Mike Freelander (Macarthur, Australian Labor Party) Share this | Hansard source

I'd like to thank the minister for bringing this proposed legislation to the parliament through the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022. It is important legislation, as has been noted. I'd also like to thank the member for Riverina for his kind words, and I understand that his community for some time has struggled to get access to high-level care and even primary care. He recognises, in an equitable manner, the importance of health care for his community and for the wider Australian community.

This bill is not by itself controversial. It strengthens the government's compliance powers with respect to inappropriate practice by corporations and improves the debt recovery process. It amends the Professional Services Review arrangements to manage and review the practice of corporations, not just single practitioners.

I think it's very important to look at the history of our national health insurance scheme to understand the Medicare compliance issues that have been made very prominent by the Nine newspaper group and media company's investigation. It's very important to understand that this is actually a system problem that relates to the history of the development of health services in Australia and the changes that have occurred in the last several decades. Medicare was based on the Whitlam government's first national health insurance program, Medibank, which was developed by Scotton and Deeble in the mid-1960s. Essentially, we are using the same system now that was developed in Australia in the 1960s.

Of course, Medibank was removed by the Fraser government, and Medicare was introduced by the Hawke Labor government in 1984. In fact, I started my private medical practice in February 1984 in the same week that Medicare became available. For almost 40 years, my income relied on Medicare, and the process was very important to me. It meant that people in my community who had previously not been able to access care by a paediatrician or had been put on long waiting lists and sometimes missed out on accessing care could see a paediatrician, a general practitioner or other specialists in an equitable manner for themselves and for their families. It was a revolution, an absolute revolution.

Prior to 1984, the commonest cause of bankruptcy in Australia were medical costs. It's important to understand that Medicare changed that dramatically. It made a big difference to the ability of people in my community to access primary care and high-level care, and it was, as I said, a revolution. Practices changed over time, and in the last 10 years changes in illness patterns, changes in bulk-billing rates, changes in rebates have made our system much less equitable. There's been a collapse of the public hospital outpatient systems. Waiting lists now are sometimes measured in years, not months, and once again people are really struggling to access primary care.

The system is not designed to deal with the current age of chronic illness and an ageing population, so people are forced into non-compliance. Does fraud occur? Of course it does. This is a $50-billion scheme, and some people will not do the right thing. But those numbers are very small. Practitioners are almost forced into non-compliance with a scheme that doesn't deal with chronic illness, doesn't deal with patients with multiple system disorders, doesn't deal with the time it takes to deal with the social determinants of health—things like housing, medication costs, family issues, education. The medical system is not designed to deal with all these issues.

I think that I am probably the only member of the House of Representatives or the parliament that really lived on Medicare repayments. I had a very high bulk-billing rate in my practice and tried to provide timely access to care for all of my patients, so I understand the system. We were subject to compliance checks—as we should have been—by regular review. I have never had a practice management review put in place because we spent a lot of time in my practice dealing with compliance issues, making sure we were billing appropriately, making sure we were not overordering pathology or radiology but rather working within the parameters that Medicare outlined. I think that is true for the vast majority of my colleagues.

The Australian public of course has a right to know that every health dollar that they spend, or the government spends on their behalf using their taxes, is spent in the most efficient manner, and this is timely legislation because the other change that we've had in medicine over the last couple of decades is the increasing corporatisation of medicine. I worry about that a lot because often the publicly listed medical corporations have links to pathology providers, to radiology and imaging providers and to other health systems such as private hospitals et cetera. Again, that introduces a more complex addition to the simple visit to the local doctor. Many people that I see in my community do not have a general practitioner that they can name, and a recent survey at one of the public hospitals in my electorate's emergency department showed that almost 35 per cent of people presenting to the outpatient department didn't have a GP that they could name, and even more used the emergency department as their general practitioner. That's put enormous pressure on our health system.

One of the reasons is that the Medicare rebates were frozen by the previous government. Admittedly, it was started as a short-term measure by the Gillard Labor government to run for 12 months. This was extended to run for 10 years by the previous government. That has meant Medicare rebates have become less and less of the billing fee, which has meant there has been a disincentive for people to bulk bill and a disincentive for patients to see a general practitioner charging private fees, putting more pressure on our public hospital system. We know that our public hospital system has been under enormous pressure during the pandemic and afterwards.

We also know that recently there has been real difficulty in getting medical students to train as general practitioners. Partly that relates to income, but it also partly relates to quality of practice and lifestyle. We need to look at ways we can encourage more people into general practice, which remains the cornerstone of our health service.

It's great to have fellow medical practitioners in the House today: the member for Mackellar, a very experienced general practitioner; the member for Kooyong, a paediatric neurologist; the member for Robertson, an emergency doctor. It's great to have them here, and I think they will provide some extra insights into this legislation.

I would say that, whilst this legislation is important, it is even more important in this day and age to see this as a system problem and to see how we can refit the Medicare system to deal with the age of chronic illness and an ageing population. We've also heard talk of medical students being enlisted by the New South Wales government to work in hospital situations to provide some extra manpower. I think that's a good thing. It's good for the medical students, and I think it's good for our system.

We've also heard of trials using pharmacists to prescribe for certain conditions, and I have no problem with that. I think that it is important that everyone in the health system works to the maximum scope of practice. But I also see huge difficulties within the pharmacy system with restrictions on practice and restrictions on prescription, where people who may have been on medication for 20 years have to go into a pharmacy every month to get a repeat prescription. This is wrong; it's very inefficient. It puts extra costs in the system and I'm sure could be modified to make our system even more efficient.

I think there are many ways that we can improve our health system if we look at how the health system itself deals with the new age. There are many issues also in our dental scheme, which is only very partially applicable. It's leading to severe inequalities in access to dental care: No. 1, particularly in children—my own specialty—but also in the elderly. Many elderly people have difficulty with nutrition, partly at least because of a lack of access to adequate dental care. Our system needs to be modified to deal with this.

As I've said previously, there is this tie-up with corporate medicine and pathology and radiology. I think that adds another possible area of difficulty within the system that needs to be really examined in close detail.

We've heard from previous managers of the Medicare compliance section. Dr Tony Webber, who I know very well, is a very honourable and a very experienced general practitioner who has raised concerns about compliance issues with Medicare, and we would be right to listen to his concerns about this. The previous manager of the compliance system, Professor Julie Quinlivan, has also given some very good information about how the compliance system could be improved.

From my point of view, as a still-practising paediatrician, the Medicare system has been vital to providing equitable care across our greater Australian community. Unfortunately, times have changed, illness patterns have changed and the delivery of health care has dramatically changed.

There have been remarkable advances in digital medicine. I recently saw a digital stethoscope that can be placed on the patient's chest. It can do an ECG and record the heart sounds.

This can all be transmitted remotely to the computer or even the phone of a GP or specialist. This is another remarkable advancement, and another way of looking at how we can best manage the telehealth system, which has been really important. We were more or less forced into it by the pandemic, but I think it is really important that we take full advantage—particularly in outer metropolitan, rural and regional areas—of the telehealth system, which should be expanded. We also need to see what advances can be made in keeping people out of hospital and managing their illnesses at home. There's much to be said for the hospital and home type of system, with better systems of managing things like heart failure, respiratory infection, asthma, diabetes and a whole range of different illnesses that can be safely managed at home with appropriate resources. It's really important for us as a new Labor government to make sure we take full advantage of these new advances.

Our electronic health records in Australia are so far behind the rest of the developed world. We really need to look at how we can improve our digital health records and make sure that we take full advantage of the cost savings and the efficiencies that would cause. We should try to update our systems so they are all compatible across private and public medicine, across our hospital system, and among general practitioners. I commend this legislation, but it is only part of the job. I know that the Albanese Labor government will continue the changes in health care that we need to deal with our ageing and growing population.

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