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Tuesday, 30 August 1994
Page: 599

Senator NEWMAN (5.34 p.m.) —In rising to speak on the Human Services and Health Legislation Amendment Bill (No. 2) today, I will first make some general comments in relation to the matter of the quality and the affordability of health care for Australians—which is very much a current matter and which I raised this afternoon in question time with the minister representing the Minister for Health, Senator Crowley. Honourable senators will recall that I asked her a question about the effective co-payment which is being introduced by the Minister for Health, Dr Lawrence, as a result of her refusal to increase the rebate to general practitioners by more than 15c. This has meant that those doctors—and it is pretty well all of them in Australia—who, over the last year, have seen their costs rise through labour and other costs, are now in the position where their income coming from the government bears no relationship whatsoever to either the costs of medical practice or the consumer price index.

  I am concerned about that, not because I am here as an advocate for the AMA or for doctors; I am here because I am concerned about the quality of health care in Australia. Sadly, what I believe will be the result of the government's intransigence on this matter is that some doctors will decide that they will no longer bulk-bill. The people who will not get bulk-billing are likely to be the battling families—particularly the people in the bush—and the independent retirees. Those are groups for whom I feel particular concern. They are not cardholders and they may well be the people who fall to the bottom of the pile. If their doctors do not bulk-bill, they will have to pay an increased amount of money to their doctor and there will be more of that uninsurable gap.

  We get the Uriah Heeps on the other side from time to time wringing their hands and talking about the need to do something about the gap, but it was their government when it came to office that abolished the ability of Australians to insure for the gap. So what is going to happen is that, despite the wails, the wringing of hands and the projects of the previous minister for health, former Senator Richardson, to do something about the gap, we now have a minister for health who is making the problem of the gap, in terms of medical treatment, much worse. So these battlers and the independent retirees who have carefully husbanded their resources on which to retire and those in the bush who are suffering so badly from drought are likely to be the ones who will be hurt most in their pocket and for whom medical care may become more and more of a luxury.

  As for those who are cardholders, I do not believe that they will come out unscathed from the minister's actions either. What we will see is production-line medicine—the very worst kind of medicine. The rebate system is already so slanted that those doctors who want to give longer consultations do so at the cost to their own pockets. It is a system which is not designed for the best quality of medical care and as you would know, Mr Acting Deputy President, so many patients will go to a doctor and only start to get comfortable about the second matter on which they wanted to consult when it is time to be ushered out the door. People do need to feel comfortable and to establish some rapport or relationship with their doctor before they get to the more sensitive issues. They may start off with an ingrown toenail, but they will move on to more personal matters later.

  I am very concerned that we are going to end up with production-line medicine instead of the quality of care which the minister, Dr Lawrence, keeps telling us she is firmly committed to targeting. Unfortunately, we have to judge her by her actions rather than her words. This failure to properly remunerate GPs will mean that the patients inevitably are going to end up with a reduced quality of care from doctors who are already hard pressed in terms of poor remuneration for the work done. I have often heard the AMA President, Dr Nelson, talk about doctors who get out in the middle of the night to go and visit patients for something like $38.70. I do not think there are too many plumbers or other tradesmen who would get out of bed in the middle of the night to go and ply their occupation, but it seems to be all right for the government to expect that of doctors.

  The government announcement was that it intended to increase Medicare rebates or refunds for GP consultations by only 0.625 per cent from 1 November this year. That means that a doctor who bulk-bills will have had, over a two-year period, a 30c increase in payments for a standard consultation, and that Australians who are paying doctors' bills are seeing their rebates increase at a rate far below that of inflation and their reasonable expectation.

  I think we should all be concerned about this because for most of us general practice is the basis of our wellbeing. Most of us see our GP on a fairly regular basis. Thank goodness, not too many of us end up in hospital with specialists. But it makes the issue of the remuneration of GPs and the resulting effects on their patients very much a national issue and an issue of real importance. It is a public health issue. When I say that GP rebates are only going up by .625 per cent in 1994, that is in the context of the CPI being expected to increase by 2.5 per cent and average weekly earnings by 3.5 per cent in the same year. That is how far the remuneration of GPs is slipping back.

  Mr Acting Deputy President, I draw your attention to a report of the Auditor-General in 1991. Talking about the administration of the Medicare benefits schedule—things have not improved too much since then—he said:

Developments in recent years would suggest that the scheduled fee simply represents the amount the government, having regard to budgetary and economic considerations, is willing to pay for the provision of particular medical services. It bears little or no relation to the actual cost of the provision of the services.

We have to remember that the majority of the costs of a medical practice are wages which cannot be discounted. The government would be the first to object if GPs around Australia were not paying their staffs the proper rate. Those wages cannot be discounted but apparently the government thinks that it can discount medical fees.

  I really feel quite incensed, not just for the doctors, but also for their patients who, one way or another, will end up bearing the brunt of Dr Carmen Lawrence's new form of co-payment—done through stealth and through the back door. In fact, I am astonished that members of the Centre Left—who were so prominent in giving their vote to the present Prime Minister (Mr Keating), to help him get his hands on the keys to the Lodge—have not risen up in wrath about this. Back in 1991 they were the ones strutting the national stage, saying how monstrous was the co-payment introduced by Brian Howe. We hear not a word from them now. Are those patients, those constituents, now all forgotten? Is it too far off an election, perhaps? Perhaps Mr Keating has them frightened. Perhaps people now have their promotions or their preferments and they can afford to forget their consciences.

  I turn now to a particular aspect of the bill before us, and that is an amendment to section 103 of the National Health Act. It is the insertion of a new subsection which will allow pharmacists to legally substitute a cheaper, equivalent generic drug for a prescribed drug. I know that previous speakers have addressed this but it is a matter in which I am particularly interested because when I was serving as shadow minister for health I consistently argued for change in this area.

  I well remember the substantial discussions that took place at an estimates committee hearing in August of last year. At that time I roundly scolded Senator Richardson because the government had had a policy for at least six years to implement generic substitution but had not got around to doing anything about it. To compound the offence, Senator Richardson was prepared to countenance a prosecution of a Wynnum pharmacist for effectively doing what the government had said should be able to be done. That was hypocritical.

  I recall a couple of segments on the 7.30 Report which highlighted the hypocrisy of the government in this matter and the treatment of the pharmacist and his patients by the HIC. I am pleased that at last some action is being taken. Pretty heavy-handed action was taken on the Wynnum pharmacy issue; at last we are going to see some action here.

  I read the House of Representatives debate on this bill and I share the observation of the honourable member for Lyne (Mr Vaile): it is somewhat ironic that at the same time as this bill is being debated by the parliament, the federal government, via the Health Insurance Commission, is prosecuting a pharmacist for behaviour that will be legitimised by the passage of the bill. I made the point at the estimates hearing that while the government might have had a minimum pricing policy, it was not doing anything about it. The summary provided to me by the department after that hearing said:

Given the concerns of the medical profession and the fact that State law is important in this area, the Government's approach to encouraging generics via the 1990 policy change was the most appropriate rate of progressing the use of generics at that time.

Given that there has been a significant increase in the use of generics since then, and that concerns about quality have been dealt with, it is now appropriate to consider moving to generic substitution as a way of making further progress.

The arguments for change—freedom of choice, competition and thus lower costs for consumers—are irresistible. In arguing for change, however, I have always been conscious of the importance of balancing the roles of the medical and pharmaceutical professions. In a speech in the Senate on 27 October last year I said:

Unless doctors have clearly indicated that there is to be no substitution, pharmacists should be able to talk to patients about the choice available between a brand name and a generic drug, in the cases where a generic drug is available, with obvious due and proper regard for bioequivalents.

The amendment before us takes account of these conditions by specifying that substitution will only be allowed if the prescription does not indicate that only the specified drug or medication be supplied and the schedule of pharmaceutical benefits issued by the department states that the two drugs or medications are equivalent. I understand that the Australian Pharmacy Guild has welcomed this change and that the Pharmaceutical Society of Australia has accepted these changes.

  I am very glad that the AMA has also accepted the need for change in this area. I know that there were some doctors who were concerned about this issue. When I discussed the matter with them last year and into this year there was some concern that their right to prescribe could be diminished by any change to the law. I do not think that has been done in this case. I would want to know that, with monitoring, the level of their satisfaction and that of their patients will remain the same after the passage of this legislation. With the conditions attached to the generic substitution that I outlined, there can be no doubt that the essential prescribing role of doctors is appropriately protected.

  I know that pharmaceutical manufacturers have raised some concerns regarding the use of the word `equivalence' in the amendment and about the issue of co-marketing. I understand that both of these issues have been addressed to the satisfaction of the manufacturers.

  In conclusion, I again say how pleased I am that the government has acted at last to bring forward amendments giving legislative authority to generic substitution. Although it has taken some time for the amendments to see the light of day and they will not actually take effect until 1 December of this year, it is nonetheless pleasing that the government has finally acted.