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Tuesday, 19 November 2002
Page: 6716


Senator JACINTA COLLINS (2:11 PM) —My question is to Senator Patterson as Minister for Health and Ageing. Can the minister confirm reports that cabinet will consider a proposal to require GPs to bulk-bill low-income patients in return for higher incentive payments? Won't this just result in increased pressure on doctors to cease bulk-billing and charge even higher fees for patients who do not meet the government's low-income test? Why is the government determined to change Medicare from a guarantee of good quality medical care for all Australians into a second-class safety net only for those who cannot afford to pay for their own health care?


Senator PATTERSON (Minister for Health and Ageing) —Senator Collins has fallen for the three-card trick, believing everything she reads in the newspaper. I would not believe everything I read in the newspaper. With all due respect to the journalists, they often get it wrong. First of all, I am not going to discuss what we were discussing in cabinet and, secondly, I am not going to discuss whether or not cabinet has discussed what was in the paper today. I can confirm, though, that it is my priority to work with the doctors groups to ensure that we have affordable access to GPs and to GP services.

Yesterday I was asking whether in 1991, when bulk-billing rates were about the rate they are now, Labor were running around talking about the world caving in. No. Were they talking about the fact that there was an uneven distribution of bulk-billing? No. Bulk-billing rates in rural areas have always been low. There has been a distribution of bulk-billing which is not fair and equitable and there has been a distribution of doctors which is not fair and equitable. When we came to government in 1996 there was a dearth of doctors in rural areas. What had Labor done about it? Nothing.

Mr Smith, in a statement yesterday, talked about the number of positions for general practice trainees—450 of them—but he did not talk about what happened to those 450 training places. Nor did he talk about the increased number of medical students: 160 more will now be graduating every year as a result of the increase. He did not talk about that and he did not talk about the 450 training places, 200 of which are located in rural areas. That means that trainees who do general practice training must work in rural areas. As for the other 250 places, trainees have to spend six months in a rural training position.

One of the things we are doing is turning around the neglect of Labor, when there was a maldistribution of doctors. We saw bulk-billing increasing unevenly in inner-city areas and going down in rural areas. To say that you are going to get the bulk-billing rates back up is not the answer; it is about access and affordability. Regarding people having access to doctors in rural areas, nothing was done by Labor. We have spent $560 million on attracting doctors into rural areas; $80 million is about to be rolled out to get doctors into outer-metropolitan areas to undo the maldistribution that Labor presided over.

As I said yesterday, you cannot turn these work force issues around over night. They take a long time to take effect. One of the factors that impacts on bulk-billing is the number of doctors in any given area, and what Labor presided over was an increase in bulk-billing in metropolitan areas—inner metropolitan areas, in particular—and a dearth of doctors in country areas. Labor did nothing. Mr Smith did not say anything about any of that. He talked about the restriction on training places. He did not talk about the fact that, of those 450 training places, 200 were in rural areas. Labor did nothing about getting doctors into rural areas and nothing about ensuring that doctors went into outer metropolitan areas. Access and affordability are the important issues we should be addressing here. Labor ought to put its mind to that rather than telling half the story in statements that it makes about access to doctors in the Australian community.


Senator JACINTA COLLINS —Mr President, I ask a supplementary question. Can the minister confirm, in the broader context, that this year the Howard government has presided over a catastrophic decline in bulk-billing, a massive increase in co-payments for a visit to the doctor, rising private health insurance premiums and larger gap payments for those who are privately insured? Can the minister confirm that the government will persist with its unfair proposal to increase the costs of essential medicines for the sickest and the poorest Australians? Why is the government determined to shift the costs of health care away from Medicare and onto individual Australians and their families?


Senator PATTERSON (Minister for Health and Ageing) —Senator Jacinta Collins ought to think about what Labor presided over: a maldistribution of doctors. They presided over the decline of private health insurance to the point that it was not viable. We have now seen admissions to private hospitals go up by 12 per cent and admissions to public hospitals go down by minus one per cent. We have taken the pressure off Medicare. That is what we have presided over. We have presided over a relocation of doctors, improving the distribution of doctors. That was one of the issues driving the lack of affordability and lack of access, especially for people in rural areas and outer metropolitan areas. We have committed $560 million to rural areas and $80 million to outer metropolitan areas to see that the location of doctors will ensure that people have access and affordability. We also presided over a decrease in the out-of-pocket payments that people have to make. Under Labor it was very small. That failed system of Carmen Lawrence's, of contracts with doctors, was an example. (Time expired)