Alex Gallacher (SA, Australian Labor Party) Share this | Hansard source

I rise to make a contribution in this adjournment debate about an issue that probably has not had the prominence it deserves. Views on this issue are widely held and deeply felt in the community. Mr Acting Deputy President Sterle, as you and I both know due to our interaction with constituents in Western Australia and South Australia, there is a great body of resentment and anger about the GP co-payment.

I want to set the scene. The Hon. Tony Abbott has broken his promise on no new taxes, with a $7 GP tax and an increase in the cost of medicines that will cost a typical family $270 per year. The GP tax alone will cost Australian families $3.5 billion in out-of-pocket costs—a hit on some of the most vulnerable Australian families. This is part of the government's plan, I believe, to dismantle Medicare. It is a lazy policy and it will deliver greater complications and sickness, more pressure on hospitals and, overall, a greater cost to the system, taxpayers and patients. Importantly, the Australian Medical Association, the Australasian College for Emergency Medicine, the Doctors Reform Society, the Public Health Association of Australia, the Royal Australian College of General Practitioners, the Consumers Health Forum, the Australian Healthcare and Hospitals Association and countless health academics and economists have advised against this tax. But the government went ahead anyway.

Importantly, we had the opportunity, through estimates, to query the making of these policies, to ask questions about modelling and the like. At a recent exchange with the fiscal group of Treasury, on 4 June 2014, my question to that group was:

Was that advice or that modelling provided to the Commission of Audit? I first heard about this Medicare $7 co-payment through the media and the Commission of Audit. Were those unelected people also privy to this modelling and advice?

The reply was:

They certainly would not have been privy to the advice that we provided to the Treasurer, no.

My reply to that was:

Unless the Treasurer gave it to them?

Senator Cormann came in and said:

I am happy to take on notice and check with the Treasurer personally and directly, but I am fairly confident that the Treasurer would not have handed Treasury modelling to the Commission of Audit.

I am trying to get to the situation where this Commission of Audit recommended to the government a Medicare co-payment. On what basis did it recommend that co-payment? Obviously, if the Treasurer and the department are correct, not on the basis of modelling.

There are plenty of people in the community who can pay a $7 co-payment. There are plenty of people in the community who now pay more. They just pay a doctor and go and get their Medicare rebate. But, if there has not been any modelling on the impact, particularly on the vulnerable, in aged-care facilities or in regional Australia, this government is going the wrong way. As you and I both know, Mr Acting Deputy President, there is a great swelling of anger about this unfairness that is creeping into what used to be a very good system.

I asked a question of Senator Nash the other day. The question for Senator Nash was quite simple:

Can the minister confirm that, under current bulk-billing arrangements, a medical practice in a regional area receives a higher bulk-billing incentive than in a metropolitan area? And can the minister confirm that under the government's budget savings measure this higher incentive for GPs has been abandoned and that regional GPs who do not charge the $7 GP tax will be more than $14 worse off per consultation?

Mr Acting Deputy President, as you and I well know—through my travels through regional South Australia and your work in the Kimberley and regional Western Australia—it is extremely hard to get doctors into regional areas in any event. There are very, very generous subsidies to attract doctors to practise in regional areas—and here we have another disincentive for them to go out there. The minister, in her reply, did what is customary in this place. She blamed someone else, she blamed the budget deficit, she blamed the budget emergency. She blamed Senator Wong, the then finance minister. She alluded to former Prime Minister Bob Hawke. She did everything except actually address the issue. Is it a fact that, in regional Australia, medical practitioners will be $14 worse off per consultation? If they are servicing people who are vulnerable and do not have the money, should they turn them away or should they service them and just cop the loss? These very important issues, I believe, have been modelled. I believe the fiscal group is not a group that would not have done the modelling to actually identify these issues; it is just that this government went ahead without any thought at all about those most vulnerable people in our regional areas.

I turn now to another really interesting area where this is going to have a catastrophic effect. I have received a letter from Dr Daniel Anderson. He has distributed this letter to all senators, to Christopher Pyne, to Kate Ellis and to the Minister for Health, Peter Dutton. The letter states:

I am a general practitioner in Linden Park, SA.

In particular, only a very few GPs practice in aged care facilities. An article in one of the weekly medical magazines a year or two ago stated that of all the GPs in Australia only about 15% are prepared to do aged care in the facilities. It is difficult medicine and I rarely see any young doctors at the variety of places I visit; usually the same "old faces". Most of us manage huge numbers of patients in these facilities; my load varies from 120-150 residents as well as full time GP work.

There is no way GPs could ask for the $7.00 co-payment (most have dementia) let alone why should we accept a $5.00 reduction in the rebate. I understand that if the co-payment is not collected from these patients the GP will not be eligible for the practice incentive payments.

I anticipate that more doctors will refuse to visit aged care facilities due to these disincentives.

My same thoughts apply to the very disadvantaged in our community.

From speaking with Dr Anderson we discovered that this is the hard end of medicine. Quite often the patients are unable to articulate any sort of reasonable conversation, let alone bring the $7 required. He said they cannot ask these people for $7, so they will continue to bulk bill even though they will be getting no incentive. This will mean we will have fewer young doctors going into these facilities and vulnerable people not getting appropriate medical advice. We will have less incentive for people to set up and practise in regional Australia.

As I said earlier, Mr Acting Deputy President, both my office and your office have contacted enough people to know that this is a deeply felt issue that is flying under the radar as we speak. We have important business before the Senate—everybody is aware of that—but this issue will not go away; it will be the subject of continuing debate in here. We must not let this co-payment go through and punish people who are suffering from the tyranny of distance. We must not punish people who, at the end of their working lives, are in an aged-care facility and suffering from dementia, Parkinson's and all sorts of afflictions. They deserve the best Medicare system possible. That does not include a payment up front. It does not include a disincentive for hardworking medical practitioners to go into these two areas of medicine. That is only the tip of the iceberg in respect of this issue. I fully expect that members of the House of Representatives and the Senate will bring many, many more examples to this place and the other chamber clearly articulating the foolhardy nature of this policy. We are going to put the most vulnerable people in jeopardy and we are going to put the most hardworking of people in a position where they have to question the viability of their practice and the continuity of their commitment in a very difficult area of general practice.

Senate adjourned at 19:28