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Tuesday, 17 June 2003
Page: 11694


Senator LEES (5:55 PM) —As I was discussing when this debate was interrupted before question time, it is most unfortunate that we have such a level of conflict, mistrust and indeed alienation between the state health ministers and the federal Minister for Health and Ageing. As I was also saying, the truth as to who is right and who is wrong, where the money is and how much whoever should be putting in is putting in—the truth as to where all the arguments finish—is somewhere between what the states and the federal government are claiming.

I certainly feel that the states should match the Commonwealth funding. Perhaps if this works—if we have the states and the Commonwealth putting in the same amount of funding and have that locked in—we might in the future see a reduction in long-term conflict and all those allegations. There is also then the problem of buck-passing and cost-shifting between the states and the Commonwealth, which wastes an enormous amount of money and resources. This can only be reduced, if not avoided altogether, if we involve ourselves in some serious debate and discussion about reforming our health system.

For a number of years now I have been advocating the need to restructure the system to a regional model. I note with interest that there is now forming a cooperative group of a number of health organisations who are also calling on the minister to look at restructuring our health system. It is still a very good system, but it is a system in which cracks are appearing. The system that I advocate is a regional system of funding for our health services. We would pool Commonwealth and state funds, and the decisions about delivery of services would then be made at a local level. I argue that this is a far better way of delivering appropriate and timely services and ensuring that the health dollars—often what few dollars there are when compared to what is needed—are spent wisely and in the most effective way.

A regional model of health funding would build on the strengths of the existing Medicare system by combining all government moneys now directed at health, aged care and community care into a single pool of funding. That source would bring with it increased purchasing power and at the same time eliminate the incentives for cost shifting from one level of government to another. I believe it would also assist in the reduction of administrative duplication.

Under this system, funding would be allocated on a per capita basis and also on a specific special needs basis. This would go directly to regional areas and they would then use the funds to provide medical, hospital, allied health, aged care and community care services for their populations. Individual communities could then respond to the specific health care priorities within their populations and focus on preventing future health problems. One of the problems within our existing system is that it does not reward prevention; it rewards or pays on the basis of treatment of illness. Some services would still be offered centrally—in particular, high-level care, crisis care for premature babies, intensive care facilities et cetera—but base facilities would operate at a regional level. I think there would be a far greater incentive and far greater opportunities for work force numbers to be matched with need far better than they are now. This regional model focuses on matching people with health services, not the other way around.

Going back to the Health Care (Appropriation) Amendment Bill 2003, I believe that the states should immediately commit to matching what the Commonwealth has put on the table and that the Commonwealth should increase the amount that it is offering to put on the table by the roughly $1 billion that has been deducted over five years. It is clear that this money has gone. If you look through the forward estimates, in 2003-04 it is down $108.9 million; in 2004-05 it is minus $172 million; in 2005-06 it loses $264.6 million; and in 2006-07, $372.9 million less is being offered. This is a total of $918.5 million for the Commonwealth which the government calls `savings'. I must say here, as others have pointed out, that this is a very similar amount to the $917 million over five years that was announced for the Fairer Medicare package.

In this bill there is also a second line of appropriations for projects or programs, including the Pathways Home program announced in the budget. I flag again that when we get to the committee stage of the bill—if we get there—I have some questions that the minister will hopefully be able to answer about the Pathways Home program, as the department was not able to answer them during estimates. There is also funding for mental health and palliative care.

I restate my commitment to an adequately funded, high-quality public hospital system. The level of funding in this bill for our public hospitals is putting them at risk. There is clear evidence that it is the responsibility of public hospitals to provide the broad, 24-hour, highly intensive accident and emergency services and the critical care services. That they have long waiting lists for elective procedures and often for a range of other treatments, including urgent cancer treatment, is not in dispute. There can also be a long waiting list for specialist appointments, and then you get on the next waiting list if you actually need an operation.

The Minister for Health and Ageing has had to go looking for excuses to make cuts. They are not based on facts—on the needs of our hospitals. She has been told by Treasury that the bottom line is the priority and that she has a certain amount of money to allocate where she can within her portfolio. Hospitals have been put under more pressure by the reduction in bulk-billing rates. As people face higher and higher costs, they are moving over to access the public hospital system. I am only in the process of tabulating the results of my Medicare survey—results are still coming in—but in answer to the question, `Have you visited a public hospital accident and emergency service because of the cost of visiting a doctor?' quite a few people in Adelaide have ticked the `yes' box.

Now we see through the reduction in funding for public hospitals that the hospitals are being put under further pressure by the government trying to repair the damage they have already done through keeping GPs' salaries low. In order to get GPs back in their surgeries with a reasonable level of income, we are seeing public hospitals starved. I will not go further into whether what the minister is doing in that area will attract GPs back into general practice or attract young graduates to study medicine and go on to train as general practitioners; that is for the Medicare inquiry. We will revisit that entire debate when that legislation comes before the Senate. It will give us some insights into whether what the government is planning to do is actually going to work. I close by saying that I support this bill, but I express my disappointment in, firstly, the continuing battle between the states and the Commonwealth; secondly, the reduction in funding the Commonwealth is offering; and, thirdly, the lack of interest generally in remodelling our health system to improve the delivery of appropriate services in a timely and cost-effective manner.