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Thursday, 24 May 2001
Page: 27016

Mr MURPHY (1:21 PM) —I rise to support the Health Legislation Amendment Bill (No. 2) 2001 and the second reading amendment moved by my colleague the shadow minister for health, Jenny Macklin. The purpose of this amendment is, firstly, to set by regulation the groups who can nominate to the board of the Australian Institute of Health and Welfare; secondly, to simplify procedures for the recognition of specialist medical practitioners; thirdly, to provide payment of Medicare benefits where cheques are made out to general practitioners which are not presented within a specified time; and, fourthly, to make changes to the 30 per cent rebate on private health insurance schemes. In particular, I wish to address the draft amendments where they deal with the particular issue of `pay doctor via claimant cheques'.

The purpose of these amendments is, in the main, technical. In relation to `pay doctor via claimant cheques', the purpose of these amendments is to ensure certainty of payment to the medical provider. In dealing with the security of payments, it also assists independent medical providers to remain viable in an environment where the market is increasingly being advocated as the only way by which to distribute medical resources in the community. As a consequence, medical providers are being forced to choose between independent practice, which caters for the entire community, and corporate medical centres, where the general practice is simply a gateway into a host of overservicing practices in such areas as pathology and radiology.

The survival of bulk-billing is at stake. My electorate of Lowe has the fifth highest proportion of citizens in Australia aged 65 years and over. Many of those people are long-term residents of suburbs in my electorate such as Drummoyne, Five Dock, Haberfield, Burwood, Concord and Strathfield. Many of my constituents have longstanding doctor-patient relationships with their medical providers. My electorate also has a very high proportion of young families. For many, their medical expenses are handled via bulk-billing. They like bulk-billing. They need bulk-billing. However, for others the payment for medical services is handled by way of a bill issued by the medical provider which the patient pays themselves and seeks reimbursement from Medicare, or the patient takes the bill to Medicare so that a cheque can be drawn to the medical provider but forwarded to the patient for on-forwarding to the medical provider.

My concern is that more and more medical providers find it more convenient to seek payment directly from their patients, who are then left to themselves to handle the bother of the additional paperwork between themselves and Medicare. Many of my constituents in Lowe have expressed to me their frustration at having to provide de facto secretarial and clerical support to both their doctors and Medicare. Elderly people in particular hate it. The reason the medical providers find this arrangement more convenient for themselves is because there is no other way—outside bulk-billing—by which medical providers can be certain of payments for their services. The route via the patient to Medicare, back to the patient and then, finally, onto the medical provider simply has too many loops in it, and the chance of something going awry is too high.

I have an acute sense of this situation, Mr Deputy Speaker, because, as you know, my name is Murphy, and Murphy's law is quite simple—if something can go wrong it will. For too many medical providers the route to their remuneration employing the patient—unpaid—is too insecure because the patient can either forget to make the claim on Medicare or forget to forward the cheque to their doctor. Moreover, cheques have been known to get lost in the post. How often have we heard `the cheque is in the mail'? These amendments are designed to assist medical providers with a secure route by which to obtain payment for their service to the patient by allowing them more easily to claim directly from Medicare after the safe threshold period of 90 days has elapsed.

Unless medical providers are able to maintain a proper remuneration for their services by secure payment systems, then independent medical providers will be forced into vertically integrated corporate medical centres—the one-stop-shop centres—where corporate shareholders' profits dictate the targeting of high turnover, quick service niche clientele, and the exclusion of those clientele which require more time and service. This is clearly unacceptable. And that means the older citizens and young families miss out because they do not fit the profit profile of the over-servicing medical corporates. It also means the independent suburban medical provider being driven to extinction. That is also unacceptable. These amendments assist in ensuring that the individual medical provider can remain viable while providing services to the whole of the community. It is sensible that we remove any obstacles in the payment process which jeopardise the viability of the medical provider and add unnecessary paperwork to the patient.

These amendments also remove any temptations medical providers might have to double-dip to make ends meet by ensuring that the payment system is fail-safe. The 90-day threshold allows for a reasonable elapse of time to determine whether the cheque is forthcoming, after which the doctor can initiate action to secure payment without causing stress to the patient. Medicare controls the disbursement of cheques and is able to ensure that the first cheque is cancelled before the second is issued. The government is not listening to the warnings by the medical profession that the rapidly increasing share of public health being delivered by profit motivated corporatised medical practices threatens the public interest by placing patient care last on the list of priorities, headed by company income targets.

I support the amendments moved by my colleagues generally, but in particular I recommend that those amendments dealing with `pay doctor via claimant' cheques need support.