Next page . . . . Previous page . . . . Speeches . . . . Contents . . . . Debates(HTML) . . . .

Legislative Assembly for the ACT: 2002 Week 12 Hansard (13 November) . . Page.. 3594 ..

MR WOOD (continuing):

ACT the government is well aware of the shortage of GPs in the Lanyon Valley and in parts of Belconnen and Gungahlin.

While I acknowledge the seriousness of the issue, I cannot agree and the government cannot agree with Ms Tucker's original motion that the solution to the problems of GP costs and access lies in the hands of the ACT government. I am happy, the government is happy and Mr Stanhope is happy to report to the Assembly on what we are doing to ameliorate the problems. That is why I have moved an amendment. Primarily, the solution lies outside the ACT.

As we all know, the Commonwealth government has retained for itself control over funding for GP services, through the fee-for-service Medicare system, and control over the supply of GPs, through control of medical training in the higher education system. The Commonwealth had given the states and territories funding for public hospital services and community-based services through the Australian Health Care Agreement. It has not passed across the resources for GP services. There is no strategy which any state or territory government could develop alone that would guarantee affordable and easy access to GPs.

There can be little doubt that the current system for the delivery of primary health care is fundamentally flawed. The Commonwealth has set up a primary care health system for the nation based on the GP as a small business operator. Then, flying in the face of this small business model, the Commonwealth expects GPs to agree to be paid a set fee, which the Commonwealth sets, and to accept 85 per cent of that fee by bulk-billing the Commonwealth directly for each occasion of service.

This may have been a fine idea in the days when GPs thought the schedule fee was set at a reasonable rate. In those days, too, GPs had a percentage of bad payers, poor patients they never did get payment from or expect to get payment from. Bulk-billing of these patients meant GPs did get paid.

These days the schedule fee is highly contested by GPs and the AMA. It is not keeping pace with the rising costs of running a practice, certainly not with the increases in schedule fees which the Commonwealth agrees for specialists. GPs have not been treated as well by the Commonwealth as the medical specialists.

I must note here that the Commonwealth solution to the medical indemnity situation is to subsidise premiums for mainly specialists, at the expense of a solution which provides actual health care for the catastrophically injured who require long-term care, sometimes lifelong care. But that is a digression.

The bulk-billing rate is declining in the ACT. It has been declining since 1997-98. The 2001-02 rate of 51.2 per cent is lower than at any time since 1990-91. The story does not end with the decline of bulk-billing. Most GPs charge above the schedule fee, and patients are left to pay the gap between the Medicare refund and the actual cost of a GP visit.

The choice to bulk-bill or charge above the schedule fee is made by an individual GP, and many GPs still bulk-bill people with low incomes, such as those with a health care card. This shows that GPs are still demonstrating the social conscience they

Next page . . . . Previous page . . . . Speeches . . . . Contents . . . . Debates(HTML) . . . .