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Shadow Minister discusses bulk billing; and private health insurance rebate.

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Stephen Smith MP Member for Perth Shadow Minister for Health and Ageing

TRANSCRIPT OF INTERVIEW - John Laws, Radio 2UE Monday 2 December 2002

E & OE

Subject: Bulk Billing; Private Health Insurance Rebate

SMITH: Hello John, Stephen Smith, Shadow Minister for Health.

LAWS: Good morning Stephen Smith.

SMITH: I thought I’d ring you because I’d half heard Senator Patterson trying to justify the Government’s approach to, on the one hand completely ignoring the crisis we have in bulk-billing, but on the other hand happily turning a blind eye to scarce taxpayers’ resources going to fund gym shoes and second-hand golf clubs and family tents for camping on the basis that that’s somehow making a contribution to health.

LAWS: Yeah, in fairness I don’t think she was turning a blind eye to it, I don’t think she liked the numbers any more than you. It was certainly part of the $64.3 million, but she maintains only a small part, hopefully we can get the figures. Have you got the figures?

SMITH: Well, no - what we’ve got from the public figures is that we know that over $60 million a year goes to what’s described as lifestyle benefits and what Minister Patterson has said in recent weeks is whether the funds allow those to go on gym shoes or CDs for relaxation is a commercial decision for them. I say that it’s taxpayers’ money. It’s a waste.

LAWS: Yeah, well I agree with you.

SMITH: On bulk-billing John, what she’s actually said is this. A couple of weeks ago we saw the September quarter figures came out, which show the second consecutive largest annual decline in bulk-billing. She described those figures as disappointing. They are a catastrophe. It doesn’t matter where you go in Australia, it’s hard to find a doctor who bulk-bills and almost impossible to find a doctor who will provide after-hours service.

LAWS: Well, I did say to her that I’m sure that some of that $64 million would have been better spent on subsidising doctors’ fees than buying gym shoes.


SMITH: Absolutely. I think that’s the essential point here. We always know that so far as health is concerned there’s going to be a limited pot of money. It’s about priorities and Simon Crean and I have made it crystal clear that our highest priority is restoring bulk-billing for Australian families. If we were in Government we certainly wouldn’t be saying that taxpayers’ funds being spent on CDs and gym shoes and golf clubs was a commercial decision. It’s an abuse of taxpayers’ money.

You’ve always got to make decisions about funding for health and the highest priority should be the restoration of bulk-billing and making general practice sustainable again so that families can get the primary and preventative health care they need.

LAWS: Okay, if you people were elected, I’ve got to say at this stage, it seems very unlikely but if you were elected, would the rebate for private health cover remain or would you remove it?

SMITH: Well, what Simon Crean and I’ve made clear from day one, is that we’ve got the rebate under review, and in the course of next year we will detail precisely how we will approach the rebate. But, there are a range of things that you can contemplate. You could leave the rebate in place, you could abolish it in whole, or you could look at modifications in between. You could means test it. You could cap it.

LAWS: Okay well, let me ask you this. Would it stay as it is?

SMITH: Well, that’s one of the things we’ve got under review at the moment.

LAWS: Yeah, but you see that’s what Kim Beazley did. That sort of doesn’t satisfy the people too much. We constantly hear that a review is being held. We want to know what you’re going to do.

SMITH: Yes, and if the election was in four weeks time, then you’d have the complete answer. What we’ve made clear is that we spend this 12 months going through party reform and looking at policy issues, in the next 12 months in a whole range of areas, we will tip out detailed policy and election commitments and this will be one of them.

One point is absolutely clear: whatever savings, if any, we make from changes to the 30% rebate, that will go to the restoration of bulk-billing, that will go to making sure that Australian families get to see a GP who bulk-bills and gets to see a GP for after-hours care as well.

LAWS: Okay now if you abolish that subsidy the cost of private health insurance would go through the roof.

SMITH: One of the reasons why I’ve said, for people like me, often you look at the 30% rebate as a health policy, but for very many Australians out there, particularly families struggling under financial pressure, it’s not a health


issue, it’s a family budget issue. That’s why we’re taking a lot of time, making sure we do the review properly and when we do come out with what our formal election commitment will be, we don’t want to be adding to the burden of those families who are under enormous financial pressure.

That’s why we’re being sensible and careful about it, but in the end, you can’t sit there and turn a blind eye to allowing taxpayers’ funds to be wasted on the one hand on CDs and then for the Government to sit there and say that bulk-billing is just a disappointment when in fact it’s a catastrophe.

LAWS: Why should family cover apply to a mother with one child just as a couple with six children, pay the same amount of money?

SMITH: In terms of the rebate?

LAWS: Yes.

SMITH: Well, the way the Government has structured the rebate, is that you get a 30% rebate directly on the private health insurance premiums that you pay.

One of the options that we’re considering is that, rather than paying the rebate on the prospect of future health services, you might pay a contribution direct to the private hospitals, so that the rebate goes directly to the provision, or the provider, of care rather than going to the funds for possible care down the track. That’s another one of the options that we have under consideration.

LAWS: How much more money would you give doctors?

SMITH: Well, what we’d like to do is to increase the rebate so that general practice becomes sustainable again and bulk-billing becomes sustainable.

One of the problems that we have is that we can’t do that in one fell swoop because the Government’s kept the screws on the doctors’ rebate for the six years that it’s been in office.

That’s why I’ve been talking about increasing the rebate in a targeted way in those areas where bulk-billing is in its most serious decline, outer-metropolitan areas in particular, where the decline has been very sharp in the last six months or so and rural and regional areas.

So, I’d like to increase the rebate to make it more attractive for doctors, but I can’t do that in my view, responsibly, across-the-board. We’ve got to look at targeting.

LAWS: Yes.


SMITH: But, to make general practice sustainable again for doctors it is not just the rebate, it’s also making sure that they’ve got the necessary support they need. One of the recent suggested reforms from the doctors’ groups has been to encourage the use of nurse practitioners. In the last election, the Government came up with a promise to provide about $80 million for outer-metropolitan doctors and in the last week or so I’ve said the doctors have made it clear they don’t think that proposal would work. One of the possible things you could do with those funds would be to spend it on nurse practitioners in outer-metropolitan areas so that the general practitioners have got the support they need in their practices to make their practices sustainable again.

So, there are a range of things we’ve got to attack and one of the fundamental things we have to attack is, it’s quite clear the Government has also been turning a blind eye to the fact that we’ve got a massive shortage of doctors on the ground, particularly in outer-metro areas and in rural and regional areas.

We’ve got to have a long-term national planning approach to the provision of doctors and nurses, health and allied health professionals in Australia.

That’s something that has been done piecemeal in the past. We need to adopt a national planning approach to the shortage of doctors and nurses and treat that as a national priority.

LAWS: Okay, thank you very much for the call Stephen.


Contact : Andrew Dempster - 0407 435 157 or 02 6277 4108