP practices. There will be new safety nets to protect against high out-of-pocket medical costs.

The Howard government has also introduced a number of other measures to improve the supply of medical practitioners in the short term. One hundred and ninety-five practitioners are currently enrolled in the five-year scheme designed to encourage extra overseas trained GPs to work in rural districts with work force shortages. In addition, in December 2002 changes to the immigration arrangements enabled graduating Australian trained international medical students to stay on and work in public hospitals during their intern year and beyond. In 2003, over 100 additional interns were working in public hospitals due to this measure. Negotiations are under way with states and territories to enable this measure to continue on a permanent basis.

In the 2002-03 budget, the government announced the More Doctors for Outer Metropolitan Areas program to improve access to medical services for people living in outer metropolitan areas of the six state capitals. There are 105 doctors participating in the scheme so far. This $80 million package over four years aims to get an additional 150 GPs into outer metropolitan areas by providing them with a relocation incentive to address the imbalance in health care delivery compared to their inner metropolitan neighbours.

The Australian government is doing all it can to get additional nurses into universities. An allocation of 210 new nursing places has been made for 2004. This will increase to 574 over four years until 2007. Regional campuses were identified as the priority for new nursing places in 2004. However, we should not forget that a major problem for health services throughout Australia is the retention of trained nurses. The employment, pay and conditions of nurses must be looked at to help reduce the number of nursing shortages. These are areas of responsibility for the state governments.

The Australian government will also be providing the states and territories with $42 billion over the next five years to help them run their public hospitals. This is $10 billion more than previous agreements and a 17 per cent increase over and above inflation. Now that the agreements have been signed through the health reform agenda, the Australian government, together with the states and territories, will be looking at how to better spend the $40 billion that the Commonwealth and states spend on health care. This will include streamlining cancer care, improving safety and quality and easing the pathway of patients from hospital to care in the home.

We have heard claims about hospital emergency departments, which I have dealt with. The premiers have been playing games. We know, for instance, that seven out of 10 services are still being bulk-billed. In the last six years of the Labor government, the Medicare rebate for a standard GP consultation increased by less than nine per cent. Mr Deputy Speaker, I think you will agree that the government is doing everything to save Medicare. (Time expired)