May 12, 2021

This bill, the Health Insurance Amendment (Prescribed Fees) Bill 2021, goes to the future of the healthcare system in this country. I thank the speakers, on both sides, for their contributions about the impact of this on modernising payment schemes. In particular, I find it incredible that we're still asking people to pay by cheques or money order. I'm 42 years old. I don't think I've ever used a money order in my life.

An honourable member:  You don't look a day over 21.

Mr CONROY:  Thank you. There's a lot of kindness in the room today. I attribute it to the budget hangover.

The DEPUTY SPEAKER (Mr Wallace):  There'll be enough of that.

Mr CONROY:  The modernisation of payment systems is really important, particularly in COVID, when we need to upgrade our payment systems to make them as contactless as possible. I think that's very important. In his contribution, particularly in his second reading amendment, the shadow minister for health went to the broader issues that surround doctor training and workforce development. I'm going to take this opportunity to make a contribution on those broader issues, which are canvassed in the second reading amendment.

The changes to the Modified Monash Model for how we pay GPs is a disgrace. The fact that they have changed the classification of regions like mine has had a huge impact on bulk-billing rates. The cut to the bulk-billing incentive has had a direct impact on my electorate. For example, I had a roundtable discussion last week with GPs. They reported that it has cut payments to GPs salaries by $9,000 a year. That's on top of the fact that GPs have had a pay freeze for many years under this government.

This government is continuing to diminish the value of GPs and, by attacking their remuneration, is making it a lot less attractive to GPs to train and go through the long process of becoming a GP. So, we're seeing that cut impacting on the workforce.

On top of that, the implication for GPs is that, if they want to stay in business, they're going to have to increase the number of patients that pay a gap. In fact, GPs reported to me that, before the cut to the GP bulk-billing incentive, they were running at about 80 per cent bulk-billing and 20 per cent non-bulk-billing. That's reversed. They are now only bulk-billing 20 per cent for their patients. To quote one GP, this payment cut was 'the straw that broke the camel's back' in terms of their focus and commitment to bulk-bill. That's incredibly tragic. It's undermining the entire Medicare system and it's incredibly counterproductive.

Medicare is based on access to health care being based on need, not financial ability. We canvassed this issue when this government launched another attack on Medicare, which was the attempted introduction of the $7 co-payment charge. In testimony to a Senate inquiry into that, the Department of Health quantified the cost savings from it. They quantified that it would avoid four million visits to GPs per year. It was able to quantify that, if just one in 50 of those people who avoided visiting the GP presented to a hospital emergency department, the savings would be wiped out. The tricky bit is that the savings would accrue to the federal government, while the cost increases for EDs would be borne by the state government.

We are seeing an attack on preventive health and an attack on primary care under this government. That's having a huge impact on the Medicare system, and that's why the second reading amendment from the shadow minister is so important.

Another part of what GPs raised with me last week was the issue of the lack of ability to see specialists through the public system. These GPs said to me that they've basically given up on referring their patients through the public system to specialists because the wait can be up to four or five years. That's catastrophic. The most tragic case I heard was of a five-year-old boy who has been on the waiting list to see an ear, nose and throat specialist for two years. He's got constant ear infections, which are impacting on his hearing, impacting on his ability to learn and leading him to be further and further behind his classmates. He's been on the waiting list for two years. This is something that has an easy fix. While I'm not a doctor, I understand that grommets are probably the preferred course of treatment. Having had grommets, I can say that they did help with my particular issue. I try not to be too personal or to give false advice, but this GP said that grommets would provide an easy fix to this poor boy's situation. But he's been on the waiting list for two years and is likely to have to wait another two years to get the grommets. During that time he will be falling further and further behind his classmates. His potential to make the greatest contribution he can to our society is being diminished because of this. Ultimately, I would submit, the economic cost of the loss of potential of that young boy's life, from a purely economic point of view, outweighs any cost savings from this government's continued attack on the ability of people to see specialists through the public health system. That was another issue that was raised in this particular forum.

The third issue—and I'll finish on the third one—is the issue of bonded doctors. A number of doctors have come to see me concerned about the incompetence displayed by the Minister for Health and Aged Care and the Department of Health in managing the transition of the bonded doctors system. These doctors said to me that a couple of years ago they received notification from the Department of Health that the way doctors were bonded was changing. Instead of having to provide six or seven years of service as bonded doctors going to rural and remote areas they only had to do three. Therefore, they received a certificate saying that they had acquitted their service. Now the Department of Health has come back to them and said: 'We made a mistake. We're changing back to that. And, by the way, for the two years that you weren't doing your rural or remote service, because we told you didn't need to, we're now going to go you and you're possibly going to lose your Medicare provider number'—and a whole lot of other catastrophic things that would mean that these GPs and other doctors wouldn't be able to practice for 12 years.

This is symptomatic of a government that can't manage the healthcare system. They can't manage primary healthcare, they can't manage the ability to make sure that people can see a doctor when they need to and not have to wait till when they can afford to. I'll end my contribution there. I commend the bill, with the second reading amendment, to the House. It covers some important areas of the health system.