Julian Simmonds (Ryan, Liberal National Party) Share this | Link to this | Hansard source

I welcome the opportunity to speak on this motion today because it gives me the opportunity to outline once again why the coalition, particularly the Morrison government now, is the best friend that Medicare has ever had. We went to the election with a simple promise to the Australian people: more accessible, affordable health care.

My electorate of Ryan is home to just over 39,000 families. Medicines and health care are a priority for them. Health care at times can be a big part of the household budget, and that's why we know the importance of Medicare providing bulk-billed GP rates and the PBS helping with the cost of medicines.

Our commitment to Medicare, the PBS and bulk-billing are rock solid. Our commitment is not a one-off; it is a continual investment now and in the future. We have guaranteed the long-term history of Medicare with the Medicare Guarantee Act. That makes us, as I said, on this side of the House, the best friends that Medicare have ever had.

Unlike those opposite, we can provide a long-term commitment to Australians when it comes to Medicare because we have the proven strong economic management to back it up. We can manage a budget. We know that when you can't manage a budget you can't invest in vital services like health care and education.

So, for all the lofty promises of those opposite, they can't actually deliver them. We saw this with their lack of commitment to the PBS the last time they were in government. Because of—if I recall the quote from their budget—fiscal constraints, they were unable to list medicines on the PBS. Shocking and shameful, yet it is something Labor members are yet to stand up to the Australian people and apologise for. When it came to the crunch, when it came to listing medicines that would save people's lives and improve the quality of life, because of their financial mismanagement, the cupboard was bare.

Despite Labor reaching into their bag of tricks time and time again and putting out a scare campaign or two on Medicare, the facts continue to speak for themselves. Since 2012-13 bulk-billing rates have increased by four full percentage points from 82.2 per cent when Labor was last in office to 86.2 per cent now. In 2018-19 patients made 136.5 million bulk-billed GP visits—an increase of 3.3 million on the previous year alone.

Medicare bulk-billing is at a record level, meaning more Australians are getting to see a GP without having to reach into their hip pocket. In fact, under this government, nine out of 10 visits to the GP are now free. In my electorate of Ryan last year, this was over 613,000 visits, some 171,000 more than in Labor's last term in government in 2012-13.

We're also, of course, broadening the benefits to patients. On 1 July this year, we increased the patient rebate for further GP items on the Medicare Benefits Schedule. Specialist procedures, allied health services and other GP services such as mental health and after-hours services were indexed.

In response to the Medicare Benefits Schedule Review, we will increase Medicare funding from $25 billion in 2018-19 to $31 billion in 2022-23. Let me repeat that: we will increase Medicare funding by $6 billion from $25 billion currently to $31 billion by 2022-23.

To ensure that patients receive procedures in line with best practice to support high-value care, next year changes will be made to items on the Medicare Benefits Schedule in the areas of intensive care, emergency medicines, diagnostic imaging, neurosurgery and neurology. This builds on the MBS Review and commitments that we have made in the 2018-19 MYEFO in the areas of cardiac items, pulmonary embolism, deep vein thrombosis and anaesthesia services.

We are not just guaranteeing Medicare, as I've spoken about; we are continuing to make it better for everyday Australians to make sure that when they visit our healthcare professionals they do so with lower costs out of their own pocket and with better services in place. We're not going to stop making these kinds of improvements, because we know how to manage an economy, unlike Labor, which stopped adding medicines to the PBS until 'Fiscal circumstances permitted'. Unlike them, you'll see us continue to list medicines on the PBS at an average rate of one a day. We'll continue to invest as well in the four pillars of our healthcare system, as we set out in our last budget, guaranteeing Medicare and access to medicines, supporting hospitals, prioritising mental health and investing in life-saving research.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

In my electorate on the New South Wales South Coast, health is something very close to our hearts. Many local people are forced to travel significant distances to get the health care they need. This results in higher out-of-pocket costs, more time away from their families and support networks, and a significant cost to our health system and economy. That is why early intervention is so important. That is why it is vital that Medicare is functioning appropriately. That is why it is essential that patients can access bulk-billing, local doctors, at-home early-intervention services, local mental health services, and drug and alcohol rehabilitation. We know that when these early interventions are not there or are not sufficient there are higher costs to the patient, higher costs to the system and poorer health outcomes.

The member for Lyne's motion talks about the government's commitment to Medicare. What it doesn't mention, however, is the Liberal-National government's freeze on the Medicare rebate indexation. What it doesn't mention is that out-of-pocket costs to visit a GP are up by 25 per cent and that around 1.3 million Australians per year skip or delay Medicare services due to costs. Out-of-pocket fees to see specialists continue to rise, and, when you also have to travel to access this specialist, this can put life-saving medical treatments out of reach. Labor created Medicare, and we have fought to protect it. But all this government has done is cut, attacking the very foundation of Medicare at every opportunity.

The Liberal-National government is failing regional and rural Australia on health. Communities like mine struggle to find and retain local doctors, and some of our only bulk-billing medical centres have been forced to close or to reduce the number of doctors because of this government's policies. Demand for home visits, residential care facility visits and after-hours services is greater than the supply of doctors. My electorate has one of the highest numbers of aged pensioners in Australia, and the lack of local GPs is causing significant strain on local services like our hospitals.

There is so much more the government could be doing to support our health system. Take, for example, a recommendation in the recent aged-care royal commission interim report. The commission described the unacceptable number of older Australians waiting for home care as 'unsafe practice' and 'neglect'. Where does the government think these people go? They go into the health system. They turn to Medicare for help and support: a system overburdened and underresourced. But there are services out there trying to fill this gap.

The Illawarra Retirement Trust saw the gap in home care services for Indigenous Australians and the impact this was having on their health outcomes. After receiving a grant under the Dementia and Aged Care Services innovation funding round in 2017, IRT worked with the Aboriginal community in Batemans Bay to build the Booraja home care pilot program. The pilot has successfully helped Aboriginal people in the Batemans Bay area access home care packages, winning a national award at the innovAGEING awards. Booraja has provided care to 20 older Aboriginal people and has a waitlist of further clients. IRT also found that 75 per cent of Booraja's clients did not know about home care or how to access it before the program.

But their grant has expired, and so far they have been unable to secure further funding—an absolute tragedy for this community. Targeted programs like this can lead to improved health outcomes for a community traditionally cut off from these vital services. Booraja has also employed all-Aboriginal caseworkers, training them in a Certificate III in Individual Support and creating a whole-of-community program, but they can't secure additional funding.

This government is simply not serious about improving our health system. The Milton-Ulladulla community continues to campaign for a CT scanner at the hospital and has seen the closure of its birthing unit. Local doctors and nurses are doing their best, and everyone in our community has nothing but praise for the wonderful work they are doing. They need the resources to adequately do their jobs, but this government continues to cut funding and support from the health system. It promised not to cut health funding, but it cut $57 billion from hospitals and another $10 billion from Medicare and other health programs in its first year. This is the real record on health for this government—cuts, cuts, cuts.

Andrew Wallace (Fisher, Liberal Party) Share this | Link to this | Hansard source

I'd like to acknowledge the member for Lyne for the outstanding motion he moved in the chamber today. The truth is that since 2013 this government has unequivocally demonstrated that there is only one side of politics in Australia which has the pragmatic approach to reform and the strong economic management required to protect and expand Medicare—that is, of course, the Liberal-National coalition. The Member for Lyne highlighted many of the national statistics which make this clear, but people living in my electorate of Fisher have seen it for themselves in the services provided every day in our community.

When the coalition took office in 2013 there were 195 GPs providing Medicare funded services in the southern and central parts of the Sunshine Coast. Today there are 260. The government's funding of Medicare in my electorate has increased over that time from $133.3 million to $174.6 million last year—and those opposite call that a cut! This increase in funding has been reflected in the delivery of appointments on the ground. Today, the GP bulk-billing rate in Fisher stands at an impressive high of 88.5 per cent, with 960,161 bulk-billed services delivered in 2017-18. This compares to just 774,000 the last time Labor were in government. That is not to mention the extra $12.1 million the government is spending per year in Fisher on the Pharmaceutical Benefits Scheme.

However, I'd like to speak to the Medicare reform of this government that is, perhaps, closest to my heart—the transformative changes we've made in mental health and, in particular, the treatment for people living with eating disorders, changes which today are already bringing hope to thousands of vulnerable people. In June 2018 the Minister for Health came to Fisher and joined me in visiting the Lake Kawana General Practice. There we met with Lexie Crouch, a courageous survivor of one of the most brutal of these insidious conditions, and Christine Morgan, who was the then CEO of the Butterfly Foundation. The minister was in Fisher to announce a $3.2 million pilot program, to be administered and evaluated by that foundation, which would provide, for the first time, specialist Medicare supported treatment for people living with an eating disorder. I strongly advocated for a treatment program like this on the Sunshine Coast which would comprehensively address the multifaceted needs of people with an eating disorder. I've had many valuable conversations on the subject with the Minister for Health, who I know shares my passion for tackling these most deadly of mental health conditions. In the end, the pilot came to Fisher.

With the coalition government's support, my community is becoming increasingly recognised as a national leader in eating disorder treatment. The Sunshine Coast is home to endED, a life-changing charity founded by Mark and Gayle Forbes, which for years has delivered much-needed support through its recovery coaches Millie Thomas and, more recently, Laura Chamberlain. With $6.2 million in coalition government support, the coast will also shortly also be home to endED Butterfly House, which will be Australia's first ever residential facility for treating people suffering from severe eating disorders. I was pleased that the Minister for Health chose Fisher for this pilot, but I was even more pleased to see what a success it had been and the crucial national outcome that had resulted. From Friday 1 November this year, thanks to this government, the Morrison government, the kinds of treatments offered under the trial in my community are now available to all Australians.

Through the government's 64 new Medicare Benefits Schedule items and with $110.7 million in new investment to support them, eligible people living with eating disorders all over Australia now have access to Medicare rebates of up to 60 treatment sessions each and every year. For people living with conditions like anorexia nervosa, bulimia and other complex eating disorders, this includes up to 40 sessions of psychological treatment and 20 sessions for dietetics. That's every 12 months. They'll also be able to claim rebates for sessions to develop an eating disorder treatment and management plan, regular GP reviews of their progress and a formal specialist review. Under this government we have made lasting changes to Medicare, particularly for those suffering from eating disorders, and I'm very proud to be part of it.

Meryl Swanson (Paterson, Australian Labor Party) Share this | Link to this | Hansard source

Medicare ensures that people can access life-saving treatment when they need it. Last year around 21 million Australians accessed Medicare services, including GP visits, vital tests and scans, and hospital treatments. The unfortunate reality, despite what those opposite seem to believe, is: when Medicare loses, people in regional and rural areas in Australia lose too. My electorate is a perfect example of that. In August last year I visited Raymond Terrace Family Practice. I met with principals Chris Boyle, Damian Welbourne and Sarah Bayley—all exemplary doctors. We discussed the difficulties the practice is facing when it comes to Medicare and out-of-pocket expenses, which we know have gone up and up and up. Raymond Terrace is an area with low socioeconomic status. The unemployment rate is 9.8 per cent—well above the national average—and almost 40 per cent of the population didn't finish high school. In 2016, when the national average income was over $1,500, in Raymond Terrace it was $554. Given this, it's unsurprising that Raymond Terrace Family Practice currently bulk-bills over 70 per cent of the patients it sees. And this is a vital service.

The Department of Health's Rural, Remote and Metropolitan Areas scale, more commonly known as the RRMA scale, determines how much a doctor's practice will get in cash incentives from the government for bulk-billing. Raymond Terrace Family Practice used to be classified as regional, but after a recent review the centre was reclassified as metropolitan. The reclassification will cost the centre around $60,000 per year, or two part-time receptionists. Reclassifying the centre from regional to metropolitan has taken away their incentive to bulk-bill. There are so many things wrong with this. Firstly, Raymond Terrace, whilst it is a fantastic community, is not metro. Secondly, this medical practice is in a community that desperately needs bulk-billing. It needs good primary health care. The principals at Raymond Terrace Family Practice know that their service is essential to our community, and they do an outstanding job—so much so that they're doing everything in their power to not end bulk-billing, including cutting their own incomes. But this isn't enough. In August the centre told me they had made the difficult decision to stop bulk-billing skin cancer procedures, meaning that patients will need to go to the hospital or pay over $500 and face a wait time as long as 12 months to be seen, because we're in a regional area. Unfortunately this is not an isolated issue.

Last week I met with Dr Mark Foster. Dr Foster is from the Community Healthcare Trustees, and he came to my office to tell me about the issues they're facing with GP and primary healthcare services in Kurri Kurri, my home town—in fact, I was born in the Kurri Kurri Hospital. Community Healthcare Trustees established a not-for-profit, bulk-billing GP service across two sites, in Kurri Kurri and in nearby Cessnock, in the seat of Hunter. Recent changes implemented by this government have had a terrible impact on these practices. Similar to the Raymond Terrace Family Practice, the centre is now classified as metropolitan. It's in the same category as the city of Sydney. I have home town bias: I love Kurri Kurri. It's a top place, but it's not Sydney. It's quite the opposite. Kurri Kurri has a population of 6,000, not six million, and an unemployment rate of 8.4 per cent, also well above the national average, with youth unemployment much higher in certain cohorts. The biggest industry is coalmining, and statistically the largest occupation groups are tradies, labourers and machinery operators. We're a great community. The community health care is the only 100 per cent bulk-billing practice in our town. The reclassification from regional to metropolitan has made it difficult to maintain this vital service.

Other issues are the changes to the district of workforce shortage boundaries. It's resulted in Kurri Kurri no longer being classified as a district of workforce shortage. This is fundamentally not true. We have difficulties getting GPs, and it's really hard to retain them. It's really hard to get those people there in the first place. I've written to the minister: 'Minister Hunt, come to Kurri; come to Raymond Terrace Family Practice. We'll give you a beautiful afternoon tea. You'll get to meet some great doctors, and we can really thrash out what's going on with Medicare in my community.'

Luke Gosling (Solomon, Australian Labor Party) Share this | Link to this | Hansard source

I commend the member for Paterson for that. I hope the Minister for Health takes up that kind invitation. It would be good for him to get out on the ground. I invite him up to the Territory as well. I'll get to that later, but there are obviously some difficulties that we face with our health system that the minister would do well to have a better look at.

I congratulate you, Deputy Speaker, for trying to put across the government's commitment to Medicare. It is great to see so much love in the House for the Medicare system, especially from those opposite. It almost feels like the 2014 budget never happened. Conservative governments and the labour movement have a fairly predictable relationship around Medibank and Medicare: we build it and you try to break it down. We introduced the universal healthcare system, of course, in the face of opposition from those opposite, from the Liberal and National parties, and we will defend it to our last breath.

Despite the efforts of those opposite over the years, as recent as 2014, Medicare remains so important to Australians. It is something that Australians can be proud of. I'm not saying it's perfect, but in the greater scheme of things, it is fair. Wherever I go, when I hear people return from overseas, they're always so thankful that we've defended our Medicare system over the years.

We can obviously improve the system, particularly in the Territory. Recent analysis by the Mitchell Institute showed that the current system does not properly factor in the needs of the Territory. We have, as you know, Mr Deputy Speaker, a much larger health burden to carry, compared with the rest of the country, yet we receive only 65c per person in Medicare payments, which is the lowest of any jurisdiction in the country. Overall, according to that report by the Mitchell Institute, there's an $82 million shortfall for medical services in the Northern Territory. I don't think anyone would doubt that there is inequality of health outcomes and services between rural and metropolitan areas. Addressing that has to be the No. 1 priority of the government.

We all know that life expectancy falls as remoteness increases. That's why the definitions the member for Paterson was talking about are important. It is important, whether something is classified as metro, rural or remote, because it means the system is able to apply sufficient resources. We all know that out-of-pocket health costs are increasing for Australians, who currently spend over $30 billion a year on such costs. My friend the member for Gilmore mentioned a little bit earlier that out-of-pocket costs are going up something like 25 per cent. This means Australians are paying a record amount out of their own pockets at a time when wages are not increasing. It is a problem.

In the time left, I'd like to flag the Medicare Benefits Schedule review. I'm worried about this review. I'm worried that the federal government is considering a recommendation to reform item 288, if you could take that on notice, please, Mr Deputy Speaker. It is around the provision of an incentive fee of 50 per cent for consultations, by psychiatrists, delivered via video conference to telehealth-eligible areas in Australia. The item is proving valuable by incentivising psychiatrists to provide services to rural and regional places, such as Darwin. So, for veterans and a whole range of other clientele, if that recommendation is taken on, that will decrease the incentive. There are a lot of no-shows in telehealth, so it will make it unviable for the providers of those services, and I ask that that recommendation not be taken up by the government.

Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

Medicare, introduced by the Whitlam government as Medibank, transformed Australia's health system. Before Medicare, Australians who could not afford private health insurance were locked out of proper medical care. They faced the prospect of becoming bankrupt when they became sick. Universal access to health care is an enduring legacy of the Whitlam Labor government. It is, along with the PBS, one of the great manifestations of Australia's commitment to an equitable and fair society. But, as we know, it is not something that we can ever just set and forget.

Labor has fought to protect and, where necessary, expand Medicare in the four or so decades since the Whitlam government, and we will always continue to do so. It is the sad truth that today, in 2019, there are still too many people in our community for whom the cost of health care is prohibitive, who either don't access the tests and treatments they need, because they simply can't afford to, or who have the added stress of financial strain on top of the strain of being sick, because they have had to access their superannuation to pay out-of-pocket costs or take out a loan, or continue to work, even though they're not well enough to do so because they're getting treatment.

In 2016 the ABS estimated that each year almost 300,000 Australians forgo a radiology service that they have been referred for because the cost is too high. That should never, ever be the case for anyone, let alone for 300,000 Australians. An MRI saved my life twice. I am incredibly lucky that, when I was referred to have an MRI, in July this year, I could afford the out-of-pocket costs. But, for too many people, people in my community and beyond, costs are prohibitive. And, sometimes, if, like me—because I didn't know that I had cancer at the time—the referral is not considered to be particularly urgent, it can be the case that the financial burden may well be enough to make the decision not to have the scan. Had I not had the MRI scan, we would not know that I have cancer, and I would not have started the treatment that I need.

On average, a woman diagnosed with breast cancer, according to the Australian Diagnostic Imaging Association, will require at least five services, and that's prior to commencing treatment. For example, I had an MRI followed by nuclear medicine, a CT, an ultrasound, and then further CTs during radiation. The ADIA also estimates that, on average, patients pay a $105 gap and a $473 up-front fee for nuclear medicine, and a $182 gap and a $524 up-front fee for MRIs. Then, once you have been diagnosed and you're in treatment, you require multiple scans, sometimes over many years, as part of the treatment—for many people, accumulating thousands and thousands of dollars in up-front fees. Under the current system, people can only access subsidised scans on MRI machines that have a Medicare licence, and there are only 216 fully licensed MRI scanners across Australia, so patients who can't afford the full upfront costs often wait weeks for an MRI, travel long distances or, as I've said, sometimes don't have one. The MRI is the only imaging service restricted by Medicare in this way, and it's a significant reason why access to MRIs in Australia is poor in comparison to our peer countries. And we must do better. We must.

I was very proud that Labor took a policy to the last election to tackle barriers to life-saving scans by scrapping restrictions on MRI machines for cancer patients. Labor's policy was that, if you need a cancer scan, every MRI machine in every postcode would be eligible for Medicare. Restrictions would be lifted so that all MRI providers that met minimum quality and safety standards would be able to bill Medicare for cancer services, provided they bulk-billed. That would mean that scans that would normally cost hundreds of dollars—often accumulating to thousands and thousands of dollars—would be free.

This government has made some good steps towards subsidising scans, and I ask the Liberal government to consider looking at Labor's policy and implementing it, because it is a policy that not only will save lives but will make life just that little bit easier for many, many Australians having to go through treatment,

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

There being no further speakers, the debate is adjourned. The resumption of the debate will be made an order of the day for the next day of sitting.