Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Health) Share this | Hansard source

Before I begin speaking on the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2024, I have to call out the emotive, manipulative spin Labor uses in the health portfolio. This bill and Labor's track record demonstrate that outcomes do not match the pre-election rhetoric. Those of us on this side of the House believe in outcomes rather than spin. Labor's rhetoric about saving Medicare and celebrating anniversaries is desperate when you compare that to actual outcomes, because their record is not good.

Not only do they keep the Department of Health under the thumb and unable to provide us or the public with data on outcomes; they manipulate departmental resources to claim bulk-billing rates are improving. They're not. GP bulk-billing has fallen by 11 per cent to 77 per cent under the Albanese government, while out-of-pocket costs have increased by 11 per cent, and that is in the past year alone. To put this into perspective, the GP bulk-billing rate rose to 84 per cent under Peter Dutton, the Leader of the Opposition, as health minister, and it continued to rise cent under the former coalition government, getting to 88 per before we left office. Under the Albanese government, Medicare is currently covering the lowest percentage of GP fees on record. On average, Australians are being forced to cover 45 per cent more of the cost to see a doctor from their own pocket, in comparison to what they covered under the former coalition government. Labor loves talking about when Mr Dutton was the health minister, but they don't like to talk about those facts.

This bill implements measures intended to protect the integrity of Medicare, enhance the regulation of goods under the Therapeutic Goods Act and amend the tobacco act. Some amendments in the bill form part of the response to the recommendations of the Independent Review of Medicare Integrity and Compliance, undertaken by Dr Pradeep Philip. The Philip review identified potential improvements to administering health benefits schemes—in particular, the power to detect, respond to, investigate, disclose and deter misconduct, fraud and noncompliance. The bill seeks to address a range of impediments to the department conducting efficient, timely and effective compliance activities.

Given the widespread implications of this bill, the coalition is seeking further scrutiny of its effect and implications through a Senate inquiry. While we support measures to strengthen the effective administration of Australia's important health benefits schemes, including the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme and the Child Dental Benefits Schedule, we want to make sure that there are no unidentified negative consequences created by this bill for Australia's healthcare professionals.

It is rather ironic that this legislation aims to make efficiencies in the way Medicare works and improve its integrity, yet, under this government, wait times for Australians trying to access vital health services through Services Australia have blown out dramatically, with Australians waiting almost three times as long for PBS patient refunds to be processed. Now, who would have thought it! This Labor government is excellent with the headlines but not so great on the implementation. They are great at beating their chests and at two-word slogans with the word 'Medicare' in them but not great at beating the delays and delivering Medicare funded services to needy Australians, especially in the regions.

New data obtained by the opposition through Senate estimates reveals a massive spike in the time it took for the agency to process key health claims during a cost-of-living crisis. The new data also shows that more health claims in 2023-24 were completed outside the agency's own internal timeliness standard than not, with 8.3 million completed after the official deadline, compared with 5½ million claims completed on time. At that level, you could excuse Australians for thinking that, under Labor, waiting an inordinate amount of time for outcomes is the norm. In 2023-24, 77 per cent of all bulk-billing claims were completed past their official deadline, the second-worst result across Services Australia's entire health work program. Now, more than ever before, it is critical that the government ensure Australians can have their Medicare and PBS claims paid on time, but instead they have sent the system backwards.

Residents in my electorate of Mallee have not seen improvements to Medicare under this government. Labor promised to strengthen Medicare, but they have weakened it. It has never been harder or more expensive to see a doctor than under the Albanese Labor government. Bulk-billing rates are falling, and the cost of seeing a doctor is rising. The bulk-billing data I gave earlier points to a primary care system at crisis point. When primary care becomes unaffordable, difficult decisions must be made in families and households and by individuals, regarding how to spend their limited resources. Australians are making the trade-off between paying their bills and seeing the doctor. Under the Albanese government, health costs have gone up by 10 per cent. We know that 1.5 million Australians avoided going to a GP in 2023-24 due to cost concerns. The proportion of people who reported that cost was a reason for either delaying seeing a GP or not seeing a GP when needed increased to 8.8 per cent in 2023-24 from seven per cent in 2022-23.

This is a concern not only in and of itself but also because people who do not receive the primary care they need in a timely manner often become sicker and need to access the hospital system, including overburdened emergency departments, when their symptoms become more severe. This is not good for patients, and it is costly for the health system. These circumstances are amplified in the regions, where the primary care system has long been stretched and is now approaching breaking point. People living in the regions, including in my electorate of Mallee, already have reduced access to primary care, rely more heavily on emergency departments and are admitted to hospital at a greater rate than those living in major cities. Worse still, those emergency departments are a long distance from where rural, remote and regional Australians live.

Earlier this sitting fortnight, I visited the CareFlight helicopter that landed in Federation Mall to promote their work. Medical evacuation to capital cities for emergency treatment has become the norm in rural, regional and remote Australia. A 2023 report published by consulting firm Nous clearly articulated the relationship between Medicare Benefits Schedule, or MBS, expenditure; emergency department, or ED, presentations; and hospital separations. MBS expenditure reduces as you get more geographically remote, and, in concert, ED and acute hospital usage increases. When this existing system strain is coupled with the degradation that is occurring under the Albanese government, the outcome is magnified.

People in the regions are really doing it tough when it comes to getting the primary care they need and deserve, and this government has not done them any favours. The Australian Bureau of Statistics data corroborates this finding, illustrating that people living in outer regional, remote and very remote areas were more likely to report waiting longer than they felt acceptable for a GP appointment in 2023-24 than those living in major cities were—36.3 per cent compared to 26 per cent. They were also less likely to see an after-hours GP, 5.6 per cent compared to 3.9 per cent; and more likely to visit a hospital ED, 20.4 per cent compared to 13.8 per cent; or be admitted to hospital, 14.2 per cent compared to 12.1 per cent. Constituents regularly tell me of the significant challenges they face just getting to see a doctor.

Here are some of their comments. 'There are no GPs in my town. The nearest is 70 kilometres away.' 'Our previous clinic closed, and it took six months to find a new GP clinic that would accept new patients. My family now has three different clinics between us, but we still do not have access to a regular doctor, because they keep leaving town.' 'The last doctor I was seeing left the nearest town. Now there are none taking new patients, so I see locums in a town further away.'

All Australians should be able to access the care of a GP when they need it, yet, under the Albanese government, this is becoming a pipedream for a few. There are just not enough GPs in the regions. This longstanding workforce crisis was amplified thanks to Labor bleeding the regions of doctors through the expansion of the distribution priority area, which funnelled international medical graduates into peri-urban settings. There is a significant and persistent maldistribution of the GP workforce, resulting in shortages in the regions, especially in small rural towns—and I have 72 in Mallee.

We know that small rural towns like Dimboola, in my electorate, have, on average, almost 60 per cent fewer health professionals than major cities do—just imagine. As older GPs retire, more young GPs are required to replace them as they're no longer willing to work the kinds of hours that were required in the past. One retiring GP might require two or even three younger GPs to cover their workload into the future. Then there is the issue of supervision. Younger GPs are pushing back against the requirement to supervise trainee GPs in their practices—and I have some in Mildura in exactly that position—in part because they are just not remunerated adequately for the time and energy involved to train the next generation of doctors to a high standard. It also takes them out of seeing their own patients. If you have a level 1 registrar, it requires for the GP—their supervisor—to sit with that registrar in every appointment. It's a requirement and it's needed, but the remuneration is not there to match the workload.

That is not to mention—as time doesn't permit—the woeful approval times at Ahpra, on this government's watch, to get doctors up and running and practising here, which at times leaves our health services desperately short, as it did in Maryborough last year. These are key issues which must be addressed to make it easier for people in the regions to see a doctor, yet this government has been moving the dial in the wrong direction. I haven't even touched on the challenges posed by the higher costs of running a GP practice in the regions, including to fund locum doctors or incentivise GPs to move to an area by reimbursing relocation costs and providing subsidised housing. All this is coupled with patient populations who have lower incomes on average and, therefore, a reduced ability to pay out-of-pocket costs.

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