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Legislative Assembly for the ACT: 2003 Week 1 Hansard (19 February) . . Page.. 128 ..

MR HARGREAVES (continuing):

The proportion of Medicare services bulk-billed varies between each state and territory, and in comparative terms the ACT's rate is the lowest of them-the Australian average is 74.9 per cent. The ACT rate also places it at the lower end of bulk-billing rates for the average Australian rural community.

This drop-off in bulk-billing is hurting those who can least afford it. The evidence is that general practitioners are gradually withdrawing from bulk-billing health care card holders, patients on low incomes and older patients. Why is this happening? The Australian Medical Association argued that, because the scheduled fee has not kept pace with either the cost of running a practice or the consumer price index, rates of bulk-billing are declining as doctors increasingly charge above the rebate limit. Consequently, the AMA claims that an increase in the scheduled fee in line with CPI would improve bulk-billing rates.

The failure to adequately reimburse doctors is a clear indication that the Commonwealth is undermining Medicare as a universal system. This undermining is further demonstrated by the increase in the average out-of-pocket expenses that patients are paying for Medicare consultations with GPs.

Recent Medicare figures indicate that the average patient contribution to patient billed services increased from $17.43 in June 2001 to $18.68 in June 2002. That is a 7 per cent increase in 12 months. In order to avoid these higher costs, patients are seeking treatment at the accident and emergency departments of public hospitals.

I understand that this issue was the subject of a letter from state and territory health ministers to the federal Minister for Health and Ageing in August last year. The state and territory ministers showed that the decline in bulk-billing, combined with the closure of 24-hour medical clinics and increased out-of-pocket expenses for patients visiting GPs, was placing added pressure on accident and emergency departments.

Findings from a recent New South Wales Department of Health study indicate that in rural towns where bulk-billing was low or non-existent, there was a significant increase in presentations at local hospital emergency departments, compared with towns in which GPs did bulk-bill.

A local report funded by the ACT Division of General Practice indicates that the lack of availability of after-hours care from GPs also results in increased presentations at accident and emergency departments. The ACT division study indicates that bulk-billing rates not only are linked to the billing practices of GPs but also are influenced by the match-or mismatch-of GP work force numbers, hours of work and patient need. This issue is no doubt going to feature in the negotiations on the next Australian Health Care Agreement.

The ACT Labor government has been acutely aware of the impact of these factors out in the community. The Chief Minister and former minister for health has implemented a number of initiatives to reduce the impact of the decline in bulk-billing on disadvantaged groups.

These included:

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