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Thursday, 28 June 2018
Page: 6850


Mr LAMING (Bowman) (16:17): Obviously, we reach silly season at the end of a sitting week, and then out rolls the health MPI from the opposition. It's remotely disappointing to have to engage every third or fourth week, when they run out of agenda, in an industrial revolution debate about Medicare, because Australians sitting up watching today and Australians sitting in the galleries understand that we have an excellent GP-centred system. We've got public hospitals doing an incredible job under trying financial circumstances that they've had under any government, not just a blue or a red one. We have an independent and successful private health system. We have a functioning PBS and MBS that are the envy of the world.

We can go back and engage in a 1970s debate about who founded Medicare and who is the defender of Medicare, but you can't debate the figures that were presented by my colleague just a few minutes ago—that is, big jumps in the number of bulk-billed services; 6.2 million more services in remote and regional Australia, an absolute priority for this government. These kinds of increases—1.19 million more bulk-billed specialist services—are the true indicators that access to medical professionals, be they general or specialist, is about the same as it has always been.

We have new regional medical schools producing graduates who are staying in the bush—train in the bush; stay in the bush. That's heading in the right direction. No-one's pretending today that all the problems are fixed the minute you change the government or that we've massively changed the direction of health policy, but I tell you what: when there's a hard problem, increasingly, when you have a Labor government in place, they really don't do much about it. That is because, as I pointed out before, when a government is utterly fixated on how many dollars are pumped into the system, it actually loses sight of value and quality. What we're asking is that both sides of this chamber, as we debate the national direction for health, really focus on the quality of spend. But, no, we can't do that, because we have the industrial revolution mob over there, the Medicare Luddites, who think it's just about the total amount of dollars pumped into a system. Increasingly, as we look around the world at the quality of hospital and health performance, we see it's not all about the dollars. It's actually about how it's directed into areas of people's lives and into health investments that truly make a difference. We need both sides of the chamber to be engaging in that debate, and we simply don't have it. So, no matter how many times you sit in the gallery or turn on the television, you will simply hear this general traducing of each other at the end of a sitting week, but actually no engagement on what really matters, which is how we purchase with our dollars the best possible health outcome we can. No, it is not just about how many dollars we spend and how many services are delivered. It is about being responsible and talking to general practice about the rate of servicing. You can only look after patients at a particular rate before quality declines—when time becomes a proxy of quality.

We've talked about GPs. Give them the incentive to stratify their patient population and say, 'These 200 people genuinely need my extra care and I need to be reimbursed for that extra amount of time.' Don't have them practising what we call 747 medicine—the person who had seen a single patient 747 times in a year. That can't be quality practice—it's never been engaged with over on the other side. What happens when the Labor Party comes into government? They scurry around in an almost rodentesque manner, seeking to do deals with individual sectors and governments, both in health and education. You're left with this farrago of health funding confusion, where there are tiny bits of money chucked in here and a bit more there and a bit of clever play with the numbers. But we know that the fundamental challenge of Australia's double-tiered health system—moderately unique in the developed world—is that there is a simple moral hazard: the more we put in, the more the states pull out. It is very simple. We write up four-year agreements and the states, to save money, simple turn the switch up or down.

It was good to have the member for the Townsville area talking about the Townsville Hospital, because the Commonwealth contributions for Townsville just keep going up, up and up. But it is the state contribution that goes up, down, up and down again as they try to save a little money, because they've got an $80 billion debt in Queensland. State funding to Townsville has gone from $329 million to $346 million to $374 million and then down again to $346 million last week. So the health funding doesn't go up. The Commonwealth contribution to the Townsville region went from $166 million to $181 million to $200 million to $226 million. Clearly, the guilty party isn't down here in this chamber. But you've got the Labor Party completely unable to talk to their mates in Queensland and get a dollar-for-dollar contribution. If the state Labor money to Townsville was actually replaced and you still had the Commonwealth contribution, you'd have more doctors, more nurses and more services, and you'd have less stress on your ICU and a better functioning health system. But we don't sit here and nickel and dime that side of the chamber about whether or not there's an extra dollar, because we keep asking about quality. In the developed world and in the international contest on health quality, we know that the truly effective systems take hard decisions and don't focus purely on the money.

The DEPUTY SPEAKER: The discussion is now concluded.