Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

I rise tonight to speak on the Health Insurance Legislation Amendment (Assignment of Medicare Benefits) Bill 2024. This bill makes a series of amendments to the Health Insurance Act 1973 to update the assignment of benefit process which underpins bulk-billed Medicare items and simplifies the billing system. The amendments will remove some of the current rigid paperwork requirements to allow for a more streamlined processing of MBS bulk-billing claims, particularly for telehealth consults. It will reduce the regulatory and administrative burden for healthcare providers who provide bulk-billed services, private health insurers and approved billing agents. Importantly, this will ensure the payment of Medicare benefits are aligned with modern practices and will reduce the administrative burden of health providers.

The coalition welcomes the reduction in red tape that is achieved by this legislation, and we support these sensible amendments, which will streamline processes for healthcare providers and private health insurers. However, although we support this legislation and its intended purpose, we are concerned that the government believes this bill represents more progress on the government's commitment to strengthening Medicare. It has become clear that, under the Albanese Labor government, Medicare has only been weakened. The data shows Labor is overseeing a primary healthcare crisis that means it has never been harder or more expensive to see a doctor. In fact, bulk billing has collapsed since they came to government. In the minister's own words, 'Bulk billing is the beating heart of Medicare,' but it's currently more than nine per cent lower than when Labor came into government, falling from 88.5 per cent under the coalition to 79 per cent now under Minister Butler. This is the worst bulk billing data in over a decade.

Recent data from the Australian Institute of Health and Welfare has also shown Medicare is now covering the lowest percentage of GP fees on record. That means that Australians are paying the highest ever amount of out-of-pocket fees to see a doctor, and this is happening in the middle of a cost-of-living crisis, at a time when Australians are already facing skyrocketing cost of living pressures. We know that many families are forced to make a decision between seeing their doctor and paying their bills. In fact, last year 1.2 million Australians avoided seeing their doctor because they said they couldn't afford to do so. Since then, we know that costs have only continue to increase, and it's become harder and harder to see a bulk-billing doctor. Since the government's bulk-billing incentive came into effect in November 2023, there have been two million fewer GP bulk-billed services in comparison to the previous year.

Australians simply cannot afford to have this primary care crisis continue. Not only is it pushing up out-of-pocket expenses for families, but we also know that a weakened primary care system is putting more and more pressure on our hospital systems, which are already overburdened. With less access to early intervention provided by primary health care, more and more patients will continue to be pushed towards emergency departments. This is particularly concerning given that in 2022-23 we saw the worst average ED wait times in a decade, while the wait times for elective surgery have almost doubled compared with 20 years ago. In my home state of South Australia, elective surgeries have been delayed indefinitely because our hospital systems simply can't cope. There's no doubt that Labor's primary care crisis is a significant contributor to the disaster that is unfolding in South Australia.

The government must start taking real and urgent action to fix the state of primary care, because only that will take the pressure off our hospital system—real action like putting downward pressure on inflation, which we know is impacting general practice as it's impacting on every other business around the country, and real action like dealing with the severe GP workforce shortages that are underpinning the current challenges in primary care. For more than a year, the coalition has been calling for the government to implement an urgent and comprehensive national workforce strategy for the entire care sector, but so far they just continue to refuse to listen.

They also could match our commitment of $400 million to securing a strong pipeline of homegrown GPs in Australia, but on this we have heard them say nothing. The coalition, if elected, will use this investment to incentivise more junior doctors to enter community general practice, providing junior doctors with direct financial incentive payments, assistance with leave entitlements and support for prevocational training. This will ensure junior doctors who pursue a GP career in a community setting are not financially worse off than graduates who remain in the hospital environment. Junior doctors who enter general practice earn about three-quarters of the salary of their counterparts in a hospital setting. This pay gap is one of the biggest disincentives to choosing a career in community general practice, along with the loss of paid leave. According to the RACGP, Australia's GP shortfall is expected to approach 11,000 doctors by 2031, as fewer medical graduates are choosing to take up general practice as their chosen speciality. We know that a strong pipeline of home trained GPs is critical to delivering essential health care to all Australians and addressing Labor's primary healthcare crisis. Until these workforce shortages are adequately addressed, Australians will not have timely or affordable access to GPs.

So, once again, the coalition supports this legislation and the fact that it removes red tape and streamlines processes for healthcare providers and private health insurers. However we put on the record that the data clearly shows that the Albanese Labor government are weakening Australia's access to affordable health care; they are not strengthening it. To that effect, I move the second reading amendment circulated in my name:

At the end of the motion, add ", but the Senate notes that:

(a) with the declining bulk billing rate across Australia since the Albanese Government came to power, despite all of Labor's promises and self-congratulatory press releases, it has never been harder or more expensive to see a GP; and

(b) this government is weakening Medicare, not strengthening it".

Malarndirri McCarthy (NT, Australian Labor Party, Assistant Minister for Indigenous Australians) Share this | Link to this | Hansard source

The government does not support this amendment. In November 2021, six months before the last election, the financial viability of general practice was in serious trouble after the coalition's six-year freeze on Medicare rebates, which started when Peter Dutton was Minister for Health. The Royal Australian College of General Practitioners took the extraordinary step of calling on every GP in the country to stop bulk-billing to maintain the viability of general practice. Dr Karen Price said, 'This is why, as a college, I am exhorting everybody, including my own practice, to move as many people as you can onto private billing.'

At the time of the last election, Health Minister Mark Butler said general practice was in the most parlous state in the 40-year history of Medicare. Bulk-billing was falling off a cliff because of the six-year freeze on Medicare rebates, which is why we tripled the bulk-billing incentive from 1 November last year in the largest investment in bulk-billing in history. I'm pleased to say that investment is working. The numbers released by the health minister today show that, in the seven months since we tripled the investment, we've seen a turnaround in bulk billing: a national increase of 3.4 percentage points, from 75.6 per cent of all GP visits being bulk-billed in October to 79 per cent in May, around two million additional estimated visits. Bulk-billing has increased in every state and territory. Members of the opposition might like to grandstand on bulk-billing as though they didn't make cuts to Medicare throughout their entire time in office, the worst of which occurred under the now Leader of the Opposition during his time as health minister, but Australians know this is a government that is committed to strengthening Medicare, and that's exactly what we have delivered since coming into office.

I commend the bill.

Louise Pratt (WA, Australian Labor Party) Share this | Link to this | Hansard source

The first question is that the second reading amendment put by the opposition be agreed to.

Question negatived.

Anne Ruston (SA, Liberal Party, Shadow Minister for Health and Aged Care) Share this | Link to this | Hansard source

Could I have it recorded that the coalition supports our own amendment.

Louise Pratt (WA, Australian Labor Party) Share this | Link to this | Hansard source

Thank you.

The next question is that the bill be read a second time.

Question agreed to.

Bill read a second time.