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- 3 March 2005
Co-Located General Practice Clinics
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Page: 14575
Debate resumed from an earlier hour.
The Hon. ROBYN PARKER [2.53 p.m.]: The Liberal-Nationals Coalition rejects the motion. The failure of the New South Wales health system should be sheeted home to Bob Carr instead of his Government trying to palm off any problems to Canberra. All our local areas have health care problems. On 20 December 2004 the Newcastle Herald ran an article about staff at Newcastle Hospital slamming as inhumane the treatment of a patient forced to sleep on the floor because of a lack of beds. Another article on 10 February highlighted growing waiting lists in orthopaedic surgery. All of us have numerous newspaper clippings highlighting problems within the New South Wales health system—bed closures and mismanagement by the Carr Labor Government—that the Government refuses to admit to because it wants to sheet home the blame to the Federal Government. It wants to shift costs from the State Government to the Federal Government at a time when it is imposing further taxes on the highest-taxing State in Australia. I move:
That the question be amended by omitting all words after "House" and inserting instead::
(a) recognises the Carr Government's closure of 4,750 hospital beds since 1995 and the pressure these closures have caused within public hospitals,
(b) notes Department of Health statistics that, contrary to Carr Government claims, show that its Triage Level 5 presentations have declined since 2000; and
(c) calls upon the Government to stop blaming others for its health failures, reopen closed beds and start to support the hardworking doctors and nurses in the public hospital system.
We oppose the motion.
The Hon. Dr ARTHUR CHESTERFIELD-EVANS [2.55 p.m.]: The motion is another example of the depressing point scoring and time wasting that goes on in this House. Private members' motions should be innovative. Their aim should be to draw attention to model legislation or problems the Government is not addressing adequately to solve problems within New South Wales. This motion contributes little and does nothing other than blame another tier of government and another party. It is true that co-located general practice clinics reduce the pressure on busy public hospital emergency departments, but why do so many people present at emergency departments rather than general practice? It is not difficult to work out. Originally the Medicare rebate was 85 per cent of the Australian Medical Association most common fee, but because it has not been raised against the consumer price index it now represents less than 50 per cent. Some doctors are not allowed to raise their fees because they do not have general practice accreditation.
Big corporations are buying into general practice and, in some cases, taking up to 55 per cent of doctors' gross salaries. Thus doctors will not provide their services at the Medicare rebate level set by the Federal Government. They will not bulk-bill so the patient must pay. Cost shifting from the Federal Government then goes back to either the patient or the private health insurance system. Many people, particularly poorer people, who are not covered by private health insurance either cannot or will not pay the difference so they present to the hospital emergency department. It is exactly because of the cost shifting of the Federal Government to the private sector and individuals that people present to emergency departments: they have been shifted there.
I understand that the emergency department staff at Newcastle Hospital were working so hard attending to people who should have been seen in general practice that the hospital agreed to pay general practitioners in session so that when patients presented at the hospital they had the choice of being seen in either the emergency department or the general practice. Some patients chose to be seen in the general practice, which took the load off the emergency department staff. However, the emergency department staff were unhappy to find that general practitioners working those sessions, and in a market situation, were being paid twice their salary. That says a lot about the state of the private and public health systems in New South Wales and Australia generally.
The Government supports private medicine in that manner, and all the resources will effectively go into the private sector. Co-location is now being discussed, which means that doctors will be able to make so much money from private medicine they will not have to work in public medicine at reduced payment. Co-location means doctors will not have to walk far from where they make the bulk of their income to where they could help the poor people. The public health system is becoming a safety net for poor people. Although the public health system does emergency cases, a profit cannot be made from intensive care cases and cases that arise unexpectedly, because they are expensive.
Evidence given at last week's inquiry into the Mona Vale Hospital closure revealed that 70 per cent of elective surgery on the northern beaches is carried out in private hospitals. Private hospitals can gear up with the right number of staff, have the right timetables and be paid for those more lucrative procedures. However, cases that arise at irregular intervals and require casualty departments, emergency staff and intensive care units are dealt with in public hospitals. Those sorts of services cost money and prevent a profit from being made under the current billing scheme. The public sector is meeting the costs of medicine and the private sector is reaping the profits. As the doctors transfer their energy because their incomes are being derived from the private sector, the public sector will be more mendicant, as it is in the United States of America.
Honourable members should make no mistake: this country is transferring its health care system from a British-style national health service that takes a lower percentage of gross domestic product but delivers more in relation to the major indices of health—such as the neonatal mortality rate and lifespan—when balanced against the proportion of GDP spent on health care, to an American path that is characterised by an increasing percentage of GDP being spent on health, greater inequalities and far less cost effectiveness in the delivery of service. The market mechanism does not work in health for the simple reason that people will obtain as much health care as they can. They are not in a position to say, "No, I will not pay for that." That is the key element in this debate. The cost shifting by both levels of government to either private health insurance or private individuals is a sad fact of life.
The motion to which an amendment has been moved, examines only one tiny aspect of the problem. This debate is talking around the point and wasting everybody's time. The motion condemns the Federal Minister for Health, Tony Abbott. Although it is true that Tony Abbott does not fund general practice clinics, it is equally true that the overall health system in Australia is being mismanaged. It is my contention that any argument about whether Tony Abbott funds general practice clinics or adequately funds the Medicare rebate should be resolved in favour of adequate funding by the Federal Minister for Health of the Medicare rebate. The last paragraph of the motion calls on the Federal Minister for Health to provide funding for a co-located general practice clinic at Canterbury Hospital. That is simply local politics from a member who technically represents New South Wales.
The motion moved by the Hon. Kayee Griffin criticises the Federal Government for shifting costs to the State. The amendment moved by the Hon. Robyn Parker attempts to shift the blame back to the Carr Government. To some extent, the Carr Government is to blame because it has refused to borrow money to provide infrastructure. Instead of having the benefit of $100 million in infrastructure, for which it pays an interest component of approximately 6.5 per cent, the Carr Government takes the $6.5 million representing the interest component and pays off the State's debt, has no funds left with which to provide infrastructure, and is then roundly but deservedly criticised for its absurd policy of buying infrastructure while being totally obsessed with controlling State debt.
There is nothing wrong with borrowing money provided there is sufficient asset backing for the debt. That is the view of the financial sector and that is the way this country has been built. It is beyond my understanding why the Carr Government follows such an insane economic policy. Be that as it may, the Opposition amendment criticises the Carr Government for the closure of hospital beds. People are obsessed with bed numbers. However, I point out that bed utilisation is not an adequate yardstick. Beds were closed down for a month over Christmas, so 10 per cent of the capacity of hospital beds has been lost. The beds have been opened but are not in use, and that is clearly an absurd situation. The amendment calls for more beds to be provided, which would result in increased costs when hospital beds that are currently available are not fully utilised. The amendment has not been thought through. The classification of "triage level 5" is a problem of definition and it contributes nothing to the debate. An amendment that is designed to simply shift the blame is of no consequence.
As I have said many times, people who participate in debates in this House ought to contribute to providing a solution. It is one thing to criticise another tier of government or another party; it is another to come up with a workable solution that will fix the problem. As I stated earlier, I do not believe that the market mechanism works in the provision of health care because most economies are not derived from procedural deficiencies but from allocation efficiencies. In other words, it is more important to be doing the right thing than to be doing something cheaper. If lots of unnecessary investigations are being conducted, even at a reduced cost, progress will not been made. That is exactly the situation with the overuse of antibiotics and some drugs, investigation services, some types of surgery, intensive care units and pathology services. A single system that better utilises available resources and allocates resources more efficiently will obtain a better result, particularly with regard to the use of preventive measures, than will increased efficiency in procedures as defined by market criteria that will save a few dollars on a gall bladder operation.
I have given a great deal of attention to the best way to fix the health system. Indeed, the public health sector has carried out a considerable amount of work on this topic, but it has received little attention from people who think health care is about treating end-stage diseases. That is what "health care" has come to mean. "Health" has come to mean paying for the treatment of end-stage disease by doctors, whereas the real definition of "health" is the absence of disease and a more holistic view of a well-functioning human body. I have devised a 10-point scheme under the heading "How to Fix the Health System". It is available at www.chesterfieldevans.com. The points are simply set out. First, maximise prevention; second, get a single source of funding; third, support a single system—the public system—but use competition to get the public system a better deal; fourth, integrate the community support system with the hospital system; fifth, have a public discussion of the limits of intensive care so that resources are not wasted on terminal patients—pre-funeral expenses, as I call them; sixth, make more intelligent use of investigations and pharmaceuticals; seventh, reform medical indemnity, replacing tort law with a safety management system; eighth, pay a reasonable Medicare rebate and move towards a salaried medical service; ninth, set up community medical centres, including salaried paramedical personnel; and, tenth, get a national dental scheme similar to Medicare.
My relatively short article also discusses the barriers to adoption of my fairly balanced approach. Some of the major stumbling blocks are Federal and State governments being reluctant to give up their powers, the private health insurance industry being unable to compete with Medicare but pretending that it can, doctors preferring to set their own fees rather than being on salaries, economic dogma as an impediment in itself, the sellers of technology and pharmaceuticals seeking to maximise profits rather than maximising health, the cost of prevention being strenuously resisted by people who do not want money being spent on causes other than their own, and the expansion of new areas such as home support that are being resisted by governments that do not want to expand services in areas of service provision in which they previously were not involved and would rather leave to people such as relatives who look after aged people in our population. To save the time of the House, I seek leave to table a longer version of the article. Whether one supports this motion is of no consequence, and whether one supports the amendment is of minimal consequence. Health should be discussed at a far more appropriate level than debate on this motion or amendment will allow.
Leave granted.
Document tabled.
Debate adjourned on motion by the Hon. Peter Primrose.
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