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Transcript of doorstop: Tuesday 18 February 2003: Merchant Court Hotel, Sydney: bulk billing, Shadow Ministry.

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

TRANSCRIPT OF DOORSTOP - Merchant Court Hotel, Sydney Tuesday 18 February 2003

E & OE

Subject: Bulk billing, Shadow Ministry

SMITH: Well, this morning I’ve addressed the Health Summit at the hotel and I was asked to address what I regarded as the most pressing crisis that we find in health policy today. I made the point that we regard the restoration of bulk billing as the most serious crisis which we need to address.

The decline in bulk billing has been catastrophic and there has been enormous pressure placed on our public hospitals. In New South Wales alone, for example, over a three-year period we’ve seen a 300,000 increase in presentations to emergency departments of public hospitals. In 1999 we saw 1.7 million presentations and in 2002 we saw 2 million presentations.

So, the 300,000 increase in presentations to emergency departments just can’t be explained by population growth. It can be explained by a dramatic decline in bulk billing and this is a point which State and Territory Health Ministers need to make to Minister Patterson when the Health Ministers meet at the Australian Health Ministers Council on Friday.

The Health Ministers from the States and Territories need to extract two guarantees from Senator Patterson.

Firstly, they need to extract a guarantee that the Government will move to restore bulk billing to respectable levels.

Secondly, we know the Australian Health Care Agreement is up for review with the new agreements to start from 1 July. Senator Patterson has to date refused to give a guarantee that there’ll be no cuts to the States for our public hospitals and she has to give a guarantee at that meeting that there’ll be no cut in real terms so far as the Commonwealth’s contribution to our public hospitals are concerned.

So, the most pressing crisis in health that we need to address is that we’ve got to restore bulk billing to respectable rates. The catastrophic decline in bulk billing has seen even more pressure on our public hospitals. Currently the Howard Government refuses to commit itself to restoring bulk billing and it’s also refusing to guarantee that it won’t cut the funds to our public hospitals when it meets with the States later this week.

JOURNALIST: Senator Patterson says she does have a plan to conquer the bulk billing crisis. We haven’t seen much of it yet. Is that something that’s important to be released?

SMITH: Well, this is the point I made in my speech to the Summit. Last week when Senator Patterson got herself into trouble by refusing to rule out means-testing for bulk billing and refusing to commit to universality of bulk billing and Medicare, to try and offset the difficulties she got herself into over that, she ran through the Gallery via her press secretary saying that they had a plan to spend $1 billion over 4 years to help restore bulk billing.

We’ve seen no detail. In fact, the only response we’ve seen to that suggestion has been Treasurer Costello last week saying that there would be no increase for health in the current budget. That effectively leaves whatever plan Minister Patterson has in tatters.

What little detail we have seen emerge of the plan seems to suggest the Government is looking at breaking down the universality of bulk billing and the universality of Medicare by limiting incentives to doctors to bulk bill pensioners only. This would lead to a second-class safety net for the poor and a system where everyone else would have to pay more for the health care they’ve come to rely upon.

So, there’s been no detail. Senator Patterson should tip that out immediately. But what suggestions there have been go to the breaking down of Medicare and bulk billing being available to all Australians irrespective of their income.

JOURNALIST: Do you think the Federal Government may have rewritten its budget given what’s going on in Iraq?

SMITH: Well, this Government has never been committed to bulk billing and has never been committed to our public hospitals. So it’s no surprise that over the years they’ve kept the screws on the Medicare rebate to help drive bulk billing into the ground, and no surprise that when they first came to office in 1996 they reduced funding to public hospitals.

The Government will use the war on Iraq as an excuse for not doing anything about health. It will use it as an excuse for not doing anything in the important domestic areas, whether it’s health care or assistance to families.

But, what we should remember is that in the run-up to the last election, the Government splurged a surplus and what it’s been doing ever since is to do or say anything to hide the fact that in the run-up to the last election, it splurged the budget surplus - it’s now in deficit. That was caused not by spending on the war or anything else but the Government in the last 12 months, in the run-up to the election, doing or saying or spending on anything to get itself re-elected.


This Government doesn’t have a commitment to bulk billing. It doesn’t have a commitment to our public hospitals and that’s been reflected by the period again [inaudible] and I expect we’ll see that again in the budget this year.

JOURNALIST: So, how would the ALP fund universal bulk billing?

SMITH: Well, I’ve made the point that restoring bulk billing is our highest health priority. I’ve made the point that, given that the Government has by a process of stealth and attrition, put the screws on the Medicare rebate for over a 6 year period, we don’t believe we are financially able to restore all that in one go.

That’s why I’ve been talking about a range of policy measures, including a targeted increase in the rebate in those areas where bulk billing is at its lowest ebb, or where the decline has been steepest, but also getting more doctors on the ground to allay the acute shortage of doctors and also turning general practice into a sustainable and attractive profession again.

That means utilising a team approach. In the course of my speech today, I draw attention to the fact that the Government currently has an $80 million program over 4 years to bring doctors to outer metropolitan areas. This has been a complete failure. That program has seen only 2 additional doctors to outer metropolitan areas in the course of this year and I suggested, in the course of my remarks today, that those funds could be used either to expand the practice nurse scheme to outer-metropolitan areas or in a targeted way to increase the rebates for doctors who practice in outer-metropolitan areas as an incentive to bulk bill.

JOURNALIST: If you talk to your average GP, they’ll say the main reason they struggle is because the rebate isn’t high enough. Why not just restore the rebate fully?

SMITH: Well, I’d love to restore the rebate fully but I can’t do in one day or even in one year what John Howard’s been doing by way of keeping the screws on the rebate over a 6-year period.

So, I don’t believe that we’re financially able nor would it be financially responsible to increase the rebate across-the-board in one go. That’s why I’ve been saying we need to look at a targeted increase in the rebate to provide doctors with an incentive to bulk bill in those areas where bulk billing is at its lowest ebb or where bulk billing has been in its most serious decline.

JOURNALIST: So, what are those areas where bulk billing has been lowest?

SMITH: If you look at the official statistics that came out on Friday, we saw bulk billing across the nation now reduced to 69.6%. There’s been under John Howard an 11% drop in bulk billing since he came to office and an over 5.5% drop in the last 12 months. It’s the first time we’ve seen bulk billing below 70% since 1989.



When you go underneath that figure and look at the national breakdown, bulk billing is at its lowest base in rural and regional areas and at its second lowest base in outer-metropolitan areas.

We now see a decline across-the-board. The sharpest declines in very many respects have been in the outer-metropolitan areas, so in terms of where the decline of bulk billing provides the most difficulty for Australian families, it’s in outer-metropolitan Australia and in rural and regional Australia. That’s where bulk billing comes off its lowest base and where the decline has been sharpest.

Finally today, my colleague Alan Griffin, who last week was elected to the Shadow Ministry.

The Leader later today will be announcing the full details and I’m very pleased to welcome Alan to the Health Portfolio.

One of his roles will be dealing with consumer health issues. He will, of course, have other responsibilities which Simon Cream will outline today, but in my area he’ll be assisting on consumer health, looking at health safety,

health privacy and consumer matters.

I very much welcome Alan’s addition to the Health Portfolio as part of the Health Shadow Ministerial team. He’ll be very effective and do a robust job and I look forward to working closely with Alan in that area.


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