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- 19 November 2003
Federal Government Medicare Policy
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The Hon. Dr PETER WONG [10.37 p.m.]: Yesterday the Federal Government announced further reforms to Medicare in the ongoing effort to resolve the health care problems in Australia. Most honourable members will recall that the original theme of Medicare was to provide universal access to quality health care irrespective of wealth or status. I believe this remains the aspiration of every Australian today, 20 years on from the initial policy of universal health cover. At one extreme is the United States of America, where this principle has been overlooked and health care has related to the wealth of an individual, and where gravely ill people are often turned away for lack of financial resources. No doubt honourable members will also recall that Medicare, then known as Medibank, was met with much opposition when first introduced. It was only passed during a joint sitting of the two Houses.
At the time many doctors expressed their reservations and antagonism about the scheme, fearing that they would be forced to relinquish their autonomy in a system similar to the British national health system, in which the Government allocates patients to practitioners according to where they live. Short of moving their place of residence, patients in this system also had little choice about the practitioner available to them. We should be thankful that Australia has had relative success and avoided major mistakes, although clearly the current system is open to overuse, misuse and abuse, as well as being a significant drain on funding resources. The rising demand on this system has been amplified by advancements in medical technology, longer life expectancy, growing need of multisystem treatments, and rising medical, surgical and pharmaceutical costs. At the same time, dissatisfied doctors claim that increments from Medicare rebates have not kept pace with the overheads of running medical practices.
The current Medicare rebate for a standard general practitioner [GP] consultation is $25.70. Many doctors consider this to be well below the price of a proper consultation, and that includes the patient's history, appropriate medical work-up, diagnostic tests and relevant paperwork. The Relative Values Study puts the appropriate rebate value as being closer to $50, of which the latest rebate adjustment still falls short. Undoubtedly, Australia still has one of the best health care systems in the world. Despite some resistance, the bulk billing rate for general practitioners in the early days of Medibank was more around 90 per cent. In recent times, the bulk billing rate has dropped alarmingly. In just under seven years since the end of 1996, the figure has dived from 80.5 per cent to just 64.7 per cent.
Clearly there is less and less financial incentive for doctors to bulk bill. Many are opting to set their own fees to cover the rising costs of practising. Processing Medicare claims is also onerous work that eats into precious consultation time. The increased time spent doing administration and paperwork has also contributed to the erosion of professional fulfilment. I have spoken on a number of health care issues throughout the year. Two relevant factors in particular deserve to be mentioned today: first, the continued support, retraining and reskilling of overseas-trained doctors remains a significant issue. They are an untapped resource of many willing and able professionals that could improve the situation with regard to the shortage of doctors. Yesterday this House debated a bill that deals with directing tax earnings into health capital investment. I ask honourable members what use new health facilities will be to anyone if there are no qualified people to staff them.
The medical indemnity insurance predicament has also been critical in the debate on health care in Australia. This factor above all others has probably been the most damaging for the morale of the medical profession. Medical students embark on a very lengthy training process to become practising doctors—up to a decade, in fact, and longer for many specialties. A poor sense of professional fulfilment, diminished income, forever-increasing paperwork and the risk of protracted liability have diminished the attraction to this profession. Doctors would rather limit the services they provide, which in turn limits the choice of practitioners, or they simply retire early to avoid being embroiled in lengthy litigation and irreparable damage to their reputation.
The Federal Government should be congratulated on its $2.4 billion attempt to reform Medicare. It will provide some support for the welfare recipients and the young in accessing quality medical care. However, the safety net perhaps will only benefit some chronically ill patients who need frequent specialist care, but may also provide some incentives to doctors to continue to bulk bill. I believe the Federal Government still needs to urgently reform our medico-legal system, particularly the long-term care of critically injured patients. Despite the Federal Government's intention to recruit doctors from overseas, without job satisfaction and freedom from the constant fear of law suits Australia will continue to face a shortage of doctors and a possible drop in the general practitioners bulk billing rate.
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