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Monday, 11 November 2002
Page: 5874

Senator LEES (2:40 PM) —My question is to the Minister for Health and Ageing, Senator Patterson. I refer the minister to a recent report, commissioned and funded by her department and written by the Health Economics Unit at Monash University, which details out-of-pocket expenses for people with chronic illnesses. Does it concern the minister that the report finds that some pensioners have to spend some 12 per cent of their income on medical copayments? Does the minister have any specific plans to reduce the growing level of medical copayments and, in particular, any measures to ensure pensioners are bulk-billed when they visit the doctor?

Senator PATTERSON (Minister for Health and Ageing) —I thank Senator Lees for her question. With regard to increased payment and that particular report, the government has done a number of things about the issue of differences in payments for individuals and out-of-pocket expenses. Let me just begin by saying that there are about one million pensioners who have private health insurance and one of the measures that has been put in place to reduce gap payments for those people has been an arrangement with doctors not to have gap payments. There has been a significant increase in the number of doctors who are actually treating patients without gap payments. That is one of the measures that have been taken.

Another measure is that we have in fact increased payments to GPs since the 2001-02 budget by 24 per cent, up to and including next financial year—by increasing payments for immunisation, practice incentive payments and other incentives—to keep doctors in rural areas. There are 14 of those programs. Doctors bulk-bill less in areas where there are fewer doctors and, as I have mentioned a number of times in this chamber, we have spent $562 million over a period of years to increase the number of doctors in rural areas. Over the last four years we have seen an 11 per cent increase in doctors. I think there has been about a 4.3 per cent or 4.4 per cent real increase in the estimated number of full-time doctors.

Some of the issues surrounding the fact that bulk-billing is declining did not happen yesterday. They happened as a result of a maldistribution of doctors over a period of time. We had a high number of doctors in metropolitan areas, where some bulk-billing rates were up around 94 per cent, and we had fewer doctors in country areas and fewer doctors in outer metropolitan areas. As I mentioned, we spent $562 million getting doctors out into rural areas but you cannot turn that around overnight. These work force issues take a long time to redress. They take a long time to develop and they take a long time to cure.

The outer metropolitan area is another issue. We are addressing the issue of trying to attract doctors into outer metropolitan areas but we have to do it in a way that does not suck doctors back from rural areas into outer metropolitan areas. We have increased the number of doctors in training by 160 through the 100 rurally bonded scholarships and 60 new places at James Cook University, and we have a new medical school coming online, through which some of those rural places will be filled, at the ANU.

We are working assiduously to try and increase the number of doctors in rural areas. I was at the Divisions of General Practice conference on Friday and was delighted to find that some divisions are actually working themselves to try and ensure that we keep our doctors. One division was working with overseas doctors training for their RACGP specialist training, giving them counselling and assisting them. It cannot all be done by government; some of it can be done by general practitioners themselves, and some of the divisions are doing very well. For example, they have taken up one of the programs we have where doctors get a benefit if they reduce overservicing in the Pharmaceutical Benefits Scheme. They can take half of that money and put it into their divisions—for example, employing practice nurses. That will relieve the strain on doctors. A large number of programs are being undertaken to actually try and redress some of the issues affecting general practice.

Senator LEES —Mr President, I ask a supplementary question. The minister mentioned the doctor shortage and the need to prevent rural doctors from moving, due to the incentives program, into outer metro areas. I ask the minister: does she agree that there is a shortage of doctors in total across Australia? The only places where they are still oversupplied are a few inner metro areas. Isn't it time, Minister, that we began training in this country several hundred more doctors a year? Finally, does the minister agree that increasing the pharmaceutical copayment—the PBS copayment—by close to 30 per cent for pensioners will put significantly more pressure on the sickest and poorest in the community?

Senator PATTERSON (Minister for Health and Ageing) —I am not sure that is a supplementary question when it went on to the PBS copayment. Senator Lees knows that the Senate actually opposed that. We have a Pharmaceutical Benefits Scheme that has gone from $1 billion in 1990 to $4.8 billion last year. It is unsustainable at that rate of growth. We were asking people to make a small—I know it is difficult—increased contribution to ensure that the Pharmaceutical Benefits Scheme is viable into the future. With regard to the number of doctors, AMWAC—the Australian Medical Workforce Advisory Committee—has indicated for a number of years that we had a sufficient number of doctors. They are actually reviewing those figures. But, as I said, we have increased the number of students going into medical school by 160 and we are looking at other ways to address some of the problems. One of the things that have happened is that doctors have changed their work pattern. There is an increased feminisation of the work force, which AMWAC says they have taken into account, but I believe that most probably some of the male doctors are now wanting to be more involved in family and work for fewer hours. (Time expired)