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Secret documents show Howard Government knew about impending bulk billing crisis - and did nothing.

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Stephen Smith MP

Member for Perth

Shadow Minister for Health and Ageing



04/2003       Monday 10 February 2003






Secret Government docume nts obtained under Freedom of Information laws and published today in The Australian show that the Howard Government knew as early as December 2001 that bulk billing rates were then in sharp decline - and that bulk billing would go into free fall unless the Government took immediate steps to fix it.


In December 2001, one month after the Howard Government was returned to office, a Health Department analysis warned the Government that:


  • beginning in late 2000-01, the rate of decline in bulk billing had incre ased and that from then on bulk billing would fall steeply, perhaps by as much as a percent a month ;


  • the trend to lower bulk billing would be exacerbated over the coming months;


  • without intervention, bulk billing rates would continue to fall significantl y further ; and


  • how long the decline would continue and where a new stable level of bulk billing would be were not able to be ascertained.


The Government has consistently tried to cover up the true extent of the bulk billing crisis by both delaying the re lease of national bulk billing figures and refusing Opposition requests for more detailed regional and local information.


Now, with the forced release of these documents, a clear picture is emerging that the Government has been fully aware of the extent o f the bulk billing crisis since it was re-elected in late 2001, but has refused completely to do anything about it.


More than twelve months later, the forecasts provided to the Government by the Health Department have proven correct.


In the September qu arter, bulk billing fell by 2.7% in the three months since June - very close to the rate of “a percent a month” predicted by the Health Department.


If the December quarter figures are released this week, a further substantial decline is expected.


Meanwhile, Prime Minister Howard won’t even acknowledge that bulk billing is disappearing.


On the final day of Parliament last year, when asked about bulk billing, John Howard said:


“Any suggestion that bulk billing has disappeared or is disappearing given the rates of bulk billing in Australia at the present time is factually incorrect .” (Hansard, 12 December 2002)


These documents show not only that the crisis in bulk billing is a reality, but that the Government knew in December 2001 that bulk billing was in the course of disappearing and that the situation would get much worse without intervention.


The reality is that despite protestations to the contrary, John Howard has never believed in Medicare or in bulk billing.


Throughout the eighties and early nine ties John Howard campaigned on a policy to destroy Medicare, threatening to “ pull it right apart ”, describing Medicare as “ an unmitigated disaster ”, and promising to “ get rid of the bulk-billing system - it’s an absolute rort ”.


Confronted with the overwhelming popularity of bulk-billing, John Howard changed his public tune in 1996 to get himself elected.


The Liberal Party’s health policy in 1996 stated:


“Under a Coalition government: Medicare will be retained in its entirety; bulk billing for medical ser vices will be retained… No amount of outright lies and distortion by Labor will change this reality.”


In 1998, the Liberal Party’s health policy repeated the promise that bulk billing would be retained.


But in 2001 it contained no commitment to retain bu lk billing into the future.


Currently, only 71.2% of GP services are bulk-billed - down from more than 80% shortly after the Howard Government came to office.


While the rate of bulk billing has declined by almost 10%, the average co-payment for someone seeing a GP has increased from $8.32 in 1996 to $12.57 today - an increase of more than 50%.

Labor built Medicare and we built bulk-billing. Under Labor from 1984 until 1996, the rate of bulk billing by GPs increased every year following Medicare’s introduction. But since the election of the Howard Government in 1996, the rate of bulk billing has fallen every year.


Only Labor is committed to restoring bulk billing. It is Labor’s highest health priority.


Media Contact: Andrew Dempster 0407 435 157


Attached is a summary of key extracts from the documents published in The Australian.




Key Extracts


1.  “ Beginning in late 2000-01… the rate of decline in bulk billing increased… Now… it is clear that the rate of bulk billing is falling steeply (perhaps by as much as a percent a month). How long this decline will continue and where the new stable level will be are unclear.”


Source: Departmental Policy Forum,  

Paper addressing bulk billing rates, 3 December 2001.


2. “This current trend may be exacerbated over the coming months.”


Source: Departmental Policy Forum, 3 December 2001.



3. “Without interventi on bulk billing rates could continue to fall significantly further.”


Source: Departmental Policy Forum,  

Executive Summary, 3 December 2001.



4. “Table 1 depicts the substantial decline of bulk billing since 1996/97… the most drastically affected [areas ] have been in RRMA2 [metro centres outside capital cities] (-7.8 percentage points) and RRMA3 [large rural centres] (-6.7 percentage points).”


Source: Departmental Policy Forum, 3 December 2001.



5. “There is a large number (42.39%) of providers… who a re already bulk billing over 90% of their attendances. However this number has fallen from 45.06% (or by 2.67 percentage points) from 1999/2000 to 2000/01.”


Source: Departmental Policy Forum, 3 December 2001.